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Dr Chandra Sekhar

Why Can’t Some Rotator Cuff Be Repaired?

A rotator cuff is a group of four tendons that work together to stabilize and move the shoulder. Each of the four tendons connect the scapula’s muscles with the upper arm’s bony portion (humerus). The names of the musculoskeletal components of the rotator cuff are:

  • Supraspinatus, which flows through the upper part of the ball of the shoulder joint (head of the humerus);
  • Subscapularis, which passes through the front of the head of the humerus ; and
  • Infraspinatus and teres minor, which flow through the back of the humeral head.

A tear in the rotator cuff results from a combination of tendon injury and weakened rotator due to damage from wear and tear, disuse, repeated use of steroid injections (cortisone), and smoking.

The degree of injury required to tear the cuff depends on the quality of the tendon. When young, the strong rotator cuff tendon is almost impossible to get torn However, older tendons, when repeatedly injured, or gets torn without injury. Tears in younger people tend to be partial (partially thick tears). Tears in the elderly are more likely to tear completely through the tendon (full-thickness tear) and affect multiple tendons.

Rotator cuff problems are a common cause of shoulder pain and difficulty performing activities requiring the shoulder joint’s normal strength and mobility. One of the most common rotator cuff problems is a rupture of the rotator cuff tendon. 

Many people with a torn cuff suggest that surgery is an inevitable step of treatment. The reality is that repairing a damaged rotator cuff may not be the best treatment, and in many cases, treatment may not even be possible. Let us see Why Can’t Some Rotator Cuff Be Repaired.

Tears on the rotator cuff

A rotator cuff is a group of four muscles that directly surrounds the shoulder joint, as explained above. Each of these muscles is connected to the bone by structures called tendons. When the rotator cuff breaks, the tendon gets separated from the bone. This can cause pain, difficulty moving your shoulders and weakness. Treatment for a rotator cuff rupture usually starts with simple steps, including physical therapy, activity changes, anti-inflammatory drugs, and possibly a cortisone injection.

When people fail to respond to typical non-surgical treatments, the question is whether the tendons can be repaired surgically. In many cases, rotator cuff repair is a sensible treatment option. However, some people with a torn cuff may be surprised to learn that surgical reconstruction is not a useful treatment.

Why no improvement?

Surgical repair of the rotator cuff tear may not be possible because of the severity of the injury or because the shoulder has become arthritic.

If the rotator cuff tear is extensive (massive rotator cuff tear) and has been present for a long time, surgical repair may not be possible. In this situation, the tendon often shrinks and cannot be returned to its normal position.

Also, the muscle that pulls the rotator cuff tendon often stops growing (weakens), and even if the tendon has recovered, the muscle does not function normally.

A condition called rotator cuff arthropathy where the rotator cuff has not only broken, but the shoulder joint has become arthritic.. This is when repairing the rotator cuff won’t solve the underlying problem with the damaged shoulder joint.

Treatment options

The fact that the torn rotator cuff may not be repaired does not mean that treatment cannot be considered, nor does it mean that people should choose to live with their condition.

While this may mean that rotator cuff repair is not possible, there are other treatment options, both surgical and non-surgical. Non-surgical treatments include anti-inflammatory drugs, cortisone injections, Ice, some activity changes, and physical therapy.

People need to understand that even with a massive rotator cuff tear , there are still many muscles and tendons above the shoulder joint that can replace the damaged rotator cuff tendon. Any treatment focus should be on therapeutic activities aimed at restoring the shoulder joint’s standard mechanisms.

Surgical options

Although surgery to repair a rotator cuff is not a treatment option in your situation, that does not mean surgery cannot be considered. There are surgical interventions that may also be considered if there is an irreparable tear in the rotator cuff.

  • Shoulder debridement surgery: Shoulder debridement surgery (abrasive arthroplasty) requires your surgeon to perform a cleanup shoulder procedure. Shoulder debridement is performed as arthroscopic shoulder surgery. Your surgeon uses laparoscopic tools to remove damaged or inflamed tissue; any uneven surfaces will be shaved to make it smooth, and remove loose cartilage or other damaged tissue to the shoulder.
  • Partial repair of the rotator cuff: If the primary cuff damage is irreparable, a tear reduction procedure may be performed. During surgery, when debridement is performed, part of the rotator cuff may be repaired.

A partial repair, which may not be a complete repair of a damaged tendon, will help restore the shoulder joint function.

  • Tendon transfer: If the rotator cuff tendon has been chronically torn and twisted irreparably, there may be an opportunity to replace the adjacent tendon to replace the damaged rotator cuff.
  • Reverse shoulders replacement: In situations where the shoulder joint becomes arthritic and painful, and the rotator cuff is badly damaged, several types of shoulder replacement may be performed. This process, known as an reverse shoulder replacement, is performed to change the shoulder joint’s mechanism to perform functional replacement even if there is damage to the rotator cuff.

Even though they have a rotator cuff tear that may not be repaired, most people with an irreparable rotator cuff tear can find better pain relief and function. People should hope that, with the right treatment, they will have better pain relief and carry out everyday activities for several months.

Surgery is sometimes necessary, but the reality is that most people get better with non-surgical treatment. Of course, non-surgical treatment should be tried at least several months, if not longer, before any invasive surgical treatment. Consider medication.

Conclusion:

Tears on the rotator cuff are a widespread problem. As we enter into the age of 60s or 70s, rotator cuff tears became a normal MRI finding. Some people with torn rotator cuffs are not good candidates for surgical repair of this damage. For more information on surgery, contact Dr Chandra Sekhar. B at 91 9959588389.

 

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