Rotator cuff tears comprise a group of injuries in which one or more of the tendons in the shoulder are torn. Tendons are dense tissue that allows muscles to anchor to bone. When a muscle contracts, it moves the joint by transferring the force of the contraction through the tendon to the bone. Tendons are similar in structure to ligaments, which connect two bones together. Patients with rotator cuff tears complain of pain and an inability to raise the arm. They commonly have a “shrug sign”. Rotator cuff tears can involve part of the tendon (partial thickness tears) or the tendon can tear completely and separate from the bone (full thickness tears). Most surgeons also classify tears as degenerative or traumatic. Degenerative tears happen slowly over time as a result of chronic inflammation and impingement (a condition in which the tendon is pinched by bony spurs) while traumatic ruptures are commonly the result of an injury. Both are treated the same but the outcome for different types of tears tends to be different. Traumatic tears tend to heal more quickly because in the tendon itself was otherwise normal before the injury whereas degenerative tendon tears have pre-existing abnormalities.
Treatment depends on how badly the tendon is damaged. An MRI is the test of choice to assess the extent and nature of rotator cuff tears. Partial thickness tears involving less than 50% of the tendon thickness can be treated with injections and physical therapy and usually heal in 6-12 months. Full thickness tears or large partial thickness tears generally require surgical repair to reattach the tendon to the bone. Recovery is prolonged and most patients have 80% recovery at 3-4 months and complete recovery at 6-8 months. Most of the time the tendon can be reattached arthroscopically without large incisions.
In cases of massive tears or in tears where the torn portion of the rotator cuff is retracted significantly, a cadaveric tissue patch called a graft jacket to reinforce and augment the repair may be necessary. Rehabilitation in patients with massive rotator cuff tears is more prolonged and often takes 8-12 months to reach maximal improvement.
Surgical repair is recommended in most patients with full thickness tears because arthritis and chronic shoulder problems tend to develop in patients with untreated tears. This condition is known as rotator cuff arthropathy and leads to a very difficult problem of arthritis in the setting of a large rotator cuff tear. In these cases, the only surgical option for reconstruction is a reverse shoulder arthroplasty, a very difficult type of surgery. Rotator cuff repair also dramatically decreases the overall pain and discomfort associated with the torn tendon.