Repair of Rotator Cuff Tears: Surgery for shoulders with torn rotator cuff tendons can lessen shoulder pain and improve function without acromioplasty.

Edited By: Winston J. Warme, MD, Frederick A. Matsen III, M.D.
Last updated Wednesday, May 14, 2008

Figure 1 - Rotator cuff, viewed from above

Summary

Overview

• Dowload this article in () pdf format.

Shoulder weakness from rotator cuff tears can be restored by surgery when the quality of the tendon tissue is sufficient.

The rotator cuff is a group of four tendons that blend together to help stabilize and move the shoulder. Each of the four tendons connects a muscle originating on the shoulder blade (scapula) to part of the upper part of the arm bone (humerus). The names of these muscle-tendon components of the rotator cuff are:

• the supraspinatus, which runs over the top of the ball of the shoulder joint (humeral head);
• the subscapularis, which runs across the front of the humeral head; and
• the infraspinatus and teres minor, which run across the back of the humeral head.

The figure shows the main elements of the rotator cuff as viewed from above. The supraspinatus is at the center of each picture, the subscapularis is in front, and the infraspinatus is in the back. The biceps tendon runs between the subscapularis and the supraspinatus. A bony prominence, known as the coracoid process, separates the subscapularis and supraspinatus.

Tears in the rotator cuff result from a combination of injury and weakening of the tendon from wear and tear, disuse, repeated use of steroid (cortisone) injection, and smoking. The extent of injury necessary to tear the cuff depends on the quality of the tendon. Young, healthy rotator cuff tendon is almost impossible to tear. However, older, multiply injured, multiply injected tendon in a smoker may tear with no injury at all. Tears in younger individuals are more likely to extend only part way through the tendon (partial thickness tears). Tears in older individuals are more likely to tear completely through the tendon (full thickness tears) and to involve multiple tendons.

The types of injuries most likely to cause cuff tears are those in which the elevated arm is forced downward (an eccentric force) or when the shoulder attempts a sudden, jerky lift (a concentric force).

Full thickness tears do not heal by themselves because the muscles pull the edges of the tear apart. However, it is possible for full or partial thickness tears to stabilize, leaving the shoulder with reasonable comfort and function.

A surgeon experienced in shoulder surgery can repair a rotator cuff tear if there is enough good quality tendon tissue.

The more force necessary to produce a tear, the more likely it is that the tear will be surgically repairable. Healthy tendon requires a major force to tear it. Tears resulting from major injury can usually be repaired successfully if surgery is not delayed more than several weeks.

Weakened, degenerative cuff tissue is more easily torn, even by normal activities. Durable repair of these tears may not be possible because of the lack of sufficient quantity and quality of tendon tissue. For these reasons, patients should seek prompt evaluation of shoulder weakness by an experienced shoulder surgeon, especially if the weakness comes on suddenly, or after an injury.

• JBJS Article on Rotator Cuff Tears (PDF) (0.36 MB)
• JBJS Article on Rotator Cuff Repair (PDF) (0.18 MB)
• JBJS Article on Rotator Cuff Repair Results (PDF) (1.30 MB)
• The New England Journal of Medicine - Rotator-Cuff Failure (PDF) (0.49 MB)

Repair of Rotator Cuff Tears

Surgery for rotator cuff tears at the University of Washington

How useful was this page or article? This article is rated out of 5 stars (3742 ratings). Not useful at all Not very useful Useful Very useful Extremely useful