The rotator cuff is made up of the muscles and tendons that help you elevate your shoulder (for details, please see the rotator cuff section in my main website). If the rotator cuff becomes damaged enough, a tear may occur. However, not all rotator cuff tears require surgery.
Rotator cuff tears can occur naturally as part of the aging process and may be normal in people aged 60 years or greater. So people who are 60 years or older who haven’t experienced any trauma and who can raise their arms over the head can be treated nonoperatively, at least initially. A steroid injection with a therapeutic strengthening program will decrease pain and other symptoms in roughly 2/3 of these patients. After 3 months, if the pain is not satisfactorily improved, an arthroscopic rotator cuff repair can be considered.
For those younger than 60 years who have had trauma, and especially for those with shoulder weakness or who are unable to elevate their arm, a rotator cuff repair should be performed. I prefer to perform rotator cuff repairs arthroscopically, which decreases postoperative pain and stiffness. The sooner the repair is performed after the rotator cuff tears, the better. If a traumatic tear is not fixed in a timely manner, which is usually a number of months, it can retract, become stiff and the muscles attached to the torn tendon can atrophy and turn to fat.
Arthroscopic rotator cuff repair is performed as an outpatient procedure. If desired, a nerve block can be performed by the anesthesiologist. This involves a needle stick into the area above the shoulder to block all of the nerves going into the arm so that nothing is felt for 12-24 hours. This is optional, and some have it done and some do not. If you don’t have a high pain tolerance you might want to consider getting the block. For those who don’t get the nerve block, I inject morphine into the shoulder joint and perform a single nerve block, which can ‘take the edge off’ of the pain for 8 to 12 hours. Regardless, arthroscopic rotator cuff repairs performed without subacromial decompression (bone removal), are not very painful. As noted on my website’s main section on rotator cuff repairs, the modern literature, including my own original research papers, has shown that removing bone from the acromion is not only unnecessary, but is painful, leads to stiffness and can cause unwanted biomechanical changes in the shoulder.
While the surgery is not very painful, the postoperative course following a rotator cuff repair is highly inconvenient. An abduction pillow, a sling with a pillow on it that is nearly-universally hated, is worn for 6 weeks. There is no ‘active’ arm elevation (ie. using the operated shoulder to lift the arm) for 6 weeks, and no lifting anything heavier than a telephone for 3 months. Please add a ‘2 week penalty’ to all of those time-periods for very large rotator cuff tears, very old rotator cuff tears and revision (redo) rotator cuff repairs. Physical therapy is used depending on how much the patient can do on their own after surgery. Some need a lot of therapy, some hardly any.
The rotator cuff tendons are very slowly healing tissues. It takes about 1-1.5 years before the shoulder feels ‘as good as it’s going to get’. However, when all is said and done, most patients who obey the restrictions and perform their home exercises are much improved and extremely happy with the improvements in their pain relief, strength and shoulder function.