Treatment Options for Rotator Cuff Tears

Limited movement

Even small shoulder and arm movements, like combing your hair, putting on a coat, or lifting groceries, may be difficult and can hurt.

Pain

The pain can range from mild, to moderate, to sharp. You may feel pain on top of and in front of your injured shoulder. The pain may spread down the outside of your upper arm. You may feel more pain at night, especially when you are lying on the injured shoulder.

Swelling

Swelling from inflammation is your body’s natural response to injury. Sometimes this swelling is inside of your body and you cannot see it. This swelling is the most common cause of your pain.

Cracking and stiffness

You may hear clicking, cracking, or popping sounds when you move your shoulder, especially when lifting something heavy.

Which treatment should I choose?

Many of these non-surgical treatments have been shown to help improve pain, weakness, and arm movement. However, there is not much information about which treatment type is better than the other.

Your doctor or health care provider may use several of these treatments at the same time to help you.

There is also not enough research to know how these treatments compare with surgery in improving the use of your rotator cuff.

Your role in treatment

You play an important role in your recovery. Be sure to follow the instructions from your doctor or other health care provider, keep your therapy appointments, and do your home exercises. Talk to your doctor about what to expect during treatment and when you should start feeling better.

How long do I wait before choosing surgery?

There is not enough information from studies to answer this question. Your doctor or health care provider may explore your options with you based on the type and size of your tear and how long you have had the injury. Physical therapy may be enough to help improve the pain and weakness, or surgery may be a better treatment choice. In some cases, surgery is used when physical therapy does not improve symptoms.

How is the rotator cuff repaired during surgery?

In most cases, a surgeon uses stitches to connect the torn edges of the muscle or tendon back together or to connect the tendon back to the ball of your humerus. This is called “rotator cuff repair.”

In addition, your doctor may consider two other surgical treatments:

• Removing loose fragments of tendon or damaged bone or cartilage that may be lodged in the joint. This is called “debridement” (pronounced dee-BREED-ment).
• Removing some of the bone underneath the shoulder blade, or some of the tissue between the bones (called “ligaments”) in your shoulder joint to give the tendon more room to move your arm freely. This is called “acromioplasty” (pronounced ah-KROM-ee-o-plast-ee).

Three types of surgery

• Arthroscopic surgery: The surgeon makes very small openings (cuts) into the muscles of your shoulder and uses a device called an “arthroscope” (a small tube attached to a camera and tiny surgical instruments) to repair the tear.
• Open surgery: The surgeon makes a larger opening into the muscles of your shoulder and repairs the tear with regular surgical instruments.
• Mini-open surgery: The surgeon uses an arthroscope for the first part of the surgery, and then makes an opening large enough to use other surgical instruments for the repair. The opening does not have to be as big or affect the muscle as much as with open surgery.

What type of surgery should I choose?

Research found that:

• There is no difference between the open, mini-open, and arthroscopic types of surgery in the improvement of shoulder function. They all work about the same. However, arthroscopic surgery usually requires less recovery time.
• A few studies found that:
  • Some patients who had mini-open surgery returned to work or sports about 1 month sooner than those who had open surgery.
  • Some patients who had open repair surgery had better improvement of their shoulder function than those who had arthroscopic debridement (removing loose tendon, bone, or cartilage fragments that are lodged in the joint) without repair of the tear.
  • The results for the patients who had arthroscopic surgery with or without acromioplasty (creating more space in the joint by removing some bone or tissue) were about the same.

Is surgery safe?

All surgeries come with some risk. You and your doctor can decide what risks may exist for you based on your overall health. Rotator cuff surgery is safe for most people. The most common problems are infection and re-tears.

What type of treatment should I have after my surgery?

Although most doctors agree that you should have rehabilitation therapy after your surgery, there is not enough evidence to tell you which type is best. Talk to your doctor or health care provider about what kind of rehabilitation therapy is best for you.

Ask your doctor

1. Given my tear, what benefits and harms for using non-surgical or surgical treatments should I consider?
2. If I need surgery, given my tear and my other medical conditions, which surgery (open, mini-open, or arthroscopic) do you think would be best for me?
3. What type of treatment will I need after surgery?
4. How long do you think it will take me after treatment to return to my activities?
5. Will these treatments help my rotator cuff for many years?
6. When should I expect my pain and other symptoms to feel better?

Other questions for your doctor:

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