Surgery Overview

Surgery may be used to treat a torn rotator cuff if the injury is very severe or if nonsurgical treatment has not improved shoulder strength and movement sufficiently.

Surgery to repair a torn rotator cuff tendon usually involves:

• Removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the rotator cuff moves. (This is called debridement.)
• Making more room for the rotator cuff tendon so it is not pinched or irritated. If needed, this includes shaving bone or removing bone spurs from the point of the shoulder blade. (This is called subacromial smoothing).
• Sewing the torn edges of the supraspinatus tendon together and to the top of the upper arm bone (humerus).

Arthroscopic surgery is the most common way that this surgery is done. But in some cases, the surgeon needs to do open-shoulder surgery, which requires a larger incision.

What To Expect

You may reduce discomfort after surgery if you take pain medicines prescribed by your doctor.

Your arm will be protected in a sling for a time.

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 hand.
• A physical therapist or a machine may help move the joint through its range of motion.
• Active exercise (you move your arm yourself) and stretches, with the help of a physical therapist, may start several weeks after surgery. This depends on how bad your tear was and how complex the surgical repair was.
• You'll be taught strengthening exercises a few months after surgery. You'll start with light weights and progress to heavier weights.

Why It Is Done

Surgery to repair a rotator cuff may be done when:

• A rotator cuff tear is caused by a sudden injury. In these cases, it's best to do surgery soon after the injury.
• A complete rotator cuff tear causes severe shoulder weakness.
• It is likely that the rotator cuff tear could worsen.
• You do not have other shoulder problems, such as arthritis.
• The rotator cuff has not improved with several months of conservative nonsurgical treatment alone (such as physical therapy).
• 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 rehab.

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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.^{footnote 1} But repairs of very large tears aren't always successful.

Rotator cuff surgery to repair frayed or thinned tendon tissue is less likely to work than surgery to repair an injury to a healthy tendon.

Risks

Along with the risks of surgery in general, such as blood loss or problems related to anesthesia, complications of rotator cuff surgery may include:

• Infection of the incision or of the shoulder joint.
• Pain or stiffness that won't go away.
• Damage to the deltoid tendon or muscle. (If the deltoid is detached, more surgery may be needed to repair it.)
• The need for repeated surgery because tendons do not heal properly or tear again.
• Nerve or blood vessel damage. (This isn't common.)
• Complex regional pain syndrome. (This is rare.)