7 December: Q&A with Mr Balanchandran Venkateswaran

My questions relate to the repair of a shoulder injury, specifically a massive rotator cuff tear. I've read that the way to obtain movement and relieve the pain is to transfer the latissimus dorsi muscle by disconnecting and raising the tendon to anchor it at the top of the shoulder, to support the injured joint.

My questions are: how is the latissimus dorsi tendon anchored to the shoulder? Where is the point of anchor? Does the tendon repair react similarly to a bone fracture, where calcium is formed and becomes as one? How soon can sporting activity be safely recommenced after surgery, such as tennis, golf and cricket?

Mr Balanchandran Venkateswaran, Consultant Orthopaedic Shoulder and Elbow Surgeon, Spire Leeds Hospital

The questions raised are very specific but before we get to that level of detail, it has to be understood that management of massive rotator cuff tears differs for every individual and their particular circumstances. If treated very early a massive rotator cuff tear can usually be repaired either arthroscopically or through open surgery. The earlier the repair is done the better it is for the recovery of the muscle. With delay the muscle belly undergoes what we call a fatty infiltration (i.e. it turns into fat), which is an irreversible process, and the rotator cuff becomes irreparable.

The latissimus dorsi transfer can be used in some circumstances to treat an irreparable rotator cuff tear. The latissimus dorsi muscle is rooted into the shoulder and is attached to the greater tuberosity (i.e. the top of the arm bone) where it attaches itself. Tendons heal onto the bone with a bone tendon interface, which is a soft tissue healing rather than a bony healing.

The results of latissimus dorsi transfer are not generally as good as a straight forward repair of the tear.  Quite often the functional improvements are only marginal. However with good physiotherapy afterwards, it may be possible to return to some sport.

Before any action is taken, the patient with the massive rotator cuff tear should be assessed by an experienced specialist clinician.

Find a treatment, test or scan available at:


Find a consultant

Use one or more of the options below to search for a consultant and link through to view their Spire profile.


Let us help you

fill out this form and we will get back to you:

Please select a hospital

We can call you

Please enter your details below and we will call you back.

What is the aim of your enquiry?

Please select a hospital

If we are unable to reach you by phone, please include your email address so that we can get in touch...

Mr Balanchandran Venkateswaran

Mr Balanchandran Venkateswaran, Consultant Orthopaedic Shoulder and Elbow Surgeon, Spire Leeds Hospital

What's up Doc? is brought to you in association with

The material published on this page is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.

Click here for the full What's Up Doc? Consultant Q&A archive

© Spire Healthcare Group plc (2016)