What is a rotator cuff tear?

The rotator cuff is a group of tendons that surround the ball of the humeral head of the shoulder joint. 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 shoulder socket (glenoid), you can see how the cuff pulls the humeral head toward the socket providing stability by concavity compression.

A rotator cuff tear is a gap in this complex of tendons, usually occurring near the their attachment to bone and usually occurring in the supraspinatus tendon- the part of the cuff at the upper aspect of the shoulder near the biceps tendon.

Below, we show a series of surgical photographs from the outside of the shoulder looking down on the area of the supraspinatus.

The term 'rotator cuff tear' can refer to anything from a small gap in the tendon as shown below

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.

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.

Our approach to management of rotator cuff tears is shown here.

See also this post.

There are many factors that affect the healing of a rotator cuff repair; some are highlighted here.

See also the information posted here and here.

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