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Man sitting in the gym and holding shoulder in pain

The rotator cuff consists of a group of muscles and tendons that encompass the shoulder joint to form a covering around the head of the humerus. The rotator cuff attaches the humerus to the shoulder blade and allows us to lift and rotate our arm. We depend on our rotator cuff to be strong and healthy in order to perform daily activities.

The rotator cuff is instrumental in maintaining shoulder strength and range of motion, so when it is injured or torn, it can greatly impair function and negatively impact quality of life. Common injuries to the rotator cuff include tendinitis, partial tears and full-thickness tears (complete tears).

Rotator Cuff Tear Symptoms

There are four tendons and muscles that make up the rotator cuff:

  • Infraspinatus tendon: Located behind the supraspinatus tendon
  • Subscapularis tendon: Located at the front of the shoulder
  • Supraspinatus tendon: Located on the top of the shoulder, this is the most commonly injured tendon in the rotator cuff
  • Teres minor tendon: Located at the back of the shoulder

If you experience any of the following symptoms, see a Penn orthopaedic specialist to be evaluated for a rotator cuff injury:

  • Shoulder pain while resting or at night
  • Shoulder pain when moving your arm in specific motions or pain while lifting or lowering your arm
  • Dull, aching pain in the shoulder
  • Shoulder weakness
  • Popping or crackling sensation that accompanies shoulder movement

Diagnosing Rotator Cuff Tears

To diagnose a rotator cuff injury or a possible rotator cuff tear, a Penn orthopaedic specialist will evaluate your symptoms, take a full medical history. and examine your shoulder and arm to assess your range of motion and how much pain you have.

Your doctor will likely order one or more of the following advanced imaging tests to diagnose a rotator cuff tear and determine the extent of the damage:

  • X-ray
  • MRI
  • Musculoskeletal ultrasound
  • CT scan

Musculoskeletal radiologists who specialize in soft tissue tears carefully review the imaging to determine the severity of your condition and whether it is tendinitis, a partial tear or a full-thickness tear (a complete tear) so you can receive the best possible treatment.

Rotator Cuff Treatment

If you have been diagnosed with a rotator cuff injury or tear, it is imperative that you begin treatment right away to avoid further degeneration and to strengthen the area as much as possible. Nonsurgical treatment for rotator cuff injuries and tears includes:

  • Activity modification
  • Anti-inflammatory medication
  • Icing or heat application
  • Injections (corticosteroid)
  • Pain management techniques
  • Physical therapy

If non-invasive techniques fail to relieve pain and restore function, or if you have sustained a traumatic rotator cuff tear, surgery may be recommended to repair it.

Rotator Cuff Surgery

When one or more rotator cuff tendons are injured or torn, the tendon does not attach to the head of the humerus. Surgery to repair a torn rotator cuff reattaches the tendon to the head of humerus, restoring function and mobility.

The type of surgery you will need depends on which tendon (or tendons) is torn and the severity of the tear (or tears). Penn orthopaedic specialists have deep knowledge and expertise in surgically treating every type of torn rotator cuff, from mild injury to the most complex tears.

In addition to standard repair techniques, we are experts in repairing rotator cuff injuries with acellular dermal grafts and patches, used for soft tissue replacement. These grafts offer treatment for rotator cuff injuries that in the past were considered not repairable.

Our surgeons may need to perform several procedures at the same time to repair your torn rotator cuff. Surgeries we perform to treat torn rotator cuffs include:

Advanced Arthroscopic Techniques

Arthroscopic techniques refer to a procedure where an orthopaedic surgeon makes a small incision in the skin and then inserts a thin instrument that contains a small lens and light that allows the surgeon to see the interior of the joint and repair the torn rotator cuff.

Muscle Transfers

Muscle transfers help to restore function in the shoulder if the rotator cuff muscle has atrophied. A muscle is taken from another area around the shoulder and transferred to substitute for the rotator cuff in order to regain strength and restore function.

Open Tendon Repair

In certain situations, your surgeon may choose to perform open tendon repair. This entails making an incision over the top of the shoulder and moving the muscle out of the way to gain access to torn tendons. Open tendon repair may be a good option if multiple complex procedures need to be performed at the same time.

Reverse Total Shoulder Replacement

In a reverse total shoulder replacement, the anatomy of the shoulder is also replaced, and the socket and the metal ball are switched. A reverse total shoulder replacement may be appropriate for certain types of non-repairable rotator cuff tears. Penn surgeons will assess your rotator cuff tear and determine if a reverse total shoulder replacement is the best option for you.

Rotator Cuff Surgery Recovery

After your surgery, you will need plenty of rest, and your doctor will begin your pain management program. Your shoulder and arm will be immobilized in a sling or wrap, and as you begin to heal you will start a physical rehabilitation program to regain as much strength, range of motion and function as possible.

Personalized Rehabilitation Programs for Rotator Cuff Tears

Recovering from rotator cuff surgery can take up to several months. You will need to follow a rehabilitation and recovery program specific to your condition. Penn physical therapists, orthopaedic specialists and pain management specialists will work together to develop a custom rehabilitation plan that takes into account the type of rotator cuff surgery performed, your unique needs and personal recovery goals. You will engage in a shared decision-making process to ensure you get the best possible long-term outcome.

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