Subacromial decompression consists of removal of a small portion of the bone (acromion) that overlies the rotator cuff, aiming to relieve pressure on the rotator cuff in certain conditions and promote healing and recovery. Although subacromial decompression may be beneficial in the management of partial and full-thickness tear repair, this procedure does not physically repair the tear and arthroscopic decompression has more recently been combined with “mini-open” repair of the rotator cuff, allowing for the repair of the cuff without disruption of the deltoid origin. Decompression alone tends to degrade with time, but the combination of repair and decompression appears to produce better results.

A complete full-thickness tear, involves tissue suture. The method currently in favor is to place an anchor in the bone at the natural attachment site, and resuture the torn tendon to the anchor. If the tissue quality is poor, mesh (collagen, Artelon or other degradable material) may be used to reinforce the repair. The repair can be performed through an open incision, again requiring detachment of a portion of the deltoid. The mini-open technique approaches the tear through a deltoid splitting approach. This seemingly causes less damage to the deltoid muscle and may produce better results. Modern techniques now use an all arthroscopic approach. Surgical recovery can take as long as three–six months, with a sling being worn for the first one–six weeks.^[34] Furthermore, in some severe cases where arthritis has developed, one option is to replace the shoulder joint, but these represent a small minority of cases.