I am so glad you asked.  The rotator interval is the part of the shoulder that consists of the front part of the supraspinatus cuff tendon, the biceps long head’s exit point from the shoulder, and the upper 1/3 of the subscapularis front cuff tendon, all of which are covered by the insertion site for a structure called the coracohumeral ligament.  This area is where most cuff tears start and symptoms often present with biceps long head pain, often down to the elbow.  Tears start here because we live our lives with our shoulders forward and to the side, whether working out with weights or using our computer’s mouse.  This area also is the most complicated area of the shoulder with a pulley to hold the biceps in place, as well as having the insertion of the two cuff tendons in a very small space.  It has become very popular to cut the biceps tendon long head and reattach it lower down the arm, but I do not subscribe to that approach.  My preference, with a normal biceps long head tendon, is to repair the pulley and subscapularis.

The following are a photos from inside a left shoulder and a drawing of the same area from outside a left shoulder.

Tears in this area of the shoulder are very common and failure of this problem to have been addressed with prior surgery is by far the most frequent source of post operative discomfort I see when giving second opinions.

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