The symposium
A/Prof Cutbush attended the International Shoulder Symposium in Paris in March 2016, which focused on tendon transfers for irreparable rotator cuff tears.
What was covered
The sessions covered tendon transfers for posterosuperior and anterosuperior tears, the management of serratus anterior, deltoid and trapezius palsies, and the use of tendon transfers together with reverse shoulder arthroplasty.
Tendon transfer is one of the options where a rotator cuff tendon cannot be repaired: a working muscle is redirected to take over part of the function that has been lost. It is a demanding option and is reserved for selected patients. Individual results vary.
When a cuff tear is irreparable
A rotator cuff tear is described as irreparable when the torn tendon cannot be brought back to the bone and held there. That usually follows from the tendon having retracted, the muscle having wasted and been replaced by fat, or the tissue having degenerated past the point at which a repair would hold. The terms posterosuperior and anterosuperior describe which part of the cuff is involved, which in turn determines which movement has been lost and therefore which transfer might restore part of it. The alternatives in this situation include partial repair, graft reconstruction, reverse shoulder replacement, and management without surgery.
Nerve palsies around the shoulder
The serratus anterior, trapezius and deltoid muscles position and power the shoulder, and each depends on a single nerve. When one of those nerves is injured, the muscle stops working and the shoulder loses a specific function, which can be disabling even though the joint itself is intact. Where recovery of the nerve is not expected, transferring another muscle to take over part of the lost work is one of the few options available, which is why these palsies are discussed alongside cuff tears at a meeting on tendon transfer.
Related information
See our rotator cuff tear and reverse total shoulder replacement pages, and our post on all-arthroscopic latissimus dorsi transfer.