Irreparable Rotator Cuff Tear
Sometimes patients develop large tears of the rotator cuff that are irreparable due to the amount of retraction and scarring. When the rotator cuff is torn for an extended period of time, the humeral head starts to migrate upward toward the acromion (dome of the shoulder), which can lead to a specific type of arthritis, called
rotator cuff arthropathy.
- Difficulty lifting due to weakness
- Difficulty raising the arm above shoulder height
- Pain that is worse at night
- Pain reaching up or away from the body.
- Physical therapy – Physical therapy can be helpful to recruit other muscles in the shoulder to compensate for the loss of the rotator cuff muscle function. This can sometimes lead to restoration of shoulder range of motion, but does not restore full strength and does not prevent the development of rotator cuff arthropathy. Learn more about Rotator Cuff Arthropathy.
- Injections – Injection of a steroid into the subacromial space (above the rotator cuff) can be considered when patients want to avoid surgery. This can help alleviate pain temporarily, but can interfere with healing and increase the risk of infection if surgery is subsequently performed. Learn more about injections.
- Anti-inflammatories – Nonsteroidal anti-inflammatory medication such as ibuprofen or Aleve can help decrease inflammation and pain. This can be beneficial in addition to physical therapy, so patients have less pain while regaining their motion and strength. Prescription-strength NSAIDs are occasionally prescribed.
- Surgery – Surgery is usually indicated for patients with large rotator cuff tears. Primary repair of the torn tendon is the first choice, but sometimes the tendon is too retracted or scarred to be repaired. If the cartilage in the joint is preserved and the humeral head has not started to migrate upward due to the rotator cuff tear, options include superior capsular reconstruction or placement of a bioabsorbable balloon in the subacromial space (Learn more about Superior Capsular Reconstruction). In cases where patients have already developed a high riding humeral head or have arthritis, reverse total shoulder replacement is the better surgical option. Learn more about Reverse Total Shoulder Replacement.