Rotator Cuff Repair
Rotator cuff repair is a surgical procedure used to repair a torn tendon in the shoulder. If the tendon is badly damaged and other treatments like physical therapy or medication haven’t helped, your doctor may recommend surgery.
What are rotator cuff injuries?
A rotator cuff injury often develops over time due to degenerative changes, which is why it is more prevalent in older adults. It typically results from wear and tear or repetitive use of the shoulder, defined by two variations:
Rotator cuff tear
A rotator cuff tear happens when one or more of the tendons in your shoulder are partially or completely torn. This can result from a sudden injury, like lifting something too heavy or falling, or it can develop gradually. Smaller or partial tears may heal with rest and therapy, but more serious full-thickness tears sometimes require surgery, especially if other treatments haven’t worked.
Tendinopathy
Tendinopathy means the tendons in your shoulder have become irritated, inflamed, or worn down. One common cause is shoulder impingement, where the tendons get pinched between the top of your upper arm bone and part of the shoulder blade called the acromion. Over time, this can cause the tendons to fray or tear. In some cases, early treatment, like physical therapy and pain management, is enough to relieve symptoms. But if the condition worsens, your doctor may recommend a minor procedure like debridement to clean out the damaged tissue, or, in more advanced cases, a rotator cuff repair if previous treatments haven’t been effective.
Understanding rotator cuff muscles and anatomy
Your rotator cuff is made up of four muscles and their tendons: the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles start at your shoulder blade and attach to the top of your upper arm bone (the humerus). They work together to help you lift, rotate, and stabilise your shoulder. Because of this important role, keeping them healthy is key to doing everyday tasks and staying active.
Symptoms of a rotator cuff injury
If you have a rotator cuff injury, you might notice:
- A dull, aching pain in your shoulder
- Pain when lifting your arm or reaching overhead
- Weakness when trying to move your arm
- Trouble moving your shoulder through its full range
- A clicking or grinding sound when you move your shoulder
These symptoms can get worse over time, especially if the injury isn’t treated. More severe or “massive” tears may take longer to heal and can be harder to repair.
What is rotator cuff repair?
Rotator cuff repair is a surgical procedure used to repair a torn tendon in the shoulder. If the tendon is badly damaged and other treatments like physical therapy or medication haven’t helped, your doctor may recommend surgery. During the procedure, the surgeon reattaches the torn tendon to your upper arm bone. This helps relieve pain, restore movement, and improve the strength and function of your shoulder.
Non-surgical treatments
Not everyone with a rotator cuff injury needs surgery. Many people get better with non-surgical treatments. These often start with rest and avoiding activities that make your pain worse. Your doctor may recommend physical therapy, which uses specific exercises to strengthen the shoulder muscles, improve flexibility, and support healing.
Pain relief is also important. You might be advised to take over-the-counter medications like ibuprofen or naproxen to reduce inflammation. If your pain is more intense, a corticosteroid injection into the shoulder may help provide temporary relief. Other options like ice or heat therapy, ultrasound, or manual therapy from a trained physiotherapist can also make a big difference.
These treatments work well for many people with mild to moderate injuries and can often help you avoid or delay surgery.
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Ways to payBefore surgery
The process begins with a thorough consultation with an orthopaedic surgeon, who will evaluate your symptoms, review your medical history, and conduct a physical examination. Imaging tests, such as X-rays or MRI scans, may be ordered to get a clearer picture of the extent and nature of the damage to your shoulder.
Based on this assessment, you and your consultant will have a detailed discussion about your diagnosis and whether surgery is the most appropriate course of action. In many cases, symptoms can be effectively managed through non-surgical treatments such as physiotherapy, medication, and lifestyle modifications. However, if surgery is recommended to help relieve pain and restore shoulder function, the next step will involve careful planning and preparation. This includes scheduling your procedure, receiving preoperative instructions, and making arrangements for your recovery at home. You may be asked to fast for a set period, stop certain medications, or complete specific shoulder-strengthening exercises to optimise healing. It’s also wise to arrange transport, have any prescribed equipment ready (such as a sling or ice packs), and line up help with daily tasks for the first week or two after surgery.
During surgery
Before the operation, you’ll be given anaesthesia to ensure you remain comfortable and pain-free throughout the procedure. Your doctor will explain the available options, which may include general anaesthesia where you’ll be fully asleep, or local anaesthesia combined with a nerve block to numb the surgical area while you stay awake.
Depending on the severity of the tear and the surgical technique chosen, the surgeon will make one or more incisions near the top of your arm. There are two common approaches. Arthroscopic surgery is minimally invasive and involves small incisions through which a tiny camera (arthroscope) is inserted to guide the repair. Alternatively, open surgery may be necessary for larger or more complex tears, requiring a larger incision for better access.
Once the torn tendon is located, the surgeon will use the most appropriate method to repair it. This may involve using sutures (stitches) to reattach the tendon to the bone, often secured with small anchors or screws. In cases of more severe damage, a tendon graft using tissue from either your own body or a donor may be required to reinforce the repair.
After the tendon has been repaired, the surgeon will close the incisions, and you’ll be moved to a recovery area where your post-operative care will begin.
After surgery
Recovery is an important part of healing. Most people go home the same day, but your arm may feel numb or heavy for a short time if a nerve block was used during the procedure. This usually wears off within 24 hours.
In the days and weeks after surgery, it’s important to follow your doctor’s instructions and not rush the healing process. Avoid lifting, reaching, or putting too much strain on your shoulder. You’ll work with a physiotherapist to gently rebuild strength and restore your range of motion.
Everyone heals at a different pace. For smaller tears, full recovery might take around 4 months, while larger or more complex tears can take up to a year. Staying consistent with your rehab exercises and keeping up with follow-up appointments will give you the best chance of a full and successful recovery.
Appointment and Treatment Plan
Initial Consultation
Your journey starts with a consultation where your orthopaedic surgeon will assess your shoulder pain, weakness, or limited movement. A physical exam and imaging, such as an MRI or ultrasound, help confirm whether there’s a tear. If your symptoms don’t improve with rest, physiotherapy, or medications, surgery may be recommended.
Pre-Surgery Preparations
Before surgery, you’ll receive instructions about stopping certain medications, fasting if needed, and arranging a ride home. You may also be advised to prepare your home for recovery and avoid smoking to support healing.
Day of Surgery
Rotator cuff repair is usually a same-day procedure, taking 1-2 hours. It may be done arthroscopically (minimally invasive) or through open surgery for larger tears. You’ll receive anaesthesia, and in many cases, a nerve block is used to manage pain during and after the procedure.
Immediately After Surgery
After surgery, your arm may feel numb or heavy from the nerve block. You’ll go home with your shoulder bandaged and in a sling. Some pain and swelling are normal and can be managed with medication. Rest and keeping the arm elevated are important in the first few days.
Early Recovery at Home
In the first few weeks, you’ll wear a sling