Rotator cuff tear is a prevalent problem in the aging population and is the most common
tendon injury in the adult population.
1
Tears can be categorized based on their size (in the anteroposterior plane), the
amount of retraction (in the mediolateral plane), their chronicity (acute or chronic),
and their thickness (partial or full thickness).
2
A partial thickness rotator cuff tear will involve fraying of the bursal side of
the tendon or more commonly the articular side of the tendon, while preserving continuity
in the lateral attachment on the greater tuberosity. It has been shown that the size
of a full thickness tear can influence the loss of strength of the patient.
3
Many full thickness tears will increase in size if not repaired, but the clinical
implications of this remain unclear.
4
In our experience, the chronicity of the tear and the amount of retraction might
render the surgical repair impossible or overtensioned. Massive rotator cuff tears
have had many definitions over the years, but the 2 most frequently cited are tears
over 5 cm and tears involving more than 1 tendon.
5
,
6
,
7
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References
- Current concepts in the management of tendon disorders.Rheumatology (Oxford). 2006; 45: 508-521
- Frequency of various tear patterns in full-thickness tears of the rotator cuff.Arthroscopy. 2007; 23: 1052-1059
- Prevalence and characteristics of asymptomatic tears of the rotator cuff: an ultrasonographic and clinical study.J Bone Joint Surg Br. 2009; 91: 196-200
- Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger.Am J Sports Med. 2011; 39: 710-714
- Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion.J Shoulder Elbow Surg. 2014; 23: 1195-1202
- Subscapular muscle transposition for repair of chronic rotator cuff tears.Surg Gynecol Obstet. 1982; 154: 667-672
- The results of repair of massive tears of the rotator cuff.J Bone Joint Surg Am. 2000; 82: 505-515
- Operatively treated traumatic versus non-traumatic rotator cuff ruptures: a registry study.Ups J Med Sci. 2013; 118: 29-34
- Rotator cuff tears: An evidence based approach.World J Orthop. 2015; 6: 902-918
- Epidemiology, natural history, and indications for treatment of rotator cuff tears.Clin Sports Med. 2012; 31: 589-604
- Partial rotator cuff injury in athletes: bursal or articular?.Rev Bras Ortop. 2015; 50: 416-421
- rotator cuff tears.American Academy of Orthopaedic Surgeons, 2013 (Available at:)
- An evidenced-based examination of the epidemiology and outcomes of traumatic rotator cuff tears.Arthroscopy. 2013; 29: 366-376
- Incidence, prevalence, and consultation rates of shoulder complaints in general practice.Scand J Rheumatol. 2012; 41: 150-155
- Prevalence and incidence of shoulder pain in the general population; a systematic review.Scand J Rheumatol. 2004; 33: 73-81
- Further evidences of attrition in the human body.Am J Anat. 1924; 34: 241-267
- The Pathology Associated with Rupture of the Supraspinatus Tendon.Ann Surg. 1931; 93: 348-359
- Anatomical observations on senile changes in the shoulder.J Bone Joint Surg Am. 1935; 17: 953-960
- Pathologic study of degeneration and rupture of the supraspinatus tendon.Arch Surg. 1943; 47: 121-135
- Age incidence of rupture of the supraspinatus tendon.Anat Rec. 1948; 100: 666-669
- Variational anatomy and degenerative lesions of the shoulder joint.Instr Course Lect. 1949; 6: 255-281
- Tears of the Humeral Rotator Cuff; a Radiological and Pathological Necropsy Survey.J Bone Joint Surg Br. 1964; 46: 314-328
- Impingement lesions.Clin Orthop Relat Res. 1983; 173: 70-77
- Surgical repair of rotator cuff ruptures. The importance of the subacromial bursa.J Bone Joint Surg Br. 1991; 73: 399-401
- The incidence of full thickness rotator cuff tears in a large cadaveric population.Bull Hosp Jt Dis. 1995; 54: 30-31
- Abnormal findings on magnetic resonance images of asymptomatic shoulders.J Bone Joint Surg Am. 1995; 77: 10-15
- Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study.J Shoulder Elbow Surg. 2013; 22: 1371-1379
