Nobody likes to hear that an injury they suffered is “irreparable,” but when it comes to shoulder injuries, an irreparable rotator cuff tear doesn’t mean that you are without options. When classifying a rotator cuff tear as irreparable, it means that the soft tissue designed to hold that portion of the shoulder joint in place has experienced so much damage or deterioration that it will not be able to heal enough on its own to provide ample support to the joint going forward. Strengthening it with physical therapy or surgically suturing the tissue will not restore function, making that irreparable.
But just because you can’t repair that specific aspect doesn’t mean that you are without options. You may not be able to fix a cracked piston in your car’s engine, rendering that specific hardware irreparable, but you can still fix your engine by taking your vehicle to a skilled mechanic, and the same can be said about your shoulder by connecting with a spine surgeon like Dr. Holloway. Below, we take a closer look at the two surgical options typically used to repair the irreparable rotator cuff tear.
Tendon Transfer For Irreparable Rotator Cuff Tears
In most instances, your surgical team will explore the possibility of using two different muscle-tendon units to restore strength and function to the damaged rotator cuff. Those two procedures are:
The Latissimus Dorsi Tendon Transfer
The more common procedure involves the large latissimus dorsi muscle, a very powerful internal rotator muscle in the shoulder region. There are a lot of internal rotator muscles in your shoulder, which aid in turning your arm in, but the only external rotators for your shoulder are your rotator cuff muscles. This means that you may have plenty of function turning your arm inwards but little ability to comfortably turning your arm outward if the rotator cuff is damaged, so taking part of an internal rotator can address this issue and still leave you with enough internal rotating muscles that this motion isn’t disabled by targeting the latissimus dorsi.
During the procedure, your surgeon will make two incisions, one on the back and one in the front of the shoulder. From the back, the surgeon detaches one end of the latissimus dorsi tendon and attaches a suture to that end. In the front the surgeon creates a flap in the deltoid muscle, which then covers the shoulder. The latissimus dorsi is moved under the deltoid muscle to its new position and sutured into place. The deltoid flap is also closed before surgical tools are removed and the surgical wounds are stitched together. Most patients experience improvements in shoulder motion and external movement while also noticing a significant decrease in pain and discomfort.
Lower One-Third Trapezius Transfer
The other potential option to solve an irreparable rotator cuff tear is the lower one-third trapezius tendon transfer. It can also help to restore external motion and may be more ideal for specific rotator cuff injuries, like damage to the:
- Supraspinatus (top tendon)
- Infraspinatus (top/back tendon)
- Teres minor (back tendon near humerus)
During the procedure, the surgeon makes an opening in order to access the trapezius tendon. They disengage the lower portion (or 1/3rd of the overall muscle, hence the name of the procedure) from its normal attachment on the shoulder blade and attach it to the upper part of the humerus. A tendon graft is typically inserted because the trapezius tendon is not long enough to reach that far on its own. These structures are sutured in place, in turn restoring external rotation and stabilization of the rotator cuff. Similar to the other tendon transfer procedure, the vast majority of patients experience a significant improvement in function and a decrease in debilitating symptoms.
To learn more about either tendon transfer procedure, or for other options to manage your rotator cuff discomfort, connect with Dr. Holloway and his team today at (865) 410-7887.
