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The human shoulder is considered to be the body’s most flexible joint since it enables rotation of the joint in all directions. ‘‘Responsible’’ for raising and rotating the arm are four tendons (the supraspinatus, infraspinatus, teres minor and subscapularis tendons) which constitute the rotator cuff.
Due to this mechanism, approximately 2 million men and women, in 2013 and in the US alone, had to visit an orthopedist complaining of shoulder pain. The pain could be attributed to a broad spectrum of causes, from acute tendonitis to tendon tears. In fact, rupture of the rotator cuff tendons is a common shoulder injury in the worldwide general population aged 40 and older.  

Conventional treatment is usually recommended in cases of partial-thickness rotator cuff tears. However, the anatomic contiguous structure is generally repaired surgically, particularly in the cases of acute rotator cuff tears, symptoms that last over 3 months, tears that are larger than 2-3 cm, significant loss of function in the shoulder, or patients with high functional demands, for example athletes.

The repair of rotator cuff tendons in their anatomical position with the use of plastic or metal ‘‘anchors’’ can be performed either by open surgery or arthroscopically. The appropriate treatment option is selected by the surgeon in relation to the patient’s age, level of physical activities and functional demands.
Arthroscopy, which is performed through small incisions, has the advantage of ensuring the deltoid muscle remains intact, repairing intra-articular injuries, as well as reducing postoperative pain. On the other hand, in cases of large rotator cuff tears or when additional reconstruction is required, such as tendon transfers, open surgery is considered the suitable option which allows the surgeon to treat the injury in a more effective way. The ‘‘middle-ground’’ is a mini-open surgery: Injuries inside the joint are evaluated and treated arthroscopically (for example removal of osteophytes), followed by a small incision through which the damaged rotator cuff is repaired.
In cases of chronic rotator cuff tears due to muscle degeneration, assistance for the repair of the rotator cuff might be necessary with the use of growth factor therapy or stem cells, autologous therapies which stimulate the body’s own healing process. 

In relation to the type of rotator cuff tear, the repair treatment and the functional demands, the patient may attain a desirable outcome in a period of 3 to 6 months. Postoperatively, the patient must follow a rehabilitation program that includes physiotherapy, kinesiotherapy as well as muscle strengthening exercises. Immediate mobilization of the joint is normally recommended in order to avoid a permanently stiff joint and regain normal joint function.

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