Massive or irreparable rotator cuff tears

Abstract

Aims: Massive or Irreparable rotator cuff tears are a challenging problem. There are several treatment options, but determining the correct treatment for each patient can be difficult. The author’s treatment algorithm is outlined in Figure 1 Methods: Patients without anterosuperior escape should initially be treated with physical therapy for anterior deltoid training. Results and Conclusions: In patients who fail physical therapy, or have escape, it is important to determine if the patient’s primary complaint is pain or weakness, and to determine if the patients is able to elevate their arm above horizontal on exam. If a patient has pain, and is not able to elevate their arm, then the authors have found an injection of local anesthesia and steroids can be helpful in determining true pseudoparalysis from pain inhibition. Patients with pain who are able to elevate either before or after an injection are excellent candidates for arthroscopic debridement or partial repair, biceps tenotomy, and possibly suprascapular nerve release. Patients who complain of weakness in external rotation, but have elevation to horizontal and an intact subscapularis are ideally suited for a latissumus transfer. Those with an irreparable subscapularis, but an intact superior cuff without escape are candidates for a pectoralis major transfer. Patients with arthritis on their radiographs in the setting of an irreparable rotator cuff tear, but are still able to elevate, are excellent candidates for hemiarthroplasty is indicated. Patients with true psuedoparalysis are best treated with the reverse shoulder prosthesis.