Review of Irreparable Rotator Cuff TearsEvery year orthopedic surgeons gather at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS). Instructional lectures are presented on a wide variety of topics. The information in this review article on irreparable rotator cuff tears (RCTs) was presented at the Academy's 2006 Annual Meeting.
The problem of pain and disability that comes with massive, irreparable RCTs is presented. Who is affected most often, symptoms presented, types of tears, and treatment are included.
Patients with irreparable RCTs are usually in one of two patient groups. The first group includes women 70 years old and older. Minor trauma brings on mild to severe symptoms. The second group is younger and more active. An acute injury or previous history of rotator cuff problems is common in this second group.
The tears are severe with muscle wasting called atrophy. Often the area fills in with fat cells. Severe arthritis of the shoulder joint adds to the complex picture. The patient presents with variable amounts of pain, loss of motion, weakness, and loss of function.
Treatment depends on the patient's symptoms, age, and activity level. Other problems such as diabetes, heart disease, or lung problems must be considered. Surgery to repair the RCT isn't possible. Studies show that fatty infiltration makes the chances of retear very likely.
Nonoperative care with antiinflammatories, steroid injections, and physical therapy may be helpful. Once the symptoms are under control then strengthening exercises can begin. Surgery can include debridement (to clean out the area), tendon transfers, or reverse shoulder replacement.
The authors conclude there isn't one best treatment for all patients with irreparable RCTs. The surgeon decides what to do based on each patient's specific needs. A description of the decision tree and details about each operation are also provided for the surgeon.
David M. Dines, MD, et al. Irreparable Rotator Cuff Tears: What to Do and When to Do It; The Surgeon's Dilemma. In The Journal of Bone and Joint Surgery. October 2006. Vol. 88-A. No. 10. Pp. 2294-2302.
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