Large-to-Massive Rotator Cuff Tears

  • Brandon D. Bushnell
  • Richard J. BorgattiJr.
  • Michael A. Terry
  • Jeffrey S. AbramsEmail author


Rotator cuff injuries have held a place in the surgical literature for well over a century, since Codman’s reports of successful repair in 1911. Rotator cuff tears can be classified in three major ways – chronicity, thickness, and size. When a definitive injury is present, tears may be classified as acute tears when the injury occurred within 6 weeks of presentation. Otherwise, they are labeled as subacute or chronic tears. Tears without a definitive history of injury can be classified in a similar manner based on the timing of the onset of symptoms. Tears may be partial thickness and involve either the bursal side or articular side or cause delamination and present as intertendinous. Large and massive tears are full-thickness rotator cuff defects that include multiple tendons.


Rotator Cuff Humeral Head Rotator Cuff Tear Rotator Cuff Repair Suprascapular Nerve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Codman EA. Complete rupture of the supraspinatus tendon. Operative treatment with report of two successful cases. Boston Med Surg J. 1911;164:708–10.CrossRefGoogle Scholar
  2. 2.
    Bassett RW, Cofield RH. Acute tears of the rotator cuff: the timing of surgical repair. Clin Orthop. 1983;175:18–24.PubMedGoogle Scholar
  3. 3.
    Green A. Chronic massive rotator cuff tears: evaluation and management. J Am Acad Orthop Surg. 2003;11:321–31.PubMedGoogle Scholar
  4. 4.
    Bryant L, Shnier R, Bryant C, Murrell GAC. A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears. J Shoulder Elbow Surg. 2002;11:219–24.PubMedCrossRefGoogle Scholar
  5. 5.
    Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg. 2000;82A:505–15.Google Scholar
  6. 6.
    Davidson J, Burkhart S. The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis. Arthroscopy. 2010;26:417–24.PubMedCrossRefGoogle Scholar
  7. 7.
    Bartolozzi A, Andreychik D, Ahmad S. Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res. 1994;308:90–7.PubMedGoogle Scholar
  8. 8.
    Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg. 1995;77A:10–5.Google Scholar
  9. 9.
    Hansen ML, Otis JC, Johnson JS, Cordasco FA, Craig EV, Warren RF. Biomechanics of massive rotator cuff tears: implications for treatment. J Bone Joint Surg. 2008;90A:316–25.CrossRefGoogle Scholar
  10. 10.
    Liu SH, Baker CL. Arthroscopically-assisted rotator cuff repair: correlation of functional results with integrity of the cuff. Arthroscopy. 1994;10:54–60.PubMedCrossRefGoogle Scholar
  11. 11.
    Templehof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic individuals. J Shoulder Elbow Surg. 1999;8:296–9.CrossRefGoogle Scholar
  12. 12.
    Maman E, Harris C, White L, Tomlinson G, Shashank M, Boynton E. Outcome of nonoperative treatment of symptomatic rotator cuff tears managed by magnetic resonance imaging. J Bone Joint Surg. 2009;91A:1898–906.CrossRefGoogle Scholar
  13. 13.
    Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CWA, Gerber C. Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Joint Surg. 2007;89A:1928–34.CrossRefGoogle Scholar
  14. 14.
    Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically-repaired large and massive rotator cuff tears. J Bone Joint Surg. 2004;86A:219–24.Google Scholar
  15. 15.
    Ecklund KJ, Lee TQ, Tibone J, Gupta R. Rotator cuff tear arthropathy. J Am Acad Orthop Surg. 2007;15:340–9.PubMedGoogle Scholar
  16. 16.
    Yamaguchi K, Baumgarten K, Gerlach DJ, Ditsios K, Teefey SA, Middleton WD. The demographic and morphological features of rotator cuff disease: a comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg. 2006;88A:1699–700.CrossRefGoogle Scholar
  17. 17.
    Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefe SA, Middleton WD. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001;10:199–203.PubMedCrossRefGoogle Scholar
  18. 18.
