• Answers to Your Questions About Rotator Cuff Tears

    by Dr. J. Michael Bennett
    on Dec 14th, 2015

Call 281-633-8600 for an appointment with Dr. Bennett.  You may have a sore shoulder and wonder if you have a rotator cuff tear, or you may have been diagnosed with a rotator cuff tear and be wondering what it is and how it’s often treated and repaired.  Dr. J. Michael Bennett talks about the anatomy of rotator cuff tears in this video and he describes how the specifics of your injury can determine the best treatment options for you.  Dr. Bennett is a Board Certified Orthopedic Surgeon and Fellowship Trained Sports Medicine Specialist with offices in Sugar Land and Houston.

This is a summary of Dr. Bennett’s talk on rotator cuff tears.

– Hi there. My name is Dr. J. Michael Bennett. I am an orthopedic surgeon with Fondren Orthopedic Group. I’m sub-specialty trained in sports medicine and minimally invasive arthroscopic procedures.  Today I wanted to talk a little bit about a common question we get in the office particularly after you hear a diagnosis like, “You’ve got a rotator cuff tear, a complete rotator cuff tear.” And a lot of patients may not know exactly what that means. And the definition of about how we treat the rotator cuff tear has changed over the past 10 to 15 years.

The Anatomy of Rotator Cuff Tears

So going over some basic anatomy in regards to the rotator cuff, the rotator cuff is not a single entity but it’s actually four tendons that surround the ball and socket mechanism of the shoulder. So if you look at the shoulder here, here is your ball and here is your socket okay. And this is the humeral head, this is the glenoid and the rotator cuff is basically four muscle tendon units that surround the ball and socket mechanism.

So you have the front tendon here called the subscapularis. You have the top one here called the supraspinatus. You have the two back ones here. You’ve got the infraspinatus and then you’ve got the teres minor in the back okay. So a lot of times it’s a little bit deceiving when people say, “Oh, I’ve got a rotator cuff tear.” It could be any of these tendons or it could be all of these tendons. It could be a partial tear. It could be a little degeneration. So it’s a little bit more understanding needs to go into exactly describing what type of tear it is and that will determine oftentimes how we treat it.

So for instance if you have a single tendon tear usually the most common place you’ll see that is in the supraspinatus which is the top tendon here okay. And if it’s a full thickness tear that means it goes all the way through the tendon down to bone. And I want you to think of these tendons and muscles almost like rubber bands and they’re constantly under tension and that gives you your strength and your leverage when you raise your arm above your head. So when this tears that muscle retracts back like a rubber band and those muscle fibers when they’re not being used they actually can turn to scar, and they can turn to fat over time and it becomes very hard to fix later on and that muscle may never come back.

Rotator Cuff Tears Can Get Worse Over Time

So there’s a window of opportunity when you can actually go in and fix that tendon. And I will tell you that the prognosis and outcomes are often better with the smaller tears you have involving the fewer tendons. So if you have a one-tendon tear that involves a full thickness tear your prognosis or outcome is going to be better than somebody that has a supraspinatus and a subscapularis tendon tear. And their prognosis will be better than somebody that has a supraspinatus, subscapularis, infraspinatus and teres minor tear because that means that basically there’s nothing covering this ball okay.

So now, it’s important that you understand that rotator cuff tears can propagate and they can get worse especially if you’re an active individual. So if you’re having that nagging shoulder pain or if you’re having that disability that’s really interfering with your daily activities it’s not a bad idea to get at least checked out so you know exactly what your tendon looks like or what’s going on in your shoulder. Because it’s important to know that, the longer you wait when you have a tear the worse off the prognosis okay.

What Happens in a Massive Tear of the Rotator Cuff?

So what happens basically when you have a massive tear? When you have a massive tear, that’s when all the tendons are gone and you no longer have coverage of this ball. And so you get a mismatch. So what does that mean? Well the ball and the socket are lined up perfectly and the tendons keep that ball and socket balance in place. But when you lose a tendon, the shoulder becomes imbalanced. And so what happens is some of the other muscles that are around the shoulder tend to take over and try to compensate for the tendons that are gone. And one of those big muscles is the deltoid and I’ve marked that with green here just to show you what it looks like.

So the deltoid wraps up here from the acromion and this is just the basic picture but it inserts down over here at the proximal humerus. And what that does is it pulls on that humerus and gives you the ability to forward flex and abduct. It actually helps you with those types of motions.

Now what happens when you have a tear here? Now here’s your superspinatus here and that’s normal. But when you have a tear, it goes all the way through that tendon and that tendon starts to retract, the supraspinatus starts to retract here and that deltoid continues to pull upward. So over time that deltoid pulls the humeral head up and then you get a mismatch between the humeral head and the glenoid. And then this tendon over here is now turning atrophic. You get what’s called fat atrophy in that muscle belly which means that it becomes a non-functional muscle tendon unit. And so the likelihood of being able to fix that are very slim to none. Sometimes you can if you get lucky and you do a lot of scar tissue release and get that tendon over but you really want to tackle this while you still have the viability of that muscle.

So what happens is that the humeral head migrates up. It’s no longer in alignment with the glenoid. Now you’re developing arthritis and now you’re developing pain, and the ball and socket are no longer lined, they are arthritic, and the ball’s actually running up into this acromion and creating arthritis underneath the acromion as well. You get what’s called a pseudo-joint up here because it almost scallops up that bone. And this actually is called rotator cuff arthropathy. And this is what you’re trying to avoid.

You Should Get a Full Thickness Rotator Cuff Tear Fixed Early

When we talk about a full thickness rotator cuff tear, why it’s in your best interest to really consider getting it fixed early while you can fix it arthroscopically through minimally invasive poke hole incisions through the shoulder. Because the only solution for this at this point with the best long-term outcomes is a replacement and it’s actually called a reverse total shoulder replacement. So if you’re diagnosed with this and you want to avoid that then your key is really making sure you get a good evaluation from an orthopedic surgeon. Make sure that if you do have long-term shoulder pain that you get a correct diagnosis on what’s causing your shoulder pain. And if it is a full thickness tear then make sure you really think about it and discuss it thoroughly with your doctor about your options regarding getting it fixed. So if you have any more questions or comments regarding these videos please go to our website or you can call our office at 281-633-8600. Thank you very much.

If you have a sore shoulder and you’d like to get it evaluated by an experienced orthopedic surgeon and shoulder specialist, please call for an appointment with Dr. Bennett at 281-633-8600 in Sugar Land, at the intersection of Sweetwater and Lexington or 713-234-3152 in Houston, near the Houston Galleria.  If you’ve been diagnosed by another doctor and you’d like to get a second opinion, please call for an appointment with Dr. Bennett.

 

Author Dr. J. Michael Bennett

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