The rotator cuff consists of four muscles that attach the ball and socket of the shoulder. These four muscles are attached to bone by the large rotator cuff tendon.
With a rotator cuff injury, the large tendon that connects the four exterior shoulder muscles to bone becomes detached.
For younger patients, a traumatic injury is the main cause of rotator cuff injury. For older patients, rotator cuff tears commonly result from overdoing it during an activity — lifting too much weight, for example.
Most rotator cuff tears cause pain on the outside of the shoulder. With activity, this pain can radiate to the elbow. Pain worsens at night. When you're reaching overhead or lifting, weakness also may occur.
Treatment usually starts with physical therapy to improve range of motion and shoulder strength. Strengthening exercises can rebalance shoulder muscles and decrease pain.
However, rotator cuff tears do not heal naturally. They tend to get larger over time. If exercises don't help, surgery may be necessary.
- Fully torn rotator cuff surgery: The surgeon removes damaged tissue and reattaches healthy tissue through anchors and sutures to the bone called the humerus. Part of the bone that wears against the rotator cuff also is removed.
- Partially torn rotator cuff treatment: The surgeon removes part of the rotator cuff (acromion) is removed. This creates more room for the tendon to glide under the acromion.
- Arthroscopic subacromial decompression: The surgeon removes the far edge of the acromion bone, creating room for the supraspinatus tendon to glide with surrounding muscles.
Physical therapy can start two weeks after rotator cuff surgery to work on passive shoulder motion that won't damage the rotator cuff repair. You shouldn't reach or lift for as long as two months after surgery. Ultimately, the size of the tear and the health of the tendon can play a role in what you'll be able to do after surgery.