Have you been told that you have a Massive Rotator Cuff Tear?

[mtomaino]

This month I have evaluated 4-5 patients with "massive tears" of their rotator cuff. This typically means a 2-tendon tear (supra- and infraspinatus), but occasionally the subscapularis is torm as well. Rarely are such large tears acute, however, a significant trauma like a fall may be causative. More commonly these occur over time, thus the tears are chronic, and as a result, often irreparable.

That having been said, Dr Gerber from Zurich, Switzerland recently authored an excellent review article (see attached pic below), which I have attached to the article on the subject (on this website).

Visit this link:
http://www.rearmyourself.com/article/Treatment-of%20Massive%20Rotator-Cuff%20Tears

In order to appropriately advise a patient regarding treatment, physical exam, x-ray, and an MRI are critical. The exam is perhaps most valuable because it will help me determine what is actually causing pain (is it the tear, AC arthritis, the biceps tendon,frozen shoulder? etc). Treatment revolves greatly around your functional needs and expecations.
In the final analysis, repair may be the best option---but as Dr Gerber's article points out, when repair is not possible, debridement and/or biceps tenotomy can provide improved function secondary to pain relief. In the final analysis, if arthroscopic treatment is unsuccessful, Reverse shoulder arthroplasty may be an option.

[steviewho]

As a 47yr old male with cronic end stage rotator cuff tears along with severe humeral migration rubbing against the acromion,tendon retraction with fatty infiltration. The tears are full thickness,3.5cm left and 4cm right at time of mri Jan,2010. As far as the reverse shoulder which seems to be my only option available, i'm very apprehensive as far as stability and implant failure and if this is even an option for somone under 50yrs.old. I would very much appreciate your opinion. Thank You.

[mtomaino]

If your main problem is pain, and you can raise your arm above shoulder level, then you may be a cadidate for a hemiarthroplasty with an extended articular surface. See this link:

http://www.rearmyourself.com/article/Hemiarthroplasty-with%20an%20Extended%20articular%20surface-for%20cuff%20tear%20arthropathy

This option avoids the potential downsides of instability following Reverse shoulder---and can be revised down the road should function decline. I would also suggest checking a nerve study to ensure that suprascapular nerve dysfucntion is not contributing to your pain, in which case an arthroscopic release of the transverse scapular ligament is an option. In addition, tenotomizing the long head of the biceps may also result in pain relief.

However, if your function is such that you can no longer elevate your arm, and you have disabling pain, then a Reverse is an option even at your age. Designs are constantly improving---and so it is not a given that your replacement will fail with time.

I have attached 2 x-ray pics below--one of a standard stemmed hemiarthroplasty with an Extended articular surface (which articulates both with the glenoid and the undersurface of the acromion) and one with a cap.