A rotator cuff tear is a common shoulder injury in which a tendon pulls partially or fully away from the bone. Many rotator cuff tears can be treated conservatively with physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs) and cortisone injections. However, a surgical procedure may be considered if nonsurgical treatment does not adequately alleviate the pain or fully restore normal shoulder function.
When Is a Rotator Cuff Tear Irreparable?
A rotator cuff tear may be deemed irreparable if the tendon damage is very severe. For instance, surgical repair of a massive rotator cuff tear may not be possible if the tendon has contracted to the point that it cannot be stretched and reanchored to its proper attachment site, or if the muscle that pulls on the rotator cuff tendon has weakened to the point that it would not function normally even if the tendon was surgically reattached. Another type of tear that may be deemed irreparable is rotator cuff tear arthropathy, which is a large rotator cuff tear accompanied by a severe and complex form of shoulder arthritis.
Surgical Options for an Irreparable Rotator Cuff Tear
Even if a rotator cuff tear is deemed irreparable, certain surgical interventions may still be considered, such as:
- Shoulder debridement surgery (abrasion arthroplasty) – Utilizing special surgical tools, a surgeon removes damaged or inflamed tissue, smooths uneven surfaces and cleans out loose cartilage and other debris from the shoulder joint.
- Partial rotator cuff repair – During a debridement procedure, a surgeon makes a large rotator cuff tear smaller and thereby restores some lost shoulder joint function.
- Tendon transfer – To address a rotator cuff tendon that has been chronically torn and contracted, a surgeon transfers a neighboring tendon to take the place of the damaged tendon.
- Reverse shoulder replacement – A surgeon alters the mechanics of an arthritic shoulder joint by reversing its normal ball-and-socket structure to improve its function.
A Shoulder Expert Among Experts
Christopher C. Schmidt, MD, is a board-certified orthopedic shoulder surgeon who practices in Pittsburgh, Pennsylvania. He regularly collaborates with other physicians to develop cutting-edge surgical techniques to address irreparable rotator cuff tears and other complex shoulder conditions. As a member of the American Academy of Orthopedic Surgeons (AAOS) Clinical Practice Guidelines Committee for Full-Thickness Rotator Cuff Tears, Dr. Schmidt contributed to the development of evidence-based, best-practice guidelines for treating irreparable rotator cuff tears. These guidelines are now used by surgeons across the nation.
If you’d like to meet with Dr. Schmidt to discuss shoulder surgery at one of his Pittsburgh-area offices, call (877) 471-0935 to request an appointment.
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