Massive Rotator Cuff Tear

The rotator cuff consists of a group of tendons and muscles that surround and stabilize the shoulder. A tear that is larger than 5 cm and involves the infraspinatus and supraspinatus muscles which are part of the rotator cuff may be characterized as a massive rotator cuff tear.

Massive rotator cuff tears usually occur in elderly patients who are over 60 years old. They are caused due to degeneration of the rotator cuff and muscle atrophy with fatty infiltration which may be age related or due to genetic factors. Once the rotator cuff has deteriorated, a minor injury or fall may result in a massive tear.

This condition can be extremely disabling with symptoms including severe pain, weakness, stiffness with decreased range of motion, snapping and clicking sounds on movement of the shoulder, and inability to lie on the shoulder.

Your doctor will examine your shoulder and move your arm in different directions to assess pain and strength. A diagnosis of a massive rotator cuff tear is made by imaging studies such as arthrograms (special types of X-rays obtained after injecting a dye into the joint), ultrasounds, magnetic resonance imaging, and arthroscopy, a minimally invasive procedure that involves insertion of a tiny camera inside the joint.

The various treatment options include:

  • Conservative Therapy: Non-surgical methods such as rest, medications, injections and physical therapy. The deltoid muscle of the shoulder may be trained to take up some of the function of the rotator cuff.
  • Rotator Cuff Debridement: Surgical removal of damaged tissue with cleaning of the shoulder joint. Though the procedure does not involve repair of the torn tendon, it may remove sources of pain such as bone spurs or dead tissue within the joint.
  • Tendon Repair: Surgical reattachment of the tendon. This procedure could be done arthroscopically or as an open surgery depending on the size of the tear.
  • Muscle Transfer: Muscles from the back or chest may be used to repair the injury if the rotator cuff is damaged beyond repair.
  • Shoulder Replacement: This option is considered when there is a severe injury associated with arthritis. The entire joint is replaced by an artificial one. This includes reverse shoulder arthroplasty, a new procedure in which the ball and socket components are reversed to provide better stability to the shoulder.

The correct treatment option would depend on factors such as patient age, general health, time elapsed since the injury, and functional level.