    Kim HM, Teefey SA, Zelig A, Galatz LM, Keener JD, Yamaguchi K. Shoulder strength in asymptomatic individuals with intact compared with torn rotator cuffs. J Bone Joint Surg. 2009;91A: 289–96.CrossRefGoogle Scholar
  19. 19.
    Neer 2nd CS, Craig EV, Fukuda H. Cuff-tear arthropathy. J Bone Joint Surg. 1983;65A:1232–44.Google Scholar
  20. 20.
    Albritton MJ, Graham RD, Richards 2nd RS, Basamania CJ. The anatomic study of the effects on the suprascapular nerve due to retraction of the supraspinatus muscle after a rotator cuff tear. J Shoulder Elbow Surg. 2003;12:497–500.PubMedCrossRefGoogle Scholar
  21. 21.
    Neer 2nd CS. Impingement lesions. Clin Orthop. 1983;173:70–7.PubMedGoogle Scholar
  22. 22.
    Hawkins RJ, Kennedy JC. Kennedy impingement syndrome in athletes. Am J Sports Med. 1980;8:151–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Bak K, Sorensen AK, Jorgensen U, Nygaard M, Krarup AL, Thune C, et al. The value of clinical tests in acute full-thickness tears of the supraspinatus tendon: does a subacromial lidocaine injection help in the clinical diagnosis? A prospective study. Arthroscopy. 2010;26:734–42.PubMedCrossRefGoogle Scholar
  24. 24.
    Miller CA, Forrester GA. The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation. Arch Phys Med Rehabil. 2008;89:1162–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Murthi AM, Vasburgh CL, Neviaser TJ. The incidence of pathologic changes of the long head of the biceps tendon. J Shoulder Elbow Surg. 2000;9:382–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears: a long-term observation. Clin Orthop Relat Res. 1990;254:92–6.PubMedGoogle Scholar
  27. 27.
    Abrams JS, Song FSS. Arthroscopic repair techniques for massive rotator cuff tears. Instr Course Lect. 2012;61:121–30.PubMedGoogle Scholar
  28. 28.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures: pre and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83.PubMedGoogle Scholar
  29. 29.
    Motamedi AR, Urrea LH, Hancock RE, Hawkins RJ, Ho C. Accuracy of magnetic resonance imaging in determining the presence and size of recurrent rotator cuff tears. J Shoulder Elbow Surg. 2003;12:550–4.CrossRefGoogle Scholar
  30. 30.
    Callaghan JJ, McNiesh LM, DeHaven JP, Savory CG, Polly Jr DW. A prospective comparison study of double contrast computed tomography (CT) arthrography and arthroscopy of the shoulder. Am J Sports Med. 1988;16:13–20.PubMedCrossRefGoogle Scholar
  31. 31.
    Oh JH, Kim SH, Choi JA, Kim Y, Oh CH. Reliability of the grading system for fatty degeneration of rotator cuff muscles. Clin Orthop Relat Res. 2010;268:1558–64.CrossRefGoogle Scholar
  32. 32.
    Oh JH, Kim JY, Choi JA, Kim WS. Effectiveness of multidetector computed tomography arthrography for the diagnosis of shoulder pathology: comparison with magnetic resonance imaging with arthroscopic correlation. J Shoulder Elbow Surg. 2010;19:14–20.PubMedCrossRefGoogle Scholar
  33. 33.
    Sipola P, Niemitukia L, Kröger H, Höfling I, Väätäinen U. Detection and quantification of rotator cuff tears with ultrasonography and magnetic resonance imaging: a prospective study in 77 consecutive patients with a surgical reference. Ultrasound Med Biol. 2010;36:1981–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Ok JH, Kim YS, Kim JM, Yoo TW. Learning curve of office-based ultrasonography for rotator cuff tendons tears. Knee Surg Sports Traumatol Arthrosc. 2013;21:1593–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Wall LB, Teefey SA, Middleton WD, Dahiya N, Steger-May K, Kim HM, Wessell D, et al. Diagnostic performance and reliability of ultrasonography for fatty degeneration of the rotator cuff muscles. J Bone Joint Surg. 2012;94A:e83.Google Scholar
  36. 36.
