Surgery for painful shoulders and shoulders weakened by rotator cuff tears
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Wednesday, October 28, 2009
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Summary
Summary rotator cuff tear
Failure
of the rotator cuff due to either tear or wear is the most common clinical
problem of the shoulder, accounting for more than 4.5 million physician visits
per year in the United States (evaluation of the weak shoulder). Failure of
the cuff tendon may result from a
major injury, but more commonly it results from age-related attrition of the
tendons, typically
starting with the undersurface of the anterior aspect of the
supraspinatus. While it was once believed that rotator cuff tears were usually caused by
impingement by the acromion and that acromioplasty was an important part of the
treatment, recent experience has demonstrated that impingement is not the cause
of rotator cuff tears in most cases.
Acute
rotator cuff tears, such as those resulting from a fall that causes weakness in
a previously normal shoulder, can often be repaired surgically.
Chronic
rotator cuff tears may respond to mobilization and strengthening exercises (i.e. stiff shoulder exercises; weak shoulder exercises) and to physical therapy.
If these
exercises are not beneficial, consideration can be given to a surgery to smooth
the area around the rotator cuff and to remove scar tissue (rotator cuff failure)
Cortisone or
steroid injections into the shoulder may temporarily relieve symptoms. Repeated
cortisone or steroid injections may weaken the tendons, making them more likely
to tear in the future.
When
arthritis accompanies a rotator cuff tear or in a condition known as rotator
cuff tear arthropathy, it may be necessary to use special joint replacement
implants to improve the comfort and function of the shoulder. If the rotator
cuff is irreparable, the shoulder is arthritic, and if the shoulder is stable,
a cuff tear arthropathy (CTA) prosthesis may be helpful. If
the rotator cuff is irreparable, the shoulder is arthritic, and if the shoulder
is unstable, a reverse, or reversed
total shoulder prosthesis may be needed. Decisions
about the best procedure for each individual patient need to be made by
consultation with a surgeon experienced in complex shoulder reconstruction.
We have
recently published a current concepts review of rotator cuff conditions in the
New England Journal of Medicine [N Engl J Med 2008;358:2138-47.]
Some of our other writings about the rotator cuff are listed below:
Mack, L.A., Matsen III, F.A., Kilcoyne, R.F., Davies, P.K.,
and Sickler, M.A.: Ultrasound: US
Evaluation of the Rotator Cuff. Radiology, 157:205-209, 1985.
Mack, L.A., Nyberg, D.A., Matsen III, F.A.: Sonographic Evaluation of the Rotator Cuff., Radiologic Clin. North. Am.,
Vol.26(1):161-177, 1988.
Mack, L.A., Nyberg, D.A., Kilcoyne, R.F., Harvey, D., and
Matsen III, F.A., Sonography of the
Post-Operative Shoulder. Am.J. Roentgenology, 150:1089-1094.
1988.
Clark, J., Sidles, J.A., and Matsen III, F.A.: The Relationship of the Glenohumeral Joint
Capsule to the Rotator Cuff. Clin. Orthop., 254:29-34, 1990.
Harryman II, D.T., Mack, L.A., Wang, K.Y., Jackins, S.E.,
Richardson, M.L., and Matsen III, F.A.:
Rotator Cuff Repair: Correlation
of Functional Results With Cuff Integrity. J.
Bone and Joint Surgery, 73A:982-989, 1991.
Arntz, C.T., and Matsen III, F.A.: Surgical Management of Complex Irreparable
Rotator Cuff Deficiencies. J. Arthroplasty, 6(4), 1991.
Harryman II, D.T., Sidles, J.A., Harris, S., and Matsen III,
F.A.: The Role of the Rotator Interval
Capsule in Passive Motion and Stability of the Shoulder. J. Bone
and Joint Surgery, 74A:53-66, 1992.
Pearl, M.L., Jackins, S., Sidles, J.A., Lippitt, S.B., and
Matsen III, F.A.: Humeroscapular
Positions in a Shoulder Range of Motion Examination. J. Shoulder & Elbow Surg.,
1(6):296-305, 1992.
Arntz, C.T., Jackins, S., and Matsen III, F.A.: Prosthetic Replacement of the Shoulder for
the Treatment of Defects in the Rotator Cuff and the Surface of the
Glenohumeral Joint. J. Bone and Joint Surg., 75A(4):485-491,
1993.
Harryman, D.T., Matsen III, F.A., and Sidles, J.A.: Arthroscopic Management of Refractory
Shoulder Stiffness. J Arthroscopic and Related Surg., 13(1) 1997.
Duckworth, D.G., Smith, K.L., Campbell, B., Matsen III,
F.A.: Self-assessment questionnaires document substantial variability in the
clinical expression of rotator cuff tears. J
Shoulder Elbow Surg., 8(4):330-3, 1999.
O'Kane, J.W., Jackins, S., Sidles, J.A., Smith, K.L., Matsen
III, F.A.: Simple home program for frozen shoulder to improve patients'
assessment of shoulder function and health status. J Am Board Fam Pract., 12(4):270-7, 1999.
Viola, R. W, Boatright, K. C., Smith, K. L., Sidles, J. A.,
and Matsen, F.A.:
Do shoulder patients insured by workers’ compensation present with worse
self-assessed function and health status?
J. Shoulder Elbow Surg.,
9(5):368-72, 2000.
Smith, K.L, Harryman II, D.T., Antoniou, J., Campbell, B.,
Sidles, J. A., and Matsen III, F.A.: A
prospective multi-practice study of shoulder function and health status in
patients with documented rotator cuff tears.
J. Shoulder Elbow Surg.,
9(5):395-402, 2000.
Goldberg, B.A., Nowinski, R.J., and Matsen III, F.A.: Outcome of nonoperative management of full
thickness rotator cuff tears. Clin Orthop, 382:99-107, 2001.
Goldberg, B.A., Lippitt, S.B., and Matsen III, F.A.: Improvement in shoulder comfort and function
after rotator cuff repair without acromioplasty. Clin. Orthop., 382:99-107, 2001.
Harryman II, D.T., Hettrich, C., Smith, K.L., Campbell, B.,
Sidles, J.A., and Matsen III, F.A.: A
prospective multipractice investigation of patients with full thickness rotator
cuff tears: The importance of
co-morbidities, surgeon, and other co-variables on self-assessed shoulder
function and health status. J. Bone Joint
Surg., 85A(4): 690-696, 2003.
Churchill, R.S., Fehringer, E.V., Dubinsky, T.J., Matsen
III, F.A. : Rotator cuff ultrasonography: diagnostic capabilities. J Am Acad
Orthop Surg. Jan-Feb;12(1):6-11, 2004.
Surgery for rotator cuff tears at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USADisclaimer
This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.