Rotator Cuff Repair
More About Rotator Cuff Tears
A rotator cuff tear is a common cause of shoulder pain and disability among adults. Each year, almost 2 million people in the United States visit their doctors because of rotator cuff tears.
A torn rotator cuff may weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult to do.
Anatomy
Your shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball, or head, of the upper arm bone fits into a shallow socket in the shoulder blade.
Your arm is kept in your shoulder socket by the rotator cuff. The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
The rotator cuff tendons cover the head of the humerus (upper arm bone), helping you to raise and rotate your arm.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of the shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.
Description
When one or more of the rotator cuff tendons is torn, the tendon becomes partially or completely detached from the head of the humerus. In most rotator cuff tears, the tendon is torn away from the bone.
Most tears occur in the supraspinatus tendon, but other parts of the rotator cuff may also be involved.
In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.
There are different types of tears.
- Partial tear. This type of tear does not completely detach the tendon from the bone. It is called partial because the tear goes only partially through the thickness of the tendon. The tendon is still attached to the bone, but it is thinned.
- Full-thickness tear. With this type of tear, there is detachment of part of the tendon from the bone.
- When only a small part of the tendon is detached from the bone, it is referred to as a full-thickness incomplete tear.
- When a tendon is completely detached from the bone, it is referred to as a full-thickness complete tear. With a full-thickness complete tear, there is basically a hole in the tendon.
(Left) Overhead view of the four tendons that form the rotator cuff. (Right) A full-thickness tear in the supraspinatus tendon.
(Left) The front view of a normal rotator cuff. (Right) A full-thickness tear in the supraspinatus tendon.
Rotator Cuff Surgery
Surgery may be recommended if your pain does not improve with nonsurgical methods. Continued pain is the main indication for surgery. Surgery may also be recommended if you are very active and/or use your arms for overhead work or sports.
Other signs that surgery may be a good option for you include:
- Your symptoms have lasted 6 to 12 months
- You have a large tear (more than 3 cm) and the quality of the surrounding tissue is good
- You have significant weakness and loss of function in your shoulder
- Your tear was caused by a recent, acute injury
Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone).
The type of repair performed depends on several factors, including:
- The size of your tear
- Your anatomy
- The quality of the tendon tissue and bone
Most surgical repairs can be done on an outpatient basis and do not require you to stay overnight in the hospital.
You may have other shoulder problems in addition to a rotator cuff tear, such as:
- Biceps tendon tears
- Osteoarthritis
- Bone spurs
