Rotator Cuff Tear
Treatment

In most cases, the initial treatment involves:

• Rest: If the tear is due in part to overuse, resting the shoulder may help.
• Nonsteroidal Anti-inflammatory Medications: These medications are used to help control pain.
• Strengthening and Stretching Exercises: Exercise may be recommended as part of a physical therapy program.
• Corticosteroid Injections: Corticosteroids can help reduce pain but cannot be repeated frequently because they can weaken the tendon.
• Ultrasound: Ultrasound can enhance the delivery of drugs applied topically or on the skin and has thermal effects that may help in the healing process.

Surgery

There are several surgical options to treat rotator cuff tears, depending on its size, depth and location. If other problems with the shoulder are discovered during the surgery, they will be corrected as well.

The three main options for surgical repair are:

• "Open" Surgery: This is conventional surgery involving a five-inch incision on the front of the shoulder. The bone spur on the undersurface of the joint is removed and the cuff is attached to the upper arm bone using stitches and holes drilled in the bone.
• "Mini-Open" Repair: This procedure involves a smaller, two-inch incision.
• Arthroscopy: This is minimally invasive surgery involving small instruments inserted through several small Band-Aid size incisions. "Bone anchors" are placed in the upper arm bone and used to help attached the cuff with stitches. The anchors are made of either metal, plastic or a special material that your body absorbs over time.

Shoulder Replacement

If you have a degenerative condition such as arthritis or a serious shoulder injury, you may require joint replacement to relieve pain and regain good use of your shoulder. There are two primary types of joint replacement procedures — total shoulder replacement and reverse shoulder replacement.

Total Shoulder Replacement

Total shoulder replacement surgery replaces your shoulder's damaged bone and cartilage with a metal and plastic implant. The shoulder is a ball-and-socket joint, much like the hip joint. The ball is the top of the arm bone, or humerus, and the socket is within the shoulder blade, or scapula.

During shoulder replacement surgery, the ball is removed from the top of the humerus and replaced with a metal implant. This is shaped like a half-moon and attached to a stem inserted to the center of the arm bone. The socket portion of the joint is then replaced with a plastic socket that is cemented into the scapula.

The procedure takes about two hours. Preparation before the operation and the recovery after may take several additional hours. Patients often spend two hours in the recovery room and two to three days in the hospital after surgery.

Reverse Shoulder Replacement

Reverse shoulder replacement is a newer procedure developed for patients whose rotator cuff can't be repaired to support or stabilize the conventional joint replacement.

A reverse shoulder replacement switches the position of the ball and socket so that the ball is attached to the scapula or shoulder bone and the socket is attached to the humerous or the top of arm bone. By reversing the ball and socket, the ball can be supported by the shoulder muscle or deltoid, the muscle that forms the rounded contour of the shoulder, rather than the rotator cuff.

This procedure — approved by the U.S. Food and Drug Administration (FDA) in 2004 — is more complex and is performed at major medical centers such as UCSF Medical Center.

Recovery after surgery typically requires a two-day hospital stay. You must wear a sling for about six weeks to minimize movement and then undergo physical therapy, including range of motion exercises. Recovery typically takes six to eight months.

Reviewed by health care specialists at UCSF Medical Center.
Last updated May 24, 2012