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...r-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.