Common causes include: 

• Irreparable rotator cuff tears 

• Severe shoulder weakness 

• Nerve-related muscle loss 

• Failed previous tendon repair 

• Loss of specific shoulder movements 

Symptoms include: 

• Difficulty lifting the arm 

• Weakness with reaching or rotating the shoulder 

• Shoulder pain 

• Loss of function during overhead activity 

• Fatigue with arm use 

• Shoulder blade winging 

Non-Surgical Treatment 

Treatment may include: 

• Rest from aggravating activity 

• Ice for soreness after activity 

• Physical therapy to improve the strength and function of nearby muscles 

• Activity modification 

• Pain management strategies 

• Injections in select cases 

Surgical Treatment 

Surgery may be recommended depending on the injury, symptoms, activity level, and response to non-surgical care. Surgical options may include: 

• Tendon transfer surgery: involves moving a nearby tendon to restore a lost shoulder movement. This may include shoulder external rotation, intern al rotation or elevation. This may also be necessary in the case of loss of function of the deltoid muscle or any muscle controlling the shoulder blade. The muscle moved is typically expendable. Tendon transfer surgery can be performed through an open incision or arthroscopically.  

• Combined procedures: in selected cases, tendon transfer may be combined with joint or nerve-related treatment depending on the cause of weakness.