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Rotator Cuff Tear

What is the Rotator Cuff?

 

The rotator cuff is a combination of four muscles around the shoulder joint. These muscles

are the Supraspinatus, Subscapularis, Infraspinatus, and Teres Minor. These four muscles help lift the shoulder and move the arm. They also provide stability to the shoulder.

 

What causes a Rotator Cuff tear?

 

The rotator cuff can tear for many different reasons.  As the population ages, there is a high

incidence of both asymptomatic and symptomatic rotator cuff tears. Most tears are

either acute or chronic. Acute tears or sudden tears are usually related to a fall or trauma.

Chronic tears are slower in onset and usually occur as a degeneration of the tissue over time.

How are Rotator Cuff Tears Treated?

Treating a rotator cuff tears depends on the quality of the tissue and the mechanism of

injury. The quality of the muscle tissue and how well it heals to the bone of the humerus

(upper arm bone) are important in outcomes studies. We try to surgically repair most

acute tears to facilitate healing. In chronic tears, many patients can compensate with

physical therapy for the deficit of a single muscle tear. If they do not improve with therapy

and conservative measures we will commonly obtain an MRI to better evaluate the anatomy of the rotator cuff and determine if surgery is needed. Smoking is also a major issue affecting cuff healing. Active smokers should stop smoking to help the cuff heal.

A video demonstrating a rotator cuff tear surgery can be found here.

Anatomy of the Shoulder.  Image courtesy of WikiCommons.

This image demonstrates the movement and function of the supraspinatus muscle on the top of the shoulder. The supraspinatus is one of the rotator cuff muscles along with the infraspinatus, subscapularis and teres minor.  Animated image courtesy of Young Lae, Moon M.D.

This image demonstrates the movement of the subscapularis (at the right of the image or front of the shoulder) and the infraspinatus muscle (at the top left of the image or back of the shoulder) and teres minor (at the bottom back left side of the image) muscles. Animated image courtesy of Young Lae, Moon M.D.

The image on the left is identifying the supraspinatus rotator cuff tear on the humerus or arm bone. The images on the right demonstrate some common repair techniques we use to repair the rotator cuff depending on the type of tear encountered. 

rct anchors.jpg

For small or large tears, we are typically placing anchors in the bone with sutures connected to the anchor that help hold the muscle back to bone.

MRI RCT.jpg

A large rotator cuff tear on an MRI.

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posterior.jpg

References

1. Schmidt CC, Morrey BF. Management of full-thickness rotator cuff tears: appropriate use criteria. Journal of Shoulder and Elbow Surgery. 2015;24(12):1860-1867. doi:10.1016/j.jse.2015.05.042.

2. Keener JD, Galatz LM, Stobbs-Cucchi G, Patton R, Yamaguchi K. Rehabilitation Following Arthroscopic Rotator Cuff Repair: A Prospective Randomized Trial of Immobilization Compared with Early Motion. The Journal of Bone and Joint Surgery-American Volume. 2014;96(1):11-19. doi:10.2106/JBJS.M.00034.

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