    Lo IKY, Burkhart SS. Arthroscopic repair of massive, contracted, immobile rotator cuff tears using single and double interval slides: technique and preliminary results. Arthroscopy. 2004;20:22–33.PubMedCrossRefGoogle Scholar
  37. 37.
    Abrams JS. Arthroscopic techniques for massive rotator cuff repairs. Tech Shoulder Elbow Surg. 2007;8:126–34.CrossRefGoogle Scholar
  38. 38.
    Boileau P, Bagué F, Valerio L, Ahrens P, Chuinard C, Trojani C. Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg. 2007;89A:747–57.CrossRefGoogle Scholar
  39. 39.
    Burkhart SS, Nottage WM, Ogilive-Harris DJ, Kohn HS, Pachelli A. Partial repair of irreparable rotator cuff tears. Arthroscopy. 1994;10:363–70.PubMedCrossRefGoogle Scholar
  40. 40.
    Duralde XA, Bair B. Massive rotator cuff tears. The results of partial rotator cuff repair. J Shoulder Elbow Surg. 2005;14:121–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Harryman D, Mack L, Wang K, Jackins S, Richardson M, Matsen F. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg. 1991;73A:982–9.Google Scholar
  42. 42.
    O’Holleran JD, Kocher MS, Horan MP, Briggs KK, Hawkins RJ. Determinants of patient satisfaction with outcome after rotator cuff surgery. J Bone Joint Surg. 2005;87A:121–6.CrossRefGoogle Scholar
  43. 43.
    Ito J, Morioka T. Surgical treatment for large and massive tears of the rotator cuff. Int Orthop. 2003;27:228–31.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Oh JH, Kim SH, Shin SH, Chung SW, Kim JY, Kim SH, et al. Outcome of rotator cuff repair in large-to-massive tear with pseudoparalysis: a comparative study with propensity score matching. Am J Sports Med. 2011;39:1413–20.PubMedCrossRefGoogle Scholar
  45. 45.
    Hollinshead RM, Mohtadi NGH, Guchte RAV, Wadey VMR. Two 6-year follow-up studies of large and massive rotator cuff tears: comparison of outcome measures. J Shoulder Elbow Surg. 2000;9:373–81.PubMedCrossRefGoogle Scholar
  46. 46.
    Lafosse L, Brozska R, Toussaint B, Gobezie R. The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. J Bone Joint Surg. 2007;89A:1533–41.CrossRefGoogle Scholar
  47. 47.
    Derwin KA, Baker AR, Spragg RF, Leigh DR, Iannotti JP. Commercial extracellular matrix scaffold for rotator cuff tendon repair: biomechanical, biochemical, and cellular properties. J Bone Joint Surg. 2006;88A:2665–72.CrossRefGoogle Scholar
  48. 48.
    Barber FA, Burns JP, Deutsch A, Labbé MR, Litchfield RB. A prospective randomized evaluation of a cellular human dermal matrix augmentation for arthroscopic rotator cuff repair. Arthroscopy. 2012;28:8–15.PubMedCrossRefGoogle Scholar
  49. 49.
    Mulieri P, Dunning P, Klein S, Pupello D, Frankle M. Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. J Bone Joint Surg. 2010;92A:2544–56.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Brandon D. Bushnell
    • 1
  • Richard J. BorgattiJr.
    • 2
  • Michael A. Terry
    • 3
  • Jeffrey S. Abrams
    • 4
    Email author
  1. 1.Department of Orthopaedic SurgeryHarbin Clinic, LLCRomeUSA
  2. 2.Shore Shoulder SurgeryToms RiverUSA
  3. 3.Department of Orthopedic SurgeryNorthwesternChicagoUSA
  4. 4.Department of SurgeryUniversity Medical Center of PrincetonPrincetonUSA

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