By Roger C. Sohn, MD
The deep layer of shoulder muscles is called the rotator cuff. There are four tendons of the rotator cuff including the supraspintatus, infraspinatus, teres minor, and the subscapularis. People can tear one or more of these tendons leading to pain and weakness. Patients describe this pain as a sharp or achy pain that emanates from the lateral side of the shoulder. Many patients with rotator cuff tears also have irritation or tendinitis of the nearby bicep tendon.
The subscapularis is a part of the rotator cuff. It is located in the front of the shoulder and is responsible for internally rotating the shoulder. When the subscapularis tendon is injured, the adjacent long head of the bicep tendon can slip into the torn “corner” of the tear. This can lead to weakness and pain in the front of the shoulder.
Among the many fun acronyms of the shoulder is the PASTA lesion. PASTA stands for Partial Articular-sided Supraspinatus Tendon Avulsion. It occurs when the undersurface of the supraspinatus tendon tears from the greater tuberosity. This type of tear can only be seen from inside the joint since the outer portion of the tendon is still intact. Although this is not a full thickness tear, it can cause significant pain and weakness of the shoulder. There are arthroscopic options for fixing this problem, allowing for an accelerated recovery.
We use an arthroscopic technique to repair the torn tendon. We place bone anchors with sutures that secure the torn tendon back to the original position on the bone. The tendon is held there by the suture tape while it heals. It takes about 12 weeks for the tendon to fully adhere to the bone.