Your rotator cuff is a collection of four muscles and tendons that support and stabilize the shoulder joint. These soft tissues handle a fair amount of stress each and every day, and over time they can weaken to the point that they are overstretched or torn when overloaded with strain. Oftentimes mild and moderate rotator cuff tears can heal with the help of targeted physical therapy and other conservative techniques, but plenty of patients are diagnosed with what’s known as an irreparable rotator cuff tear.
Now, this doesn’t mean you have no recourse for treatment, it just means that certain treatments will fail to provide relief for one reason or another, so specific care needs to be taken. In today’s blog, we take a closer look at how these irreparable rotator cuff tears are generally treated.
Understanding Irreparable Rotator Cuff Tears
A severe rotator cuff tear can be deemed irreparable for a few different reasons. Some of the issues we see inside a shoulder that would lead us to classify a rotator cuff tear as irreparable include:
- Tendon Contraction – If the tendon has worn and contracted to the point that it will no longer be able to be elongated and reattached to its normal anchor site, the rotator cuff tear may be considered irreparable.
- Muscle Weakness – If the muscle that pulls on the rotator cuff tendon has weakened to the point that its function is severely stunted, the tendon may not be functional even if it is surgically reattached.
- Arthritis – If a more severe rotator cuff tear is accompanied by significant or complex shoulder arthritis, addressing only the rotator cuff tear may not be enough to resolve the totality of issues in the shoulder.
Treating Irreparable Rotator Cuff Tears
Despite the moniker, you still have treatment options for managing irreparable rotator cuff tears. Depending on your unique circumstances, your surgeon may recommend one of the following surgical corrections:
- Shoulder Debridement – A shoulder debridement will clean out loose bodies, smooth surfaces, and address shoulder tears as best as possible in hopes of restoring as much function as possible, knowing that some limitations should still be expected. Paired with weeks of physical therapy and other conservative recovery techniques, patients can make significant functional strides in their recovery.
- Latissimus Dorsi Tendon Transfer – Tendon transfers are a popular way to address irreparable rotator cuff tears, and oftentimes it’s the latissimus dorsi that is brought in for the fix. The latissimus dorsi is a large, wide, flat muscle spanning the width of your back, behind your arms, connecting the upper arm bone to the spine and hip. Its large size, strength and good vascularization make it an ideal tissue to transfer. One end of the latissimus dorsi is detached and connected to the remaining rotator cuff tendon against the shoulder bone, restoring strength and stability to the region.
- Reverse Shoulder Replacement – When the integrity of the rotator cuff is compromised, a reverse shoulder replacement procedure will be more ideal than the anatomical replacement. By switching the position of the ball and socket components, a reverse shoulder replacement shifts the burden of shoulder and arm movement from the rotator cuff to the deltoid muscle, overcoming the obstacles presented by an irreparable rotator cuff tear.
So if you suffer a major rotator cuff tear that is deemed irreparable or doesn’t respond to conservative techniques, know that you are not out of options. There are a few different surgical corrections that can overcome the challenge of an irreparable rotator cuff tear and restore strength and function to the area. Let Dr. Holloway and his team help find the right solution for you.
For more information, contact Dr. Holloway’s office today at (865) 410-7887.