- Comparison between surgery and physiotherapy in the treatment of small and medium-sized tears of the rotator cuff: A randomised controlled study of 103 patients with one-year follow-up.J Bone Joint Surg Br. 2010; 92: 83-91
- National trends in rotator cuff repair.J Bone Jt Surg. 2012; 94: 227-233
- Decision-making in massive rotator cuff tear.Knee Surg Sports Traumatol Arthrosc. 2015; 23: 449-459
- History of rotator cuff surgery.Knee Surg Sports Traumatol Arthrosc. 2015; 23: 344-362
- Arthroscopic assisted rotator cuff repair: preliminary results.Arthroscopy. 1990; 6: 55-60
- Repair of the rotator cuff. Mini-open and arthroscopic repairs.Clin Sports Med. 2000; 19: 77-99
- Mini-open rotator cuff repair.J Surg Orthop Adv. 2006; 15: 145-153
- Arthroscopic rotator cuff repair: transition from mini-open to all-arthroscopic.Clin Orthop Relat Res. 2001; : 83-94
- Systematic review of all-arthroscopic versus mini-open repair of rotator cuff tears: a meta-analysis.Sci Rep. 2016; 6: 22857
- Open, mini-open, and all-arthroscopic rotator cuff repair surgery: indications and implications for rehabilitation.J Orthop Sports Phys Ther. 2009; 39: 81-89
- Rotator cuff repair.Joint Bone Spine. 2007; 74: 551-557
- Repair of the rotator cuff. End-result study of factors influencing reconstruction.J Bone Joint Surg Am. 1986; 68: 1136-1144
- Results of surgical repair of full-thickness tears of the rotator cuff.Orthop Clin North Am. 1997; 28: 241-248
- Long-term functional outcome of repair of large and massive chronic tears of the rotator cuff.J Bone Joint Surg Am. 1999; 81: 991-997
- Postoperative assessment of shoulder function: a prospective study of full-thickness rotator cuff tears.J Shoulder Elbow Surg. 1996; 5: 449-457
- Outcomes of arthroscopic versus open rotator cuff repair: a systematic review of the literature.Am J Orthop (Belle Mead NJ). 2010; 39: 592-600
- Outcomes of rotator cuff surgery: what does the evidence tell us?.Clin Sports Med. 2012; 31: 665-674
- Single-row repair versus double-row repair of full-thickness rotator cuff tears.Arthroscopy. 2011; 27: 978-985
- Outcomes of single-row versus double-row arthroscopic rotator cuff repair: a systematic review and meta-analysis of current evidence.Arthroscopy. 2013; 29: 1437-1449
- Outcomes of single-row and double-row arthroscopic rotator cuff repair: a systematic review.J Bone Joint Surg Am. 2010; 92: 732-742
- Summary of Meta-Analyses Dealing with Single-Row versus Double-Row Repair Techniques for Rotator Cuff Tears.Open Orthop J. 2016; 10: 330-338
- Factors affecting healing after arthroscopic rotator cuff repair.World J Orthop. 2015; 6: 211-220
- Clinical outcomes of double-row versus single-row rotator cuff repairs.Arthroscopy. 2009; 25: 1312-1318
- Does the literature support double-row suture anchor fixation for arthroscopic rotator cuff repair? A systematic review comparing double-row and single-row suture anchor configuration.Arthroscopy. 2009; 25: 1319-1328
- Does double-row rotator cuff repair improve functional outcome of patients compared with single-row technique? A systematic review.Am J Sports Med. 2012; 40: 1176-1185
- Arthroscopic single-row versus double-row technique for repairing rotator cuff tears: a systematic review and meta-analysis.Orthop Surg. 2014; 6: 300-312
- Massive Rotator Cuff Tears: Trends in Surgical Management.Orthopedics. 2016; 39: 145-151
- The management of partial-thickness tears of the rotator cuff.J Bone Joint Surg Br. 2003; 85: 3-11
- Tendon integrity and functional outcome after arthroscopic repair of high-grade partial-thickness supraspinatus tears.J Bone Joint Surg Am. 2009; 91: 1055-1062
- Arthroscopic repair of partial-thickness tears of the rotator cuff.J Shoulder Elbow Surg. 2007; 16: 193-201
- Magnetic resonance imaging tendon integrity assessment after arthroscopic partial-thickness rotator cuff repair.Arthroscopy. 2011; 27: 306-313
- Repair integrity and functional outcome after arthroscopic conversion to a full-thickness rotator cuff tear: articular- versus bursal-side partial tears.Am J Sports Med. 2014; 42: 451-456
