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I have had an X-ray, CT scan, and now an MRI of my shoulder. The surgeon thinks there is a very large ("massive" is the word he used) tear in my rotator cuff. He wants to do an arthroscopic exam next. If it's that big, is there any point to another test? Can it be repaired? I thought I heard him say "inoperable."

Large, full-thickness tears of the rotator cuff can be very challenging for patient and surgeons alike. Loss of motion and loss of strength leads to loss of function for the patient. Finding a way to repair the problem without re-tears and surgical failure is a goal surgeons strive for. Arthroscopic examination does give the surgeon a look inside the joint that isn't possible with any imaging study. At that point, he can see the location, type, and extent of damage to the rotator cuff. He will also be able to look around and see what else might be wrong. Often when there is an injury traumatic enough (or with enough force behind it) that the rotator cuff is torn clear through, there will be other soft tissues torn as well. During the arthroscopic procedure, the surgeon can remove any loose pieces of tissue that might be floating around in the joint -- a possible hazard for you later. If the rotator cuff can't be repaired, the surgeon can at least clean up the area and possibly shave down the ragged torn tendon edges, a procedure called debridement. The surgeon will also check to see if the torn tendon can be repaired. If it hasn't retracted (snapped back away from the bone) too far, it might still be possible to stretch the tendon end back to the bone and reattach it. The surgeon can also make other minor changes that might help improve your shoulder function even if it is impossible to restore the rotator cuff back to normal. For example, it might be helpful to remove any bone spurs that have formed and are causing pain and swelling by rubbing against the soft tissues or impinging joint movement. If the rest of the rotator cuff is stuck down by adhesions, the surgeon can gently lift it back up and restor the normal slide and glide of the remaining tendons. And sometimes the end of the clavicle (collar bone) is shaved or even partially removed to give the rotator cuff more room to slide and glide and to take pressure off the tissue. So, there are many different reasons why the surgeon might recommend an arthroscopic procedure. If you are uncertain about going ahead with this next step, talk to your surgeon. Find out more about what he is thinking about the need for further evaluation in your case.

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