If you have good motion despite an irreparable rotator cuff tear, but have pain that interferes with function, what are your options?

This is a frequent problem, and an increasingly common question. If enough posterior cuff and anterosuperior cuff are working (and this usually means subscapularis in the front and teres minor in the back) a "force couple can exist which maintains '"biomechanics" to allow over head motion. However, there may still be superior migration of the humeral head, which results in painful shear stresses at the glenoid, and painful articulation with the undersurface of the acromion. In addition, the biceps tendon may be degenerative---and can be a significant pain mediator. Lastly, retraction of the supra- and infraspinatus tendons may result in suprascapular neuropathy, which can potentially cause pain as well.

Assuming that you have had a failed repair, or failed attempt at repair, it's worth understnding what the status of the biceps tendon is. Dr. Pasal Boileau and others have achnowleged that simple biceps tenotomy can improve function in patients with an irreparable cuff tear because of pain relief that follows. It may also be worthwhile to be evaluated with a nerve conduction study; even if the cuff is not fixable, suprascapular nerve-related pain may potentially improve after arthroscopic release of the transverse scapular ligament.

The good news is that if you can raise your arm over your head, and the two points just mentioned do not apply, then you may benefit from hemiarthroplasty with an Extended Articular Surface. A reverse shoulder is an option too, but if you are younger than 70 and very active, EAS hemiarthroplasty may improve function by decreasing the pain you are experiencing.

For more information, visit this link:

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

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