A torn rotator cuff is a common injury affecting the shoulder, which is a complex ball-and-socket joint. The rotator cuff is a group of four muscles and their tendons that surround the head of the upper arm bone, holding it securely in the shoulder socket and enabling arm rotation and lifting. A tear occurs when one or more of these tendons is damaged or detached from the bone. Tears range from partial-thickness, where the tendon is frayed but not completely severed, to full-thickness, where the tendon is split. Because a tear can lead to significant pain, weakness, and limited mobility, intervention is necessary to restore function.
Immediate Steps for Pain Relief
Managing acute pain and inflammation is the first priority following a rotator cuff injury. The initial strategy focuses on conservative, short-term home care to calm the irritated tissues. This approach begins with immediate rest and activity modification to prevent further strain on the injured tendon.
Resting the shoulder means avoiding overhead movements, heavy lifting, and any activity that causes a sharp increase in pain. Applying ice to the affected area for 15 to 20 minutes at a time, several times a day, reduces acute pain and local swelling. Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, help manage the inflammation and discomfort. Using a sling temporarily may be recommended by a doctor to immobilize the shoulder, taking pressure off the joint.
Non-Surgical Medical Interventions
When immediate home care is not sufficient, or for tears that do not involve a complete detachment, medical professionals recommend a structured course of non-surgical treatments. The most effective non-surgical treatment is a formal physical therapy (PT) program. A therapist creates an individualized rehabilitation plan with the primary goals of improving the shoulder’s range of motion and strengthening the surrounding musculature.
Physical therapy focuses on restoring flexibility and building strength in the muscles that stabilize the shoulder joint. This strengthening helps to improve function and compensate for the torn tendon. If pain or inflammation is severe enough to hinder participation in physical therapy, a corticosteroid injection may be considered. Corticosteroids are powerful anti-inflammatory agents that provide temporary pain relief. However, these injections do not repair the tear itself and are limited in frequency because repeated use can potentially weaken the tendons.
Considering Surgical Repair
Surgical intervention is reserved for specific injury patterns or when conservative treatment options have failed to provide adequate relief after an extended period, often 6 to 12 months. Surgery is necessary for most full-thickness tears, especially in younger patients or those whose tear resulted from a single, acute trauma. The goal of surgery is to reattach the torn tendon directly to the head of the humerus (upper arm bone).
The two most common surgical techniques are arthroscopic and open repair. Arthroscopic repair is a minimally invasive procedure where the surgeon uses a tiny camera and specialized instruments inserted through small incisions. This approach is preferred for smaller tears due to reduced tissue damage, less post-operative pain, and a faster initial recovery. Open repair involves a larger incision and is reserved for more complex cases or massive tears. Surgery requires extensive rehabilitation to regain full function.
Long-Term Recovery and Strengthening
Long-term rehabilitation is the most substantial phase in regaining full shoulder function, whether recovery follows non-surgical treatment or post-operative repair. Recovery is structured into specific phases designed to progress gradually, allowing the tendon time to heal while slowly increasing the load on the surrounding muscles. The initial phase, often lasting several weeks, focuses on protection and passive range of motion, where the arm is moved gently by a therapist or the non-affected arm.
The subsequent phase introduces active range of motion, where the patient begins to move the arm without assistance, followed by the strengthening phase. Strengthening exercises begin with low-impact movements like isometric exercises, where the muscle is contracted without moving the joint, and gentle resistance work using light resistance bands. Consistency is important in this final phase, often continuing for 12 to 18 months, as the goal is to build long-term stability and strength to prevent future re-injury. The program progresses to heavier resistance and functional training, ensuring the shoulder can withstand the demands of daily life and physical activities.