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Pathophysiology of Rotator Cuff Tears

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Massive Rotator Cuff Tears

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Abstract

The development of rotator cuff pathology is multifactorial in nature, resulting from a combination of intrinsic and extrinsic factors. Age-related degeneration, oxidative stress, vascular changes, and inflammation are all potential contributors to the intrinsic pathology of the rotator cuff. Of the variety of cellular and morphologic changes that are observed in the setting of massive rotator cuff tears, two changes—muscle atrophy and fatty degeneration—are strongly correlated with high repair failure rates and worsening functional outcomes. Yet, the precise molecular basis for these changes is largely unknown.

Massive tears of the rotator cuff prevent the cuff from stabilizing the humeral head on the glenoid to allow other muscles to generate motion across the joint. It is unclear exactly how large a tear must be to cause a loss of the force coupling effect of the rotator cuff and normal shoulder biomechanics. Another major question, still unanswered, is the mechanism behind the evolution of subjective pain in the setting of rotator cuff pathology as many cuff tears are asymptomatic. Investigation and further understanding of these fundamental mechanisms will not only lead to better diagnostic and prognostic capabilities but will also aid in the development of better treatment modalities and adjunctive therapies for massive rotator cuff tears.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, UCLA Santa Monica Orthopaedic Center, 1250 16th Street, Santa Monica, CA, 90404, USA

    Trevor P. Scott MD

  2. Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA

    Adam Z. Khan BS

  3. UCLA David Geffen School of Medicine, 10833 Le Conte Avenue, 76-143-CHS, Los Angeles, CA, 90095, USA

    Frank A. Petrigliano MD

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  1. Trevor P. Scott MD
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  2. Adam Z. Khan BS
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  3. Frank A. Petrigliano MD
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Correspondence to Frank A. Petrigliano MD .

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  1. Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA

    Lawrence V. Gulotta

  2. Professor of clinical surgery, Attending Surgeon, Medical School, Hospital for Special Surgery, New York, New York, USA

    Edward V. Craig

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Scott, T.P., Khan, A.Z., Petrigliano, F.A. (2015). Pathophysiology of Rotator Cuff Tears. In: Gulotta, L., Craig, E. (eds) Massive Rotator Cuff Tears. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7494-5_1

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