Shoulder arthroscopy
A view into the shoulder joint through mini incisions
06/19/2008 8:52 AM

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Cuff repair
Arthroscopic reconstruction of torn tendons and muscles
06/27/2008 6:38 PM

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Rotator cuff tears


rotatorcuff tear, rupture, tendon defect shoulder
U-shaped rotator cuff tear on the anterolateral side of the right shoulder - arthroscopic view.
Here you can read:
What is a rotator cuff tear ?
Where are the rotator cuff muscles and tendons ?
Signs and symtoms of a rotator cuff tear ?
Development of a rotator cuff tear ?
How to treat a rotator cuff tear ?
Who is at risk for a rotator cuff tear ?


What is a rotator cuff tear ?
The term "rotator cuff" describes four muscles. In front of the shoulder joint it´s the subscapularis muscle, above and anterior it is the supraspinatus and above and posterior the infraspinatus muscle. At the back side of the shoulder joint, the fourth muscle and it´s tendon, is the teres minor. Most often ruptures and defects occur at the tendon of the supraspinatus muscle, followed by defects / ruptures of the infraspinatus. Subscapularis ruptures are rare and the teres minor is affected nearly never.
Besides complete ruptures partial tears, at the upper or bottom side of the tendons, are also possible. Most often partial tears can be detected at the bottom / joint side of the supraspinatus. They are called PASTA lesions (abbrev.: partial articular supraspinatus tendon avulsion ).


Where are the rotator cuff muscles and tendons ?
The subscapularis muscles - with it´s tendon - is lying in front of the shoulder. The most important muscle and tendon of the supraspinatus is lying on top of the shoulder joint and on the upper backside the infraspinatus muscle is running with it´s tendon.
At the backside the teres minor muscle and tendon can be found. All four muslces with their tendons are surrounding the shoulder in a cuff like manner, so that they are called rotator cuff.


Signs and symptoms of a rotator cuff tear ?
Pain is present in the shoulder or the upper part of the affected arm. A lot of people are suffering from constant night pain. Being present for a longer time the cuff tear can lead into a shoulder stiffness.


Development of a rotator cuff tear ?
Most of the cuff defects occur due to degeneration of the rotator cuff tendons. The area beneath the shoulder roof / acromion is a critical zone, because of narrowing. A genetic susceptibilty for tendon degeneration might be the other reason. A tendon fraying is developing and ending in a complete cuff defect / hole and after decades in a cuff tear arthropathy.


Open suture of a rotator cuff tear
Today, an open suture of a rotator cuff has become rare.


How to treat a rotator cuff tear ?
Most of the cuff tears are treated nonoperatively. A lot of cases could be managed going this way. Pain medication, antiinflammatory drugs, physical and physiotherapy are combined.
On eyeballing, according to an operation, one could say: the younger the patient ( 20 to 50 years of age ), the smaller the defect ( beneath 15 square inches ) and the better the expected tissue quality, the earlier an operation makes sense.
Depending on the size of the defect, it´s tissue quality and patient expectations according to daily living, work and sports and a few other factors the kind of operation ( arthroscopic, mini-open or open ) will be choosed. You can find further informations about rotator cuff sutures / operations here.
The majority of our cuff repairs are performed arthroscopically.
If there´s a hughe defects, which can´t be sutured, because of it´s size and bad soft tissue quality, there are other possibilities of operative treatment:
1. The cuff defect and is margins are debrided, arthroscopically. This might be combined with an acromioplasty to get rid of the narrowing of the supraspinatus tunnel under the acromion. Pain relief is the main advantage of this procedure. Muscel tranfers can be avoided. The rehabilitation is short.
2. Muscle transfers of the muscles and tendon in the neighbourhood, e.g. of the latissimus dorsi or pectoralis major tendon / muscle. Rehabilitation takes a longer. Results are better than arthroscopic debridement ( see: 1. )
3. A partial closure might be possible, also, and performed arthroscopically or in an open procedure.
Most of the rotator cuff tears and defects can be closed arthroscopically / debrided. Arthroscopic rotator cuff reconstruction is a technically high demanding procedure. It gets more and more a routine procedure. The advantages of an endoscopic repair are: 1. it´s less painful within the first days after an operation, 2. soft tissue damage is low, 3. rehabilitation is easier, 4. there are less scares and 5. the stay in hospital is shorter.


Who is at risk for rotator cuff tears ?
Most cuff tears occur beyond the 50 years of age. Which means: the older you are the more likely is the appearence of a cuff tear ( degenerative one ).
Traumata like falling on an outstretched arm or a force against the contracted supra- or infraspinatus tendon is another risk to experience a rotator cuff rupture.
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