These authors review some of the options available for managing irreparable rotator cuff tears. The abstract of this article is as follows, "When evaluating patients with irreparable rotator cuff tears, orthopaedic surgeons have an increasingly wide array of surgical options, including both established techniques and emerging technologies. However, significant variability exists in the clinical evaluation and surgical indications in this subset, and definitions for pseudoparalysis and tear irreparability are inconsistent. In older patients with symptomatic rotator cuff arthropathy and relatively sedentary demands, the reverse total shoulder arthroplasty has been established as the preferred treatment option, producing reliable improvements in both pain and function. In younger patients without glenohumeral arthritis or pseudoparalysis, joint-preserving options are preferred, with recent literature highlighting alternative options including partial repair, bridging or interpositional graft placement, tendon transfers (ie, latissimus, trapezius, and pectoralis major), superior capsular reconstruction, and subacromial spacer placement. In this review article, we address the topic of irreparable rotator cuff tears, emphasizing the workup, indications for various treatment options, and clinical outcomes."
Comment: We recognize a number of other opportunities for improving the comfort and function of patients with rotator cuff tears that deserve emphasis.
(1) Rehabilitative exercises - since these tears are usually chronic, the patient has time to use exercises to address the stiffness and weakness that are often present. With these exercises many patients have been able to substantially improve their comfort and function without surgery; shoulders with pseudo paralysis have been able to regain active flexion. Our basic exercise program is shown in this link.
(2) The smooth and move procedure - most patients with pain, stiffness and crepitance, but with active flexion above 90 degrees can be significantly improved by this procedure that allows immediate postoperative return to active use of the shoulder. The details of this procedure are shown in this link.
(3) The CTA arthroplasty - most patients with irreparable cuff tears and arthritis, but with active flexion above 90 degrees and be significantly improved by this procedure that has fewer complications and fewer surgeon-imposed limitations than a reverse total shoulder. The details of this procedure are shown in this link.
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To see our new series of youtube videos on important shoulder surgeries and how they are done, click here.
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