Surgery may be used to treat a
rotator cuff disorder if the injury is very severe or
if nonsurgical treatment has failed to improve shoulder strength and movement
The rotator cuff is a group of four tendons and the related muscles
that stabilize the
shoulder joint and allow you to raise and rotate your arm. The shoulder is a
ball-and-socket joint with three main bones: the upper arm bone (humerus), the
collarbone (clavicle), and the shoulder blade (scapula). These bones are held
together by muscles, tendons, ligaments, and the joint capsule. The rotator
cuff helps keep the ball of the arm bone seated into the socket of the shoulder
The spine, or backbone, is made up of small bones (vertebrae) stacked -- along with discs -- one on top of another. A healthy spine when viewed from the side has gentle curves to it. The curves help the spine absorb stress from body movement and gravity.
When viewed from the back, the spine should run straight down the middle of the back. When abnormalities of the spine occur, the natural curvatures of the spine are misaligned or exaggerated in certain areas, as occurs with lordosis, kyphosis, and...
Surgery to repair a torn rotator cuff tendon usually
Removing loose fragments of tendon, bursa, and
other debris from the space in the shoulder where the rotator cuff moves (debridement).
Making more room for the
rotator cuff tendon so it is not pinched or irritated. If necessary, this
includes shaving bone or removing bone spurs from the point of the shoulder
blade (subacromial smoothing).
Sewing the torn
edges of the supraspinatus tendon together and to the top of the upper arm bone
In open shoulder surgery, a surgeon makes an incision [2 in. (5 cm) to
3 in. (7.6 cm)] in the shoulder
to open it and view the shoulder directly while repairing it. A smaller
incision can be done with a mini-open procedure that allows the surgeon to
reach the affected tendon by splitting the deltoid muscle. This method may
reduce your chances of problems from a deltoid injury.
Open-shoulder surgery often requires a short stay in the
Discomfort after surgery may decrease with taking pain medicines
prescribed by your doctor.
The arm will be protected in a sling for a defined period of time,
especially when at risk of additional injury.
Physical therapy after surgery is crucial to a successful recovery.
A rehabilitation program may include the following:
As soon as you awake from anesthesia, you may
start doing exercises that flex and extend the elbow, wrist, and
The day after surgery, if your doctor allows,
passive exercises that move your arm may be done about 3 times a day (a machine
or physical therapist may help the joint through its range of
Active exercise (you move your arm yourself) and
stretches, with the assistance of a physical therapist, may start 6 to 8 weeks
after surgery. This depends on how bad your tear was and how complex the
surgical repair was.
Strengthening exercises, beginning with light
weights and progressing to heavier weights, can start a few months after
Why It Is Done
Surgery to repair a rotator cuff is done when:
A rotator cuff tear is caused by a sudden
injury. In these cases, it's best to do surgery soon after the
A complete rotator cuff tear
causes severe shoulder weakness.
The rotator cuff has failed to
improve with 3 to 6 months of conservative nonsurgical treatment alone (such as
You need full shoulder strength and function for
your job or activities, or you are young.
You are in good enough
physical condition to recover from surgery and will commit to completing a
program of physical rehabilitation.
How Well It Works
Rotator cuff repair surgery for a tear from a sudden injury works
best if it is done within a few weeks of the injury. But repairs of very large
tears are not always successful.1
Rotator cuff surgery to repair frayed or thinned tendon tissue is
less likely to work than surgery to repair an injury to a healthy
In addition to the risks of surgery in general, such as blood loss
or problems related to anesthesia, complications of rotator cuff surgery may
Infection of the incision or of the shoulder
Pain or stiffness that won't go away.
the deltoid tendon or muscle (if the deltoid is detached, additional surgery
may be needed to repair it).
The need for repeated surgery
because tendons do not heal properly or tear again.
Very large tears [greater than
2 in. (5 cm) or involving more
than one rotator cuff tendon] often cannot be repaired.
Grafting and patching procedures are possible, but
they are not much better at restoring strength than debridement and smoothing,
which are less risky and require less rehabilitation.
Less active people (usually those older than 60) with confirmed
rotator cuff tears that do not cause pain, significant weakness, or sleep
problems can safely go without surgery unless symptoms get worse.
Some people who do not have surgery to repair
severe rotator cuff tears develop cuff tear arthropathy, a condition of
arthritis, pain, and significant loss of strength,
flexibility, and function.
In some cases, arthroscopic debridement
and smoothing adequately relieves pain and restores enough function to allow
daily activities, and open surgery is not necessary.
Andrews JR, ed. (2005). Impingement syndrome,
Procedure-subacromial bursa injection, Overhead throwing shoulder, and Rotator
cuff tears sections of Shoulder. In LY Griffin, ed., Essentials of Musculoskeletal Care, 3rd ed., pp. 188-193. Rosemont, IL: American
Academy of Orthopaedic Surgeons and American Academy of Pediatrics.
Beasley VidalLS, et al. (2007). Shoulder injuries. In
PJ McMahon, ed., Current Diagnosis and Treatment in Sports Medicine, pp. 118-145. New York: McGraw-Hill.
Other Works Consulted
Devinney DS, et al. (2005). Surgery of shoulder
arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp. 995-1015. Philadelphia:
Lippincott Williams and Wilkins.
Husni EM, Donohue JP (2005). Painful shoulder and
reflex sympathetic dystrophy syndrome. In WJ Koopman, LW Moreland, eds.,
Arthritis and Allied Conditions, 15th ed., vol. 2, pp.
2133-2151. Philadelphia: Lippincott Williams and Wilkins.
Lin KC, et al. (2010). Rotator cuff: 1. Impingement lesions in adult and adolescent athletes. In JC DeLee et al.,
eds., DeLee and Drez's Orthopaedic Sports Medicine, Principles and Practice, 3rd ed., vol. 1, pp. 986-1015. Philadelphia: Saunders Elsevier.