The rotator cuff is a wreath of muscles and tendons that surround the top of the upper arm bone (the humerus) and hold it in the shoulder joint.

There are two types of rotator cuff tears:

• Partial, which is a tear that doesn't completely sever the tendon. This type of injury may respond well to nonsurgical treatments. If it does not, surgery may be done.
• Full thickness tears, in which the tendon is torn into two pieces. This type of tear requires surgery to repair.

When conservative care such as rest, anti-inflammatory drugs or physical therapy fail to relieve pain and promote proper healing of a rotator cuff tear, surgery may be needed. More than one approach to surgery is available depending on the size, depth and location of the rotator cuff tear. During these procedures, other problems that may be found can be repaired at the same time.

Surgical options for repairing a torn rotator cuff include:

• Arthroscopy, in which miniature instruments are inserted into small incisions, can be used to remove bone spurs or inflammatory portions of muscle and to repair lesser tears.
• A mini-open repair that combines arthroscopy and a small incision can be used to treat full-thickness tears.
• In more severe cases, open surgery is required to repair the injured tendon. Sometimes a tissue transfer or a tendon graft is used.
• Shoulder joint replacement is also an option for extreme cases.

It takes time to recover from shoulder surgery. It may be six months or more before you are able to fully return to your normal activities. Your doctor will recommend a program of exercises to strengthen and restore motion, including physical therapy. Although every case is unique, surgery can relieve pain for most people and rehabilitation can restore functional range of motion.