These authors introduce the term "functionally irreparable rotator cuff tear (FIRCT)" to capture patients who would experience failure of an attempted primary rotator cuff repair because of the extent of cuff muscle and tendon damage and other patient-related factors.
Their "bullet points" are listed below.
*Debridement, biceps tenodesis, and/or partial repair of the torn rotator cuff may reduce pain and improve function for selected patients with a FIRCT.
*Static soft-tissue restraints to abnormal glenohumeral head translation, such as implantation of an absorbable balloon in the subacromial space or superior capsular reconstruction (SCR), appear to reduce pain and improve function, although some have reported a relatively high structural failure rate with SCR. (It is of note that neither the balloon or SCR are included in the authors' recommended methods (see their figure below)).
*When improvement of strength is the primary goal of treatment, tendon transfers provide a viable treatment alternative; most tendon transfers for management of a FIRCT are currently performed with arthroscopically assisted techniques.
*Transfer of the lower portion of the trapezius has emerged as a successful alternative to transfer of the latissimus dorsi, whereas transfer of the latissimus dorsi to the lesser tuberosity is being explored as an alternative to transfer of the pectoralis major for functionally irreparable subscapularis tears.
*Debridement, biceps tenodesis, and/or partial repair of the torn rotator cuff may reduce pain and improve function for selected patients with a FIRCT.
*Static soft-tissue restraints to abnormal glenohumeral head translation, such as implantation of an absorbable balloon in the subacromial space or superior capsular reconstruction (SCR), appear to reduce pain and improve function, although some have reported a relatively high structural failure rate with SCR. (It is of note that neither the balloon or SCR are included in the authors' recommended methods (see their figure below)).
*When improvement of strength is the primary goal of treatment, tendon transfers provide a viable treatment alternative; most tendon transfers for management of a FIRCT are currently performed with arthroscopically assisted techniques.
*Transfer of the lower portion of the trapezius has emerged as a successful alternative to transfer of the latissimus dorsi, whereas transfer of the latissimus dorsi to the lesser tuberosity is being explored as an alternative to transfer of the pectoralis major for functionally irreparable subscapularis tears.
Comment: This article provides some thoughts on managing irreparable cuff tears. These authors are particularly experienced in the use of tendon transfers.
We use the guidelines below for discussing rotator cuff tear treatment options with our patients (we are not experienced with the tendon transfers described).
We recognize that the presence of a cuff tear is not in and of itself an indication for surgery in that many cuff tears are either asymptomatic or responsive to non operative management.
We recognize that the presence of a cuff tear is not in and of itself an indication for surgery in that many cuff tears are either asymptomatic or responsive to non operative management.
Acute traumatic reparable rotator cuff tear
- consider acute rotator cuff repair (see this link)
Chronic cuff tear without arthritis
- gentle progressive stretching and strengthening (see this link)
- if unsatisfactory response to non-operative program:
- if tear is reparable - consider attempting repair
-if tear is irreparable
-if patient can actively elevate arm above horizontal, consider smooth and move
-if patient is unable to actively raise arm above horizontal, consider reverse total shoulder (see this link)
Chronic rotator cuff tear with arthritis
- gentle progressive stretching and strengthening
- if unsatisfactory response to non-operative program:
-if patient can elevate arm above horizontal and if coracoacromial arch is intact, consider CTA arthroplasty (see this link)
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