Houston Methodist. Leading Medicine

Shoulder FAQ


What is a massive rotator cuff tear? I get the idea that it's bad but what makes a tear severe versus massive?


The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint. The four muscles/tendons are the infraspinatus, supraspinatus, subscapularis, and teres minor. Together, these muscles/tendons support, stabilize, and move the shoulder. The infraspinatus and supraspinatus tendons are the two tendons most often involved in rotator cuff tears. When two or more tendons are involved at the same time, the tear is termed massive. Or if one tendon is torn so badly it is fully ruptured or the tear is more than an inch in diameter, the injury is also called massive. Severe and massive can both be used to describe the same injury. Usually if the subscapularis muscle and especially the teres minor are torn, the other tendons have already been damaged. The more tendons involved in the injury, the more difficult repair can be. The surgeon is faced with many decisions about how and when to do surgery, what type of suture would hold best, and whether healing is even possible. With massive tears, retears are common. The tissues just don't heal as strong as normal, healthy, tissues. Fibrosis (a type of scar tissue) forms instead of real tendon tissue. The tissue is stiffer and loss of good blood supply at the cellular level. In older adults with degenerative (aging) tissue, tears often fill in with fatty tissue that isn't strong at all. Some tears can't be repaired. Others require extensive surgery to debride (clean up) any frayed edges and remove tissue damaged beyond repair. A tendon transfer may be needed. No matter what decision is made, there are various techniques to choose from when performing the procedure. The bottom line is to restore the shoulder to as near normal as possible and have the repair hold up over time. Shane J. Nho, MD, MS, et al. Biomechanical and Biologic Augmentation for the Treatment of Massive Rotator Cuff Tears. In The American Journal of Sports Medicine. March 2010. Vol. 38. No. 3. Pp. 619-629.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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