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Disorders and injuries of the rotator cuff
Major RC defects and their treatment
A major RC defect is characterised partly by the fact that a large part of the head of humerus is no longer covered by the tendon cuff, nor is it any longer centred in its socket. Varying proportions of the cuff are usually still present at the front and back. As a rule, the upper part of the cuff, the supraspinatus tendon, is missing or retracted so far back that it can no longer be sufficiently mobilised for reconstruction. As a result of the large hole in the RC, the joint is no longer watertight with respect to the nourishing joint fluid, causing the joint to lose its source of nutrition. Moreover, the joint cartilage gradually wears away between the head of humerus and acromion, resulting over time in defect arthrosis in the shoulder.
Major RC defect with elevation of the head beneath the acromion
Major defect with tendon sections still visible

Although covering the huge defect and restoring centring function by transferring a muscle flap can produce good results even in difficult, advanced cases, the success rate is not as high as with the "normal" RC procedure. The success of the operation depends on many small details during the actual procedure, on the patient's positive attitude and on the quality of the physiotherapy.

Regardless of the surgical technique employed in these cases, the procedure is always difficult and requires a surgeon with considerable experience. Whereas certain colleagues prefer the latissimus dorsi muscle transfer, i.e. the transfer of a back muscle to cover the defect, I prefer deltoid flap reconstruction.