Skip to main content
Top
Published in: Current Reviews in Musculoskeletal Medicine 4/2011

01-12-2011 | Modern Techniques in Shoulder Surgery (Lawrence V. Gulotta, Section Editor)

Treatment of irreparable rotator cuff tears

Authors: M. Michael Khair, Lawrence V. Gulotta

Published in: Current Reviews in Musculoskeletal Medicine | Issue 4/2011

Login to get access

Abstract

Irreparable rotator cuff tears are a challenging problem for patients and surgeons. There are several treatment options, but deciding the correct one for each patient can be difficult. Treatment options include physical therapy, arthroscopy, muscle transfers, reverse shoulder arthroplasty, and hemiarthroplasty. An understanding of the patient’s chief complaint and their functional ability to elevate their arm above horizontal should guide the treatment. This article reviews the current literature on various treatment options for irreparable rotator cuff tears, then outlines an algorithm for determining treatment.
Literature
1.
go back to reference • Levy O, Mullett H, Roberts S, Copeland S. The role of anterior deltoid reeducation in patients with massive irreparable degenerative rotator cuff tears. J Shoulder Elbow Surg. 2008;17(6):863–70. This study showed good results with anterior deltoid training for patients with massive, irreparable rotator cuff tears.PubMedCrossRef • Levy O, Mullett H, Roberts S, Copeland S. The role of anterior deltoid reeducation in patients with massive irreparable degenerative rotator cuff tears. J Shoulder Elbow Surg. 2008;17(6):863–70. This study showed good results with anterior deltoid training for patients with massive, irreparable rotator cuff tears.PubMedCrossRef
2.
go back to reference Ainsworth R. Physiotherapy rehabilitation in patients with massive, irreparable rotator cuff tears. Musculoskeletal Care. 2006;4(3):140–51.PubMedCrossRef Ainsworth R. Physiotherapy rehabilitation in patients with massive, irreparable rotator cuff tears. Musculoskeletal Care. 2006;4(3):140–51.PubMedCrossRef
3.
go back to reference Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CW, Gerber C. Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Joint Surg Am. 2007;89(9):1928–34.PubMedCrossRef Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CW, Gerber C. Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Joint Surg Am. 2007;89(9):1928–34.PubMedCrossRef
4.
go back to reference Rockwood Jr CA, Williams Jr GR, Burkhead Jr WZ. Debridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am. 1995;77(6):857–66.PubMed Rockwood Jr CA, Williams Jr GR, Burkhead Jr WZ. Debridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am. 1995;77(6):857–66.PubMed
5.
go back to reference Gartsman GM. Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression. J Bone Joint Surg Am. 1997;79(5):715–21.PubMed Gartsman GM. Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression. J Bone Joint Surg Am. 1997;79(5):715–21.PubMed
6.
go back to reference Zvijac JE, Levy HJ, Lemak LJ. Arthroscopic subacromial decompression in the treatment of full thickness rotator cuff tears: a 3- to 6-year follow-up. Arthroscopy. 1994;10(5):518–23.PubMedCrossRef Zvijac JE, Levy HJ, Lemak LJ. Arthroscopic subacromial decompression in the treatment of full thickness rotator cuff tears: a 3- to 6-year follow-up. Arthroscopy. 1994;10(5):518–23.PubMedCrossRef
7.
go back to reference Burkhart SS. The principle of margin convergence in rotator cuff repair as a means of strain reduction at the tear margin. Ann Biomed Eng. 2004;32(1):166–70.PubMedCrossRef Burkhart SS. The principle of margin convergence in rotator cuff repair as a means of strain reduction at the tear margin. Ann Biomed Eng. 2004;32(1):166–70.PubMedCrossRef
8.
