A rotary cuff rupture is a tear in the tendons surrounding the shoulder joint. In the formation of tears to the rotary cuff (supraspinatus and infraspinatus tendon, subscapularis tendon), the supraspinatus tendon is particularly prone to early signs of degeneration with small tears (ruptures); however, such tears can also occur as the result of accidents. The frequency of rotary cuff tears increases with age. The rupture disturbs the biomechanics of the shoulder joint and results in painful impairment to mobility with a loss of strength.
MRI image of a complete rupture
of the supraspinatus tendon
(A: acromion, D: deltoid muscle,
SSP: retracted supraspinatus tendon)
Surgical treatment of rotary cuff ruptures
Surgical treatment of rotary cuff ruptures is being increasingly performed in elderly patients, too, in order to prevent or eliminate
- progressive destruction of the joint (defect arthropathy)
- loss of strength
- loss of ability to lift the arm (making combing, shaving and eating difficult or impossible) and
- unbearable pain during movement, stress or at night.
The surgical procedure is very complex; to date, it has only been possible in some cases to perform it arthroscopically.
In an arthroscopic reconstruction, the torn tendon is reattached to the humeral head through a small skin incision after subacromial decompression has been performed (see above). However, if the defect is pronounced, it is more sensible and safer to grasp the rotary cuff through a small incision at the edge of the summit of the shoulder (acromion) and reconstruct to the humeral head using suture anchors. This can generally be done as part of a mini-open-repair procedure, with an initial 4 cm skin incision.
Arthroscopic placement of a suture anchor into the humeral head, which is then used for the suture of the torn tendon.
 Following an open mini-open-access placement of suture anchors into the humeral head in a complete supraspinatus tendon rupture. |
 After the reconstruction of the rotary cuff, the tear is completely closed. |
The development of irreparable ruptures to the rotary cuff causes the rising (cranialization) of the humeral head under the summit of the shoulder, subsequently resulting in considerable and painful movement impairments. Procedures lending themselves to the repair of these rather rare tears are muscle transposition procedures such as the delta flap and latissimus dorsi transfer or the implantation of special shoulder prostheses (inverse prostheses); in addition to a noticeable increase in the mobility range, these also achieve a reduction in pain levels.
Concept and model of an inverse shoulder prosthesis for an irreparable rotary cuff rupture (by kind permission of DePuy).
Aftercare following the suture of a rotary cuff rupture
Because the tendon has to heal back to the bone, several weeks of immobilization in a shoulder abduction sling are necessary. It must be noted that tendon tissue in mostly elderly patients is very thin and fragile; if the muscles are tensed suddenly, the edge of the tendon may tear from the freshly inserted sutures. For this reason, passive mobility exercises only should be carried out for 4-6 weeks, before embarking on an active mobility exercise programme under the instruction of a physiotherapist. Because of the risk of movement impairments caused by adhesions, in some cases we also recommend the use of a continuous passive motion device.