The rotator cuff serves as the primary source of stabilization for the glenohumeral joint. It is formed by the strong tendinous attachments to the humerus of four key muscles.
Supraspinatus
Along with the deltoid, the prime mover for abduction
Innervated by the suprascapular nerve
Infraspinatus
The prime mover for external rotation.
Innervated by the suprascapular nerve
Subscapularis
Innervated by the supscapular nerve
Teres Major
Innervated by the subscapular nerve
The muscles of the rotator cuff must always be a balance
between strength and control.
Other key muscle for shoulder movement include:
Deltoid
Innervated by the axillary nerve
Long head of biceps
Pectoralis major
Coracobrachialis
Long head of Triceps
Teres minor
Innervated by the axillary nerve
Q: My doctor told me that I have a Massive Rotator Cuff Tear. What does this mean? How will it be treated?
A: Massive tear usually means a tear of at least 5cm length in the long axis of the rotator cuff.
Basically, there are usually three options for treatment.
Conservative Treatment: Using Rest, Ice, Compression, Elevation, and Physiotherapy, one can expect a 50-90% chance of recovery. This may be helped further by local injection into the shoulder of corticosteroids. Negative prognostic factors, predicting a poor response to conservative treatment include:
External rotation / abduction strength less than 3/5
Atrophy of shoulder muscles
Superior migration of the humeral head
Decreased Passive range of motion
Shoulder (glenohumeral) arthritis
Arthroscopic Debridement and Repair usually leads to around 80% success rate. It is often required if patients fail to improve from conservative treatement. Interestingly, patients who have a subscapularis tear are far more likely to get a poor result from arthroscopic intervention.
Open Surgical Repair leads to successful outcome in approximately 85% of patients.