go back to reference Burkhart SS, Athanasiou KA, Wirth MA. Margin convergence: a method of reducing strain in massive rotator cuff tears. Arthroscopy. 1996;12(3):335–8.PubMedCrossRef Burkhart SS, Athanasiou KA, Wirth MA. Margin convergence: a method of reducing strain in massive rotator cuff tears. Arthroscopy. 1996;12(3):335–8.PubMedCrossRef
9.
go back to reference Walch G, Edwards TB, Boulahia A, Nove-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg. 2005;14(3):238–46.PubMedCrossRef Walch G, Edwards TB, Boulahia A, Nove-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg. 2005;14(3):238–46.PubMedCrossRef
10.
go back to reference Mallon WJ, Wilson RJ, Basamania CJ. The association of suprascapular neuropathy with massive rotator cuff tears: a preliminary report. J Shoulder Elbow Surg. 2006;15(4):395–8.PubMedCrossRef Mallon WJ, Wilson RJ, Basamania CJ. The association of suprascapular neuropathy with massive rotator cuff tears: a preliminary report. J Shoulder Elbow Surg. 2006;15(4):395–8.PubMedCrossRef
11.
go back to reference Vad VB, Southern D, Warren RF, Altchek DW, Dines D. Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy. J Shoulder Elbow Surg. 2003;12(4):333–6.PubMedCrossRef Vad VB, Southern D, Warren RF, Altchek DW, Dines D. Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy. J Shoulder Elbow Surg. 2003;12(4):333–6.PubMedCrossRef
12.
go back to reference Costouros JG, Porramatikul M, Lie DT, Warner JJ. Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears. Arthroscopy. 2007;23(11):1152–61.PubMedCrossRef Costouros JG, Porramatikul M, Lie DT, Warner JJ. Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears. Arthroscopy. 2007;23(11):1152–61.PubMedCrossRef
13.
go back to reference Bedi A, Dines J, Warren RF, Dines DM. Massive tears of the rotator cuff. J Bone Joint Surg Am. 2010;92(9):1894–908.PubMedCrossRef Bedi A, Dines J, Warren RF, Dines DM. Massive tears of the rotator cuff. J Bone Joint Surg Am. 2010;92(9):1894–908.PubMedCrossRef
14.
go back to reference Williams Jr GR, Rockwood Jr CA. Hemiarthroplasty in rotator cuff-deficient shoulders. J Shoulder Elbow Surg. 1996;5(5):362–7.PubMedCrossRef Williams Jr GR, Rockwood Jr CA. Hemiarthroplasty in rotator cuff-deficient shoulders. J Shoulder Elbow Surg. 1996;5(5):362–7.PubMedCrossRef
15.
go back to reference Zuckerman JD, Scott AJ, Gallagher MA. Hemiarthroplasty for cuff tear arthropathy. J Shoulder Elbow Surg. 2000;9(3):169–72.PubMedCrossRef Zuckerman JD, Scott AJ, Gallagher MA. Hemiarthroplasty for cuff tear arthropathy. J Shoulder Elbow Surg. 2000;9(3):169–72.PubMedCrossRef
16.
go back to reference Sanchez-Sotelo J, Cofield RH, Rowland CM. Shoulder hemiarthroplasty for glenohumeral arthritis associated with severe rotator cuff deficiency. J Bone Joint Surg Am. 2001;83-A(12):1814–22.PubMed Sanchez-Sotelo J, Cofield RH, Rowland CM. Shoulder hemiarthroplasty for glenohumeral arthritis associated with severe rotator cuff deficiency. J Bone Joint Surg Am. 2001;83-A(12):1814–22.PubMed
17.
go back to reference Frankle M, Levy JC, Pupello D, Siegal S, Saleem A, Mighell M, et al. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. a minimum two-year follow-up study of sixty patients surgical technique. J Bone Joint Surg Am. 2006;88(Suppl 1 Pt 2):178–90.PubMedCrossRef Frankle M, Levy JC, Pupello D, Siegal S, Saleem A, Mighell M, et al. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. a minimum two-year follow-up study of sixty patients surgical technique. J Bone Joint Surg Am. 2006;88(Suppl 1 Pt 2):178–90.PubMedCrossRef
18.
go back to reference •• Wall B, Nove-Josserand L, O’Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 2007;89(7):1476–85. Comprehensive review of the French experience with the reverse total shoulder. PubMedCrossRef •• Wall B, Nove-Josserand L, O’Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 2007;89(7):1476–85. Comprehensive review of the French experience with the reverse total shoulder. PubMedCrossRef
19.
