Overview
The rotator cuff is a group of four muscles and tendons—the supraspinatus, infraspinatus, teres minor, and subscapularis—that surround the shoulder and are essential for normal shoulder strength and function. Most rotator cuff tears develop gradually over time as continued shoulder impingement and age-related degeneration weaken the tendon. Tears may also occur after an injury, often in a tendon that has already begun to degenerate. They may be partial-thickness or full-thickness tears. A rotator cuff tear will not heal on its own. Over time, many tears enlarge, the tendon retracts, the muscle weakens, and repair becomes more difficult.
Presentation
Patients typically present with pain, weakness, and loss of function, especially during overhead activities or when reaching away from the body. Night pain is very common and often interferes with sleep. During the examination, I often explain that the tendon is either sore, tearing, or torn, and that an MRI is usually needed to determine exactly where it falls on that spectrum. Symptoms may improve after a complete tear even though the tendon remains torn. Unfortunately, the tear may continue to enlarge silently, making later repair more difficult or impossible.
Conservative Treatment
Initial treatment may include activity modification, maintaining shoulder range of motion, rotator cuff strengthening, and physical or occupational therapy. Corticosteroid injections are used more selectively because repeated injections may negatively affect tendon quality and healing. Some older patients with small, minimally symptomatic tears may be observed without surgery.
Surgical Treatment
For most healthy and active patients with a full-thickness tear or a significant partial-thickness tear, surgical treatment is recommended. I perform repairs arthroscopically through several small incisions called portals. Through these portals, a camera and specialized instruments are used to repair the torn tendon. The tendon is reattached to the bone using absorbable anchors. Selected patients may also benefit from a rotator cuff patch. The repair itself often takes 10–15 minutes as part of a procedure lasting approximately 45 minutes.
Recovery
Patch-only procedures often allow shoulder use within 1–2 weeks. Full-thickness repairs require approximately six weeks of no active shoulder use while the tendon heals to bone, although the elbow, wrist, and hand may be used immediately. Passive therapy generally begins 1–2 weeks after surgery, while some larger tears require delayed therapy.
Rotator cuff repair has a high success rate. The smaller the tear and the earlier it is repaired, the greater the chance of complete healing. Even many large tears achieve excellent outcomes when treated in a timely manner.