Rotator Cuff Repair Indications and Considerations

Key Decision Factors Against Reverse Shoulder Arthroplasty (RSA)

The American Academy of Orthopaedic Surgeons specifically states that reverse shoulder arthroplasty is indicated for patients with massive, unrepairable rotator cuff tears with pseudoparalysis who have failed other treatments 1, 2
RSA is also indicated for rotator cuff tear arthropathy (massive tear combined with glenohumeral arthritis), which is not mentioned in this case 1, 2
The presence of intact posterior fibers of the supraspinatus indicates this is not a complete tendon loss, suggesting the tear may be repairable 1
A 3.4 cm transverse gap with some intact fibers represents a large but potentially repairable tear, not the "massive, unrepairable" category that defines RSA candidacy 1, 2

Rotator cuff repair is an option for patients with chronic, symptomatic full-thickness tears 3
The primary indication for rotator cuff repair is significant pain, not tear size alone 3
Patients treated surgically demonstrated statistically significant less pain on shoulder range of motion and at night compared with nonsurgical treatment 3
The American Academy of Orthopaedic Surgeons reports that 81% of surgical patients with full-thickness tears achieved excellent results with rotator cuff repair 3

Moderate muscle atrophy of supraspinatus and infraspinatus is a negative prognostic factor but does not preclude repair 4
Fatty infiltration status is critical to assess, as advanced fatty degeneration influences treatment decisions 4
Multiple level IV studies suggest overall positive outcomes of repair despite muscle disease often present in chronic rotator cuff disease 3

Severely impaired deltoid function is an absolute contraindication to RSA, as the deltoid must power shoulder motion after this procedure 2
Patients under 50 years face increased risks of prosthetic loosening and decreased survivorship with arthroplasty 2
Multiple steroid injections should be avoided as they may compromise rotator cuff integrity and affect subsequent repair 1

If the patient is asymptomatic or minimally symptomatic, surgery may not be warranted at all 3
NSAIDs, acetaminophen, and a single corticosteroid injection may provide adequate relief 4