How are rotator cuff tears treated?

The "rotator cuff" is actually made up of 4 tendons—the tissue that attaches muscles to bone. When you hear the term "rotator cuff tear" it can mean many different things. A "partial rotator cuff tear" is typically an age-related change that is a very frequent finding on MRI and may not have much clinical significance (many people with no symptoms in their shoulder over the age of 40 will have "positive findings" on an MRI and so we have to be careful about correlating symptoms with MRI findings!).

If you have a symptomatic "partial tear" this is often treated successfully without the need for surgery. This includes instruction in home exercises, physical therapy, anti-inflammatory medicines, and occasionally a cortisone injection if the pain persists. The pain actually comes from associated "bursitis" not usually from the rotator cuff "tear" itself. The bursa is a fluid-filled sac that sits on top of the rotator cuff and is designed to help with smooth, gliding motion (we have bursa all over our body including the hip, knee, shoulder, elbow, etc...). When the bursa gets inflamed we call it "bursitis".

If you have a full thickness tear (tendon detached from bone) this will more often lead to the recommendation of surgery especially if you suffer an acute tear following trauma for example. Many surgeons perform rotator cuff repairs all arthroscopically today and this does minimize the associated trauma to the shoulder but does NOT change the time for healing and recovery. In fact, in many situations you will be asked to delay the onset of post-operative rehabilitation for 4-6 weeks if you have an arthroscopic large or massive rotator cuff repair to decrease the risk of re-tearing.

An important issue to keep in mind is that unfortunately rotator cuff tearing is associated with age-related degenerative changes meaning that you may have a rotator cuff tear and not even know it (especially as we progress beyond the 5th and 6th decades). This is sometimes very frustrating for patients and orthopaedic surgeons to discover that a patient who had no prior symptoms comes in and has a massive (sometimes irreparable) rotator cuff tear. When in doubt, you should always seek medical attention for pain around the shoulder and especially if you notice any associated weakness in the arm.

Rotator cuff tears are treated according to the size, location and chronicity of the tear. A partial tear may not require a repair, but a simple debridement (trimming) of torn tissue. A complete tear requires reattaching the torn tendon back to the humerus (upper arm bone). This is typically done with suture anchors, where an anchor is placed in the bone and the suture attached to the anchor is then looped around the torn edge of the tendon. The tendon is then positioned back to the bone and tied in place.

Both debridements and repairs are typically done arthroscopically. However, for very large rotator cuff tears, an open incision may be required for optimal visualization.