Thursday, December 8, 2011

What is a rotator cuff tear?

In the mind of many, all rotator cuff tears are the same. This view creates problems when discussing the results of treatment and when deciding on the best management for an individual patient. Publications on the topic tend to lump all rotator cuff tears together.  As we've emphasized in previous posts, the best management for a rotator cuff tear depends on many factors, including the size and duration of the tear, the age of the patient and the amount of force that was necessary to cause the tear. We've put together a handout describing some of the different 'faces' of rotator cuff tears. Hopefully the gallery below will help show the spectrum of what we really see in rotator cuff disease.

This is a view of the rotator cuff from inside the joint, showing the humeral head in the center of the healthy shoulder, the biceps tendon upper left, and the tendons of the cuff surrounding the head. If you imagine that you are looking at this anatomy from the glenoid socket, you can see how the cuff pulls the humeral head toward the socket providing stability by concavity compression.

The term 'rotator cuff tear' can refer to anything from a small gap in the tendon from use and wear


to a larger tear involving the supraspinatus tendon from an old injury with what appears to be sufficient quality and quantity of tissue for a robust repair


to a long-standing large tear without enough tissue for a repair


to a massive tear of the entire rotator cuff


to tears with deterioration of the joint surface of the humeral head

to full on rotator cuff tear arthropathy without or with collapse of the humeral head and essentially no rotator cuff remaining.


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