Rotator Cuff Tears
The rotator cuff is comprised of four muscle/tendon units that insert on the humeral head. Working in concert with the other shoulder muscles, they allow great strength and mobility of the upper extremity. Rotator cuff tendon tears are unfortunately a very common injury which usually results in significant shoulder pain and weakness. The actual tendon tear is usually caused by a combination of factors including age related tendon degeneration, impinging bone spurs causing abrasive wear, and an acute trauma event.
There is very little capacity for rotator cuff tendon tears to heal naturally, and consequently many people with rotator cuff tears undergo surgery. Fortunately, not every Rotator cuff tear produces severe pain and dysfunction. Smaller and partial thickness tears are often well tolerated left alone or successfully treated with conservative measures like physical therapy or steroid injections. Larger full thickness tears that involve one or more tendons will usually result in more profound pain and weakness. When symptoms warrant, I will generally recommend surgical rotator cuff repair, particularly in the younger individual with a recent injury. The results of rotator cuff repair surgery are generally very good for diminishing shoulder pain and improving function. However, studies have clearly shown that younger patients and those repaired in the acute setting (shortly after injury) tend to have the best results. Therefore, in the case of full thickness, symptomatic tears, I like to repair them as quickly as possible. I generally will not recommend surgical repair for individuals over the age of 75 because there is a diminished capacity for tendon healing and it is increasingly difficult to get through the rehabilitation.
Left alone, most rotator cuff tears will progressively increase in size and produce proportional strength loss. Over time, the tendon edge will pull further and further away from its attachment site. Several years after tear, the rotator cuff muscle will atrophy and be replaced by fat and the tendon can retract to the point that it is no longer repairable back to its normal bone insertion.
I have extensive experience with rotator cuff repair surgery and consider myself an expert in treating this condition. I have trained with the most innovative and advanced shoulder surgeons in the country and I now treat all rotator cuff repairs with minimally invasive arthroscopic techniques. I utilize Suture anchors to reattach the tendons back to the humeral bone as depicted.
Please also refer to the second educational listing I have included on Rotator cuff tears for a more detailed discussion. It is prepared by the American Academy of Orthopedic Surgeons.