- Arthroscopic transtendon repair of partial-thickness articular-side tears of the rotator cuff: anatomical and clinical study.Am J Sports Med. 2005; 33: 1672-1679
- Transtendon arthroscopic repair of partial-thickness, articular surface tears of the rotator cuff.Arthroscopy. 2004; 20: 214-220
- Arthroscopic Repair of Articular Surface Partial-Thickness Rotator Cuff Tears: Transtendon Technique versus Repair after Completion of the Tear-A Meta-Analysis.Adv Orthop. 2016; 2016: 7468054
- Outcome comparison between in situ repair versus tear completion repair for partial thickness rotator cuff tears.Arthroscopy. 2015; 31: 2191-2198
- Quality of life and functional results of arthroscopic partial repair of irreparable rotator cuff tears.Arthroscopy. 2017; 33: 261-268
- Debridement of degenerative, irreparable lesions of the rotator cuff.J Bone Joint Surg Am. 1995; 77: 857-866
- The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis.Arthroscopy. 2010; 26: 417-424
- Surgical management of irreparable rotator cuff tears.Knee Surg Sports Traumatol Arthrosc. 2015; 23: 494-501
- Partial repair of irreparable supraspinatus tendon tears: clinical and radiographic evaluations at long-term follow-up.J Shoulder Elbow Surg. 2011; 20: 1170-1177
- Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair.J Orthop Traumatol. 2010; 11: 13-20
- Results of arthroscopic partial repair of large retracted rotator cuff tears.Arthroscopy. 2013; 29: 1275-1282
- Partial repair of massive rotator cuff tears: the evolution of a concept.Orthop Clin North Am. 1997; 28: 125-132
- Arthroscopic “interval slide” in the repair of large rotator cuff tears.Arthroscopy. 1999; 15: 527-530
- Arthroscopic repair of massive, contracted, immobile rotator cuff tears using single and double interval slides: technique and preliminary results.Arthroscopy. 2004; 20: 22-33
- Tendon transfer options about the shoulder in patients with brachial plexus injury.J Bone Joint Surg Am. 2012; 94: 1391-1398
- Modified L'Episcopo tendon transfers for irreparable rotator cuff tears: 5-year follow-up.Clin Orthop Relat Res. 2010; 468: 1572-1577
- Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a systematic review.J Bone Joint Surg Am. 2012; 94: 891-898
- Outcome of lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear.J Shoulder Elbow Surg. 2016; 25: 1346-1353
- Deltoid muscular flap transfer for the treatment of irreparable rotator cuff tears.Orthop Rev (Pavia). 2009; 1: e15
- Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: long-term results at a minimum follow-up of ten years.J Bone Joint Surg Am. 2013; 95: 1920-1926
- Irreparable Rotator Cuff Tears: Restoring Joint Kinematics by Tendon Transfers.Open Orthop J. 2016; 10: 266-276
- Growth factors for rotator cuff repair.Clin Sports Med. 2009; 28: 13-23
- Inflammatory and angiogenic mRNA levels are altered in a supraspinatus tendon overuse animal model.J Shoulder Elbow Surg. 2005; 14: 79S-83S
- Rotator cuff biology and biomechanics: a review of normal and pathological conditions.Curr Rheumatol Rep. 2015; 17: 476
- Rotator cuff defect healing: a biomechanical and histologic analysis in an animal model.J Shoulder Elbow Surg. 1998; 7: 599-605
- Early reactions after reimplantation of the tendon of supraspinatus into bone. A study in rabbits.J Bone Joint Surg Br. 2000; 82: 1072-1076
- Arthroscopic repair of massive contracted rotator cuff tears: aggressive release with anterior and posterior interval slides do not improve cuff healing and integrity.J Bone Joint Surg Am. 2013; 95: 1482-1488
- Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part II–prognostic factors for clinical and radiographic outcomes.J Shoulder Elbow Surg. 2011; 20: 941-946
- Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal?.J Bone Joint Surg Am. 2005; 87: 1229-1240
- Arthroscopic repair of the rotator cuff: prospective study of tendon healing after 70 years of age in 145 patients.Orthop Traumatol Surg Res. 2013; 99: S379-S384
- Repair integrity and functional outcomes for arthroscopic margin convergence of rotator cuff tears.J Bone Joint Surg Am. 2013; 95: 536-541
