Recognizing and Repairing a Rotator Cuff Tear

Your rotator cuff is comprised of 4 muscles the supraspinatus, infraspinatus, teres minor and subscapularis. The muscles attach to the bones via tendons. They are responsible for motor control and stability of the shoulder and are active in every motion of the shoulder. Rotator cuff tears happen when one or all of the tendons in the shoulder are torn away from their attachment to the head of the long bone of the arm in the shoulder joint. These tears can cause a significant degree of pain and loss of function. Surgical repair is sometimes necessary to reduce pain and regain the function of the shoulder. With advancements in imaging of the body and surgical techniques rotator cuff tears are now better recognized, classified and treated. This allows a more planned and precise surgery and hopefully and more accurate prognosis.

A high quality MRI can be used to predict specific tear patterns that will be encountered in arthroscopy. Studies have been done that now allow surgeons to detect three-dimensional tear patterns using high-resolution MRI, select an appropriate repair method and estimate prognosis at a consultation visit before entering the surgical site. Three-dimensional tear pattern recognition is used to as a standard method of evaluation in patients with posterosuperior rotator cuff tears. However, arthroscopy still allows for better visualization than an MRI.

When a repair is being performed the reestablishment of the normal anatomy is the goal as it is thought to enhance healing and restore normal muscle function. When a rotator cuff tear is present it is classified in multiple planes because of the three-dimensional recognition. The recognition of tears takes into account the anterior-posterior dimension (front to back), how much the tendon is retracted from the normal site of attachment, number of muscle/tendon tears, health of the muscle/tendon. The classifications are: crescent tears, U-or L-shaped, massive, contracted, and immobile. The prognosis of each depends on the above factors and is something that will vary.

Repair techniques will depend on the surgeon and all of the above qualities that a rotator cuff tear can have. Repairs can be full or partial, have one or two rows of sutures and use different anchoring or fixation methods. The goal though of any repair is to obtain the best functional outcome that is possible taking into consideration the quality of the rotator cuff tear.