Surgery – Rotator cuff tear

Definition of rotator cuff tear:

Rotator cuff is the name given to the group of muscles of the shoulder located under the deltoid muscle in direct contact with the shoulder's gleno-humeral joint. The cuff’s muscles contribute to rotational mobility and elevation of the shoulder. The shoulder’s rotator cuff is made up of the tendons of four muscles: the supraspinatus muscle, the infraspinatus muscle, the teres minor muscle, the tendon of the long head of the biceps and the subscapularis muscle. The tendons of the cuff’s muscles are among the most fragile of the human body, their lesions, called “tears” are frequent, in particular infraspinatus tears. Shoulder rotator cuff tears are a frequent pathology that causes shoulder pain and stiffness. This shoulder pathology is usually degenerative but shoulder injuries can also contribute to it.

Rotator cuff tear, CT arthrography of the shoulder: retraction of infraspinatus 2+, ToulouseRotator cuff of the shoulder, CT arthrography: evaluation of amyotrophy and fatty degeneration of the infraspinatus

 

Whenever possible, rotator cuff tears must be repaired surgically by a specialized surgeon with experience in shoulder arthroscopy, which has become the method of choice for shoulder surgery.

Video of arthroscopic repair surgery for the rotator cuff of the shoulder:

Shoulder surgery video showing arthroscopic repair surgery for a lesion of a rotator cuff tendon / Toulouse specialist

Arthroscopic surgical treatment of rotator cuff tears at the shoulder:

This shoulder surgery is performed arthroscopically, with overnight hospitalization.  The patient is in the beach chair position under general or regional anaesthesia.

Setup for arthroscopic surgery of the shoulder’s rotator cuff, Toulouse

With the arthroscopic procedure, only four or five 5-mm incisions around the shoulder are necessary to visualize and then repair the rotator cuff tear.
These arthroscopic views show the glenohumeral joint (the main joint of the shoulder) after a spontaneous tear of the biceps. The interval of the shoulder's rotators is inflamed, the tendon of the supraspinatus muscle has a tear that propagates to the tendon of the infraspinatus muscle through intratendinous delamination. 

Intra-articular arthroscopic view of an extended tear of the shoulder’s supraspinatus

The rotator cuff repair surgery will be performed through a subacromial portal; this repair surgery begins with the removal of the subacromial bursa using a shaver and resection of the lower part of the acromion (or acromioplasty), which provides more space to the tendons of the shoulder’s rotator cuff muscles.  Sometimes the scope of these subacromial release procedures can be broadened to the lateral end of the collarbone as here.
Once these refreshing procedures are performed, it is possible to have a perfect superior view of the tear of the rotator cuff, which is retracted at the top of the humeral head with a tendon already showing signs of wasting.

Arthroscopic subacromial view of rotator cuff tear, ToulouseCuff tear with wasting of supraspinatus tendon, Toulouse

Proper rotator cuff mobility is verified and to help healing, the tendons are debrided with the blade of the shaver, as well as the “footprint”, which is the natural insertion site of the cuff on the shoulder, at the top of the humerus. 

Arthroscopic shoulder surgery for rotator cuff tear, anchors used to reattach the cuff, ToulouseArthroscopic shoulder surgery for rotator cuff tear, positioning of anchor onto greater tubercle, Toulouse

 

 

Anchors can then be positioned in the greater tubercle, one anteriorly and one posteriorly; then the sutures are passed one by one through the shoulder’s rotator cuff.
In this case, the cuff's torn tendons will be repaired using 2 anchors and 6 sutures. Each suture passed in the cuff is doubled.

Arthroscopic shoulder surgery for rotator cuff tear, threads are passed through the supraspinatus, ToulouseArthroscopic shoulder surgery for rotator cuff tear, thread passed through the supraspinatus, Toulouse

 

Once all the sutures are passed, they can be tied and the rotator cuff can be restored to its natural origin at the shoulder, on the greater tuberosity at the top of the humerus.  Tendonc repair solidity is verified, as well as the absence of interference from soft tissues.
A second row of anchors may prove necessary

<img alt="Arthroscopic shoulder surgery for rotator cuff tear, cuff repositioned and secured with 6 “U” sutures, Toulouse" data-cke-saved-src="/sites/default/files/coiffe_11_suturee.png" src="/sites/default/files/coiffe_11_suturee.png" style="width: 250px; height: 180px; float: left;" arthroscopic="" shoulder="" surgery="" for="" rotator="" cuff="" tear,="" repositioned="" and="" secured="" with="" 6="" “u”="" sutures,="" toulouse"="">Arthroscopic shoulder surgery for rotator cuff tear, cutaneous suture with absorbable thread, Toulouse

 

 

The four 5-mm incisions at the shoulder will be closed with absorbable stitches.
Shoulder immobilization will be necessary with the elbow against the trunk for 6 weeks. This immobilization will make it possible to protect the repaired rotator cuff, but also to reduce shoulder pain.

Arthroscopic shoulder surgery for rotator cuff tear, post-operative x-ray, ToulouseArthroscopic shoulder surgery for rotator cuff tear, post-operative immobilization, Toulouse

 

Recovery and shoulder rehabilitation after rotator cuff tear surgery:

After surgery, the shoulder must be immobilized for 5 weeks. Specialized shoulder rehabilitation must be started immediately after surgery, and follow a specific protocol. Active shoulder rehabilitation only starts the 6th week after surgery. Driving often resumes toward the end of the 2nd postoperative month. Normal recovery spreads over 4 to 6 months, with maximal recovery of active articular range of motion toward the end of the 6th post-operative month, and maximal shoulder strength recovery toward the end of the 9th month after surgery.

Recovery and recuperation from rotator cuff tear, intensive sports resume after 6 months, Toulouse