Most rotator cuff disorders are treated without surgery. But surgery may be considered if the injury is very severe. Surgery also may be recommended if the shoulder does not respond well after 3 to 6 months of nonsurgical treatment (rest, ice or heat, use of nonsteroidal anti-inflammatory drugs, and physical therapy).

Rotator cuff problems: Should I have surgery?

Surgery for rotator cuff disorders is done to:

• Repair tendon tears and smooth the underside of the upper point of the shoulder blade (acromion ) to make more room for the tendon and bursa.
• Restore strength and use of the shoulder.

Surgery may be a good first choice for shoulder weakness caused by complete tears, especially when the rotator cuff is otherwise healthy (little or no degeneration). Surgery may be considered if you have severe pain and loss of shoulder function that has not responded to appropriate nonsurgical treatment. Surgery focuses on creating a smooth passage for the tendon and bursa beneath the acromion.

You may regain more of your shoulder strength and movement after an acute tear if it is repaired soon after the injury. And small tears are easier to repair and are more likely to heal than large tears. If surgery is delayed, repair of a large tear may not be as successful, but damaged tissues can still be removed and pressure on the tendon and bursa reduced. This usually relieves pain and restores enough strength for you to do routine, nonstrenuous activities.

Rehabilitation after surgery (home treatment and physical therapy) is important to the success of surgery. People who are not willing or able to commit themselves to the rigors of physical rehab may not do as well after surgery.

Surgery Choices

Shoulder surgery for rotator cuff disorders usually involves one or more of the following procedures:

Subacromial smoothing

Rotator cuff repair

These procedures may be done arthroscopically, by traditional open surgery, or by a combination of the two approaches.

What To Think About

Both arthroscopic surgery and open surgery can be effective. Your surgeon may be more comfortable with one of the methods.

• Open surgery is the traditional type of surgery for rotator cuff disorders.
• Arthroscopic debridement and smoothing to repair the rotator cuff is becoming more common.
• A combination of open surgery and arthroscopy may allow your doctor to split rather than cut the shoulder muscle (deltoid) during open surgery, so you may have a less difficult recovery.

The success of surgery for rotator cuff tears depends on many things, such as:

• The amount of degeneration present.
• Your age.
• Other medical conditions. Some medical conditions may cause you to heal slower.
• Your recovery goals and commitment to and compliance with a physical rehabilitation program.
• Whether you smoke, because smoking decreases the blood supply throughout the body and slows the healing process.