Editing Rotator cuff (section)

=== Surgery ===
Surgical approaches include [[acromioplasty]] (a part of the bone is removed to decrease pressure placed on the rotator cuff tendons), removal of a bursa that is inflamed or swollen, and [[subacromial decompression]] (the removal of tissue or bone that is damaged in order to allow more space for the tendons).<ref name=":0">{{Cite journal|last1=Karjalainen|first1=Teemu V.|last2=Jain|first2=Nitin B.|last3=Page|first3=Cristina M.|last4=Lähdeoja|first4=Tuomas A.|last5=Johnston|first5=Renea V.|last6=Salamh|first6=Paul|last7=Kavaja|first7=Lauri|last8=Ardern|first8=Clare L.|last9=Agarwal|first9=Arnav|last10=Vandvik|first10=Per O.|last11=Buchbinder|first11=Rachelle|year=2019|title=Subacromial decompression surgery for rotator cuff disease|journal=The Cochrane Database of Systematic Reviews|volume=1|issue=1 |pages=CD005619|doi=10.1002/14651858.CD005619.pub3|issn=1469-493X|pmc=6357907|pmid=30707445}}</ref>

Surgery may be recommended for patients with an acute, traumatic rotator cuff tear resulting in substantial weakness.{{Citation needed|date=April 2020}} Surgery can be performed open or arthroscopically, although the arthroscopic approach has become much more popular.<ref name=":0" /> If a surgical option is selected, the rehabilitation of the rotator cuff is necessary in order to regain maximum strength and range of motion within the shoulder joint.<ref name="Brewster93">{{cite journal |vauthors=Brewster C, Schwab DR |title=Rehabilitation of the shoulder following rotator cuff injury or surgery |journal=J Orthop Sports Phys Ther |volume=18 |issue=2 |pages=422–6 |year=1993 |pmid=8364597 |doi=10.2519/jospt.1993.18.2.422 }}</ref> [[Physical therapy]] progresses through four stages, increasing movement throughout each phase. The tempo and intensity of the stages are solely reliant on the extent of the injury and the patient's activity necessities.<ref>{{cite journal |author=Kuhn JE |title=Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol |journal=J Shoulder Elbow Surg |volume=18 |issue=1 |pages=138–60 |year=2009 |pmid=18835532 |doi=10.1016/j.jse.2008.06.004 }}</ref> The first stage requires [[immobilization (pathology)|immobilization]] of the [[shoulder joint]]. The shoulder that is injured is placed in a sling and shoulder flexion or abduction of the arm is avoided for 4 to 6 weeks after surgery (Brewster, 1993). Avoiding movement of the shoulder joint allows the torn tendon to fully heal.<ref name="Brewster93" /> Once the [[tendon]] is entirely recovered, passive exercises can be implemented. Passive exercises of the shoulder are movements in which a physical therapist maintains the arm in a particular position, manipulating the rotator cuff without any effort by the patient.<ref name="Waltrip03">{{cite journal |vauthors=Waltrip RL, Zheng N, Dugas JR, Andrews JR |title=Rotator cuff repair. A biomechanical comparison of three techniques |journal=Am J Sports Med |volume=31 |issue=4 |pages=493–7 |year=2003 |pmid=12860534 |doi=10.1177/03635465030310040301 |s2cid=24737981 }}</ref> These exercises are used to increase stability, strength and range of motion of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles within the rotator cuff.<ref name="Waltrip03" /> Passive exercises include internal and external rotation of the shoulder joint, as well as flexion and extension of the shoulder.<ref name="Waltrip03" />

A 2019 Cochrane Systematic Review found with a high degree of certainty that subacromial decompression surgery does not improve pain, function, or quality of life compared with a placebo surgery.<ref name=":0" />