Chronic massive rotator cuff tears can cause substantial shoulder pain and dysfunction. The goals of surgical treatment must be considered in the context of the individual patient and the complexity of the procedure itself, as well as postoperative recovery and rehabilitation. Complete primary repair is possible in some patients (see article on massive cuff reapair), while in others only a partial repair can be achieved.

When the cuff cannot be repaired and a patient complains of easy fatigueability above shoulder level, and has trouble raising the arm above chest level, Latissimus dorsi tendon transfer may improve function.

Latissimus dorsi muscle transfer is the preferred reconstructive option for active individuals disabled by shoulder pain who have weakness of elevation and unfixable cuff tears, but have good deltoid muscle strength and an in tact subscapularis tendon.

Postoperative outcomes are in large part related to proper patient selection. A functioning deltoid, functioning subscapularis, and an in tact coracoacromial arch are absolute essentials. The primary objective is to augment/restore to role of the posterosuperior cuff in centralizing the humeral head on the glenoid during forward flexion.

In that light, numerous studies, as well as my own experience have shown that preoperative function must include the ability to raise the arm to chest level, to hold it there, and to have some control as the arm is lowered. Pseudoparalysis--the inability to raise the arm to chest level--is associated with poor results.

After successful surgery forward flexion of between 120 and 160 degrees is possible. A sling is mandatory for 6 weeks before active motion is started, and full recovery may take up to 1 year or so.

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