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A rotator cuff tear is a common cause of pain and disability in the adult population. The rotator cuff is made up of 4 muscles and their tendons. These combine to form a "cuff" over the upper end of the arm (head of the humerus). The 4 muscles - supraspinatus, infraspinatus, subscapularis, and teres minor - originate from the "wing bone" (scapula), and together form a single tendon unit. This inserts on the greater tuberosity of the humerus. The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint.

Most tears occur in the supraspinatus but other parts of the tendon may be involved.

Once a diagnosis of rotator cuff tear has been made, your orthopaedic surgeon will recommend the most effective treatment. In many instances, nonsurgical treatment can provide pain relief and can improve the function of your shoulder.

Treatment options may include:

• Rest and limited overhead activity
• Use of a sling
• Anti-inflammatory medication
• Steroid injection
• Strengthening exercise and physical therapy

It may take several weeks or months to restore the strength and mobility to your shoulder.

Your orthopaedic surgeon may recommend surgery if nonoperative treatment does not relieve your symptoms. Surgery may also be considered if the tear is acute and painful, if it is the dominant arm of an active individual or if you need maximum strength in your arm for overhead work or sports.

The type of surgery performed depends on the size, shape and location of the tear. A partial tear may require only a trimming or smoothing procedure called a "debridement." A complete tear within the substance of the tendon is repaired by suturing the two sides of the tendon. If the tendon is torn from its insertion on the greater tuberosity of the humerus, it can be repaired directly to bone.

Many surgical repairs can be done on an outpatient basis.

In the operating room, your surgeon may remove part of the front portion of the scapula, the acromion as part of the procedure. The acromion is thought to cause "impingement" on the tendon. This may lead to a tear. Other conditions such as arthritis of the AC joint or tearing of the biceps tendon may also be addressed.

In general, three approaches are available for surgical repair. These include :

Arthroscopic Repair. A fiberoptic scope and small instruments are inserted through small puncture wounds instead of an open incision. The scope is connected to a television monitor and the surgeon can perform the repair under video control.

Mini-Open Repair. Newer techniques and instruments allow surgeons to perform a complete rotator cuff repair through a small incision, typically 4 to 6 centimeters.

Open Surgical Repair. A traditional open surgical incision is often required if the tear is large or complex or if additional reconstruction, such as a tendon transfer, has to be done. In some severe cases, where arthritis has developed, shoulder replacement is an option.

Your surgeon will recommend which technique is best for you.