Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I found out yesterday that my rotator cuff is completely ruptured. I'm doing some checking around on the Internet to find out what's the next step. I thought it might be helpful when I see the orthopedic surgeon if I at least knew what are my options.

Answer:

Treatment of complete rotator cuff tears (also known as full-thickness tears) varies depending on the person's age, activity level, and severity of the injury. There are three main treatment options: rehab, repair, and reconstruction. Rehab refers to a program of conservative (nonoperative) care. A physical therapist will guide you through a program of motion and strengthening. Other appropriate activities will be used depending on your pain, function, and movement. In other cases, if the tendon hasn't retracted too far, it may be possible to repair the injury. This is done by reattaching it to the bone where it pulled away (or close to it). If the two ends of the torn tendon are too far apart, it isn't possible to bring the two ends together. Or sometimes the two ends can be pulled together, but there's too much pressure on the healing tissue. It just tears again when the person starts using the arm. Reconstruction may involve shaving or removing the acromion. The acromion is a curved piece of bone that comes from the back of the scapula (shoulder blade) and forms a protective shelf over the shoulder joint. Tendons from the muscles of the rotator cuff attach to the bone underneath this shelf. Removing the acromion takes pressure off the rotator cuff. A biceps interposition is another possible surgical technique used to bridge the gap between the two ends of the rotator cuff. The long head of the biceps tendon is cut close to its attachment at the glenoid labrum. The labrum is a dense ring of fibrous cartilage. It goes around the rim of the acetabulum (shoulder socket) to increase the depth and stability of the shoulder joint. The surgeon uses a suture retriever to reach in and pull the ends of the RCT back together as closely as possible. The biceps tendon is then used as a graft. It is placed between the two torn ends of the RCT and stitched in place (interposition repair). This bundle of soft tissue is then attached to the bone in a procedure called a tenodesis (tendon-to-bone attachment). Braided sutures and suture anchors are used to hold everything together while it heals. If the injury is old, there can be a fair amount of scar tissue, degenerative changes of the tendon, and muscle atrophy. The presence of any of these factors can impact the treatment decision. In older adults, osteoporosis (brittle bones) can be a factor in types of repair/reconstruction possible. The surgeon can use MRIs and arthroscopic exam to plan the best way to repair the damage. But sometimes, the exact surgical technique is determined at the time of the operation. Once the area has been opened up and the surgeon can see the exact type and location of the tear, then it's more obvious the best approach to the problem. Yong Girl Rhee, MD, et al. Bridging the Gap in Immobile Massive Rotator Cuff Tears. In The American Journal of Sports Medicine. August 2008. Vol. 36. No. 8. Pp. 1511-1518.

*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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