- Tendon to bone healing: differences in biomechanical, structural, and compositional properties due to a range of activity levels.J Biomech Eng. 2003; 125: 106-113
- Long durations of immobilization in the rat result in enhanced mechanical properties of the healing supraspinatus tendon insertion site.J Biomech Eng. 2007; 129: 400-404
- Experimental rotator cuff repair. A preliminary study.J Bone Joint Surg Am. 1999; 81: 1281-1290
- Early versus delayed rehabilitation following arthroscopic rotator cuff repair: A systematic review.Phys Sportsmed. 2015; 43: 178-187
- Delayed versus early motion after arthroscopic rotator cuff repair: a meta-analysis.J Shoulder Elbow Surg. 2014; 23: 1631-1639
- Does immobilization after arthroscopic rotator cuff repair increase tendon healing? A systematic review and meta-analysis.Arch Orthop Trauma Surg. 2014; 134: 1279-1285
- Optimal shoulder immobilization postures following surgical repair of rotator cuff tears: a simulation analysis.J Shoulder Elbow Surg. 2013; 22: 1011-1018
- Postural dependence of passive tension in the supraspinatus following rotator cuff repair: a simulation analysis.Clin Biomech (Bristol, Avon). 2011; 26: 804-810
- Effect of arm elevation and rotation on the strain in the repaired rotator cuff tendon. A cadaveric study.Am J Sports Med. 2001; 29: 788-794
- Passive tension in the supraspinatus musculotendinous unit after long-standing rupture of its tendon: a preliminary report.J Shoulder Elbow Surg. 1998; 7: 393-396
- Passive tension and gap formation of rotator cuff repairs.J Shoulder Elbow Surg. 2004; 13: 664-667
- The efficacy of cryotherapy in the postoperative shoulder.J Shoulder Elbow Surg. 1996; 5: 62-68
- The efficacy of continuous cryotherapy on the postoperative shoulder: a prospective, randomized investigation.J Shoulder Elbow Surg. 2001; 10: 522-525
- The effect of continuous cryotherapy on glenohumeral joint and subacromial space temperatures in the postoperative shoulder.Arthroscopy. 2002; 18: 748-754
- Does early versus delayed active range of motion affect rotator cuff healing after surgical repair? A systematic review and meta-analysis.Am J Sports Med. 2016; 44: 785-791
- The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair.J Shoulder Elbow Surg. 2016; 25: 521-535
- Activation of the shoulder musculature during pendulum exercises and light activities.J Orthop Sports Phys Ther. 2010; 40: 230-237
- The effect of limb support on muscle activation during shoulder exercises.J Shoulder Elbow Surg. 2004; 13: 614-620
- Electromyography of the shoulder: an analysis of passive modes of exercise.Orthopedics. 1998; 21: 1181-1184
- Rehabilitation after arthroscopic rotator cuff repair: current concepts review and evidence-based guidelines.Int J Sports Phys Ther. 2012; 7: 197-218
JHT Read for Credit
Quiz: #487
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.The term “massive rotator cuff tear” has been defined as tears
- a.which are full thickness
- b.greater than 5 cms and more than one tendon
- c.greater than 2 cms and 3 or more tendons
- d.which include both longitudinal and transverse elements
- a.
- #2.Most degenerative damage to the rotator cuff occurs
- a.following trauma
- b.concomitantly with other immune deficiencies
- c.to the bursal side of the tendon
- d.to the articular side of the tendon
- a.
- #3.Acute cuff tears in young patients often occur with a FOOSH with the arm in the ____________ position
- a.overhead
- b.neutral
- c.abducted and externally rotated
- d.adducted and internally rotated
- a.
- #4.The population which is the focus of the article is patients who
- a.refused surgery and completed an intensive course of rehabilitation
- b.failed conservative treatment and required surgery
- c.opted for 6 weeks of sling immobilization followed by self-directed exercises
- d.were non-compliant to therapy
- a.
- #5.The authors argue against arthroscopic repair of full thickness cuff tears
- a.false
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
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