go back to reference Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87(7):1476–86.PubMedCrossRef Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87(7):1476–86.PubMedCrossRef
20.
go back to reference Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg. 2006;15(5):527–40.PubMedCrossRef Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg. 2006;15(5):527–40.PubMedCrossRef
21.
go back to reference Gerber C, Maquieira G, Espinosa N. Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg Am. 2006;88(1):113–20.PubMedCrossRef Gerber C, Maquieira G, Espinosa N. Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg Am. 2006;88(1):113–20.PubMedCrossRef
22.
go back to reference Birmingham PM, Neviaser RJ. Outcome of latissimus dorsi transfer as a salvage procedure for failed rotator cuff repair with loss of elevation. J Shoulder Elbow Surg. 2008;17(6):871–4.PubMedCrossRef Birmingham PM, Neviaser RJ. Outcome of latissimus dorsi transfer as a salvage procedure for failed rotator cuff repair with loss of elevation. J Shoulder Elbow Surg. 2008;17(6):871–4.PubMedCrossRef
23.
go back to reference Iannotti JP, Hennigan S, Herzog R, Kella S, Kelley M, Leggin B, et al. Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Factors affecting outcome. J Bone Joint Surg Am. 2006;88(2):342–8.PubMedCrossRef Iannotti JP, Hennigan S, Herzog R, Kella S, Kelley M, Leggin B, et al. Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Factors affecting outcome. J Bone Joint Surg Am. 2006;88(2):342–8.PubMedCrossRef
24.
go back to reference Warner JJ, Parsons 4th IM. Latissimus dorsi tendon transfer: a comparative analysis of primary and salvage reconstruction of massive, irreparable rotator cuff tears. J Shoulder Elbow Surg. 2001;10:514–21.PubMedCrossRef Warner JJ, Parsons 4th IM. Latissimus dorsi tendon transfer: a comparative analysis of primary and salvage reconstruction of massive, irreparable rotator cuff tears. J Shoulder Elbow Surg. 2001;10:514–21.PubMedCrossRef
25.
go back to reference Jost B, Puskas GJ, Lustenberger A, Gerber C. Outcome of pectoralis major transfer for the treatment of irreparable subscapularis tears. J Bone Joint Surg Am. 2003;85-A(10):1944–51.PubMed Jost B, Puskas GJ, Lustenberger A, Gerber C. Outcome of pectoralis major transfer for the treatment of irreparable subscapularis tears. J Bone Joint Surg Am. 2003;85-A(10):1944–51.PubMed
26.
go back to reference Galatz LM, Connor PM, Calfee RP, Hsu JC, Yamaguchi K. Pectoralis major transfer for anterior-superior subluxation in massive rotator cuff insufficiency. J Shoulder Elbow Surg. 2003;12(1):1–5.PubMedCrossRef Galatz LM, Connor PM, Calfee RP, Hsu JC, Yamaguchi K. Pectoralis major transfer for anterior-superior subluxation in massive rotator cuff insufficiency. J Shoulder Elbow Surg. 2003;12(1):1–5.PubMedCrossRef
Metadata
Title
Treatment of irreparable rotator cuff tears
Authors
M. Michael Khair
Lawrence V. Gulotta
Publication date
01-12-2011
Publisher
Current Science Inc.
Published in
Current Reviews in Musculoskeletal Medicine / Issue 4/2011
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-011-9098-3

Other articles of this Issue 4/2011

Current Reviews in Musculoskeletal Medicine 4/2011 Go to the issue

Spine (Matthew Cunningham, Section Editor)

Cervical spine: degenerative conditions

Modern Techniques in Shoulder Surgery (Lawrence V. Gulotta, Section Editor)

Biologic augmentation of rotator cuff repair

Modern Techniques in Shoulder Surgery (Lawrence V. Gulotta, Section Editor)

The glenoid in total shoulder arthroplasty

Modern Techniques in Shoulder Surgery (Lawrence V. Gulotta, Section Editor)

Proximal humeral fractures

Modern Techniques in Shoulder Surgery (Lawrence V. Gulotta, Section Editor)

Anterior shoulder instability: a review of pathoanatomy, diagnosis and treatment

Spine (Matthew E. Cunningham, Section Editor)

Pediatric scoliosis