Educational video describing the condition of a massive rotator cuff tear in the shoulder.
Massive rotator cuff tears are a disabling problem. These tears can cause pain, weakness and sometimes swelling of the shoulder.
The rotator cuff consists of four muscles that function to stabilize the shoulder joint:
1-Supraspinatus rotator cuff tendon: the supraspinatus tendon is the most common of the rotator cuff tendons to become ruptured.
2-Subscapularis
3-Infraspinatus
4-Teres minor
Massive tear of the rotator cuff that is greater than 5 cm usually involving both the supraspinatus ad infraspinatus tendon. Retraction of the rotator cuff tendons along with muscle atrophy and fatty infiltration can occur. This makes surgical reconstruction difficult with the surgical outcome being unpredictable and less than satisfactory.
Treatment varies from physiotherapy to replacement of the humeral head. Arthroscopic or oper repair is usually the selected treatment. Reconstruction can be done in selected cases.
Massive cuff tears that are associated with superior migration of the humeral head as well as instability and arthritis of the shoulder.
Rotator cuff arthropathy
•Patient will have pseudoparalysis
•an x-ray will show shift of the humerus proximally.
•MRI will show massive cuff tear with retraction at the level of the glenoid with atrophy of the muscle and fatty infiltration.
•Treatment: reverse shoulder is the treatment of choice for the elderly with rotator cuff arthropathy. It improves the pain and the function. Hemiarthroplasty is the treatment for younger patients. A standard head or a big humeral head can be selected. It could improve the function.
Patient examples
•Patient with massive tear of the cuff usually develops weakness of the shoulder and becomes unable to actively lift the arm without assistance.
•Fluid collection within the shoulder may occur with a massive tear of the rotator cuff.

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