All ruptures of the rotator cuff are not operated.

Indeed in most cases they are well tolerated when they are ‘degenerative’

These degenerative ruptures appeared slowly and gradually and are therefore perfectly asymptomatic for a long time.

These shoulders can become painful by accumulation of inflammation in the subacromial space due to the rise of the humeral head related to the disappearance of the tendon of the cap normally interposed between the humeral head and the acromion.

A work aimed at refocusing the humeral head downwards can completely reduce this inflammation, therefore the pain, in the form of a decoaptation of the humeral head and a toning of the humerus humerus muscles (to be done with caution).

We do not recommend the multiplication of corticosteroid infiltrations on broken caps that can weaken these tendons and decrease the rate of tendon healing in case of repair …

Injections of PRP (platelet-rich plasma) have not yet produced significant results in this indication.

Stopping activities requiring the shoulder is also fundamental when possible (workstation layout, stop DIY activities etc …)

In case of failure the tendon repair is logical later

Traumatic fractures or traumatic decompensation of degenerative fractures are the subject of earlier operative indications in young and active subjects, especially in the absence of co-morbidities that are unfavorable to tendon healing (smoking, diabetes, etc.).


A ‘rupture’ (in fact lesion) tendon is not necessarily synonymous with surgery, unlike minor or invisible lesions on imaging can explain significant pain and require repair.

Therapeutic indications depend on different criteria:

• the age of the patient, his activity or profession, his field (smoker, diabetes or other diseases)
• repairable or irreparable nature of the rupture (size, retraction, ascension of the humeral head, durable pseudoparalysis ..)
• muscle trophicity and degree of fatty degeneration
• motivation and socio-professional context
• result of pre-operative rehabilitation

Rehabilitation is prescribed almost systematically from the diagnosis of injury to 2 to 3 times a week. After 15 to 30 sessions, this functional treatment can result in a painless shoulder with complete mobility, stopping any surgical procedure.

If surgical repair is decided it is essential that the shoulder has complete passive mobility. Rehabilitation is an adjuvant often necessary or even mandatory preoperatively. Rehabilitation aims to increase the space under acromial and thus avoid contact between the tendon and the acromion and relax the shoulder.