- 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.
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 basically
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. 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. 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. And 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.