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Introduction

The term “rotator cuff” of the shoulder (Rotator cuff) describes the tendons of the area, which “embrace” the articular surface of the humeral head. Their main role is to achieve movements (internal and external rotation) from the shoulder but also to lift weight when the upper limb is in abduction, that is, away from the body. Due to the anatomy of the area and the inherent instability of the shoulder, the tendons of the rotator cuff stabilize the joint by holding the head against the articular surface of the scapula (glenoid cavity).

Symptoms

Rotator cuff tears of the shoulder occur with a great heterogeneity of symptoms and usually cause great distress to the patient, either continuously or with multiple recurrences. The common problem is pain (at rest, during movement or at night), while stiffness and weakness are often included in the patients’ symptoms. The restoration of the anatomical continuity of the torn tendons depends on the time of treatment of the damage, that is, on the distance between the traumatic event that caused the rupture and the surgical repair.

Acute injuries

Thus, in “acute injuries”, arthroscopic repair of the patella, as is done with devices called anchors, is usually sufficient. Even in patients aged >65 years, the functionality of the patella returns to pre-injury levels without leaving residual pain or other symptoms.

Chronic Injuries

In injuries that have been left for a long time and have become “chronic”, it is usually not enough to simply repair them, due to the muscle degeneration that coexists. In these cases, it is necessary to strengthen the suturing of the heel either mechanically, using subacromial implants (e.g. InSpace Balloon) or using grafts, or biologically, using autologous healing factors from platelets (PRP) or stem cells. Alternatively, another way is to transfer “neighboring” tendons such as the latissimus dorsi which strengthens the suturing of the heel, especially when there is an external rotation deficit. This transfer aims to use a healthy anatomical element, which will “train” in its new position and will substitute the function of degenerated and weak tissues.

Arthropathy due to chronic tears

Finally, in lesions involving arthritis along with extensive destruction or major degeneration of the tendon sheath, the articular surfaces lose their parallelism and the humeral head loses its correct anatomical position, making it difficult to move the shoulder at all levels. In these cases, it is necessary to perform more serious, open operations to restore the functionality of the upper limb and to allow the patient to get rid of pain.

Reverse total arthroplasty is one such operation. This involves changing the articular surfaces, in a way that changes the anatomy of the joint so that movement does not depend on the tendon sheath.

For the greatest effectiveness of the treatment, the patient follows a rehabilitation program that aims to recover the range of motion of the shoulder joint and strengthen the muscles of the adjacent muscles. The rehabilitation time varies depending on the severity of the damage and the functional requirements of the patient.

Thus, while the return to daily activities and office work is immediate, in some cases the return to full sports activity or heavy manual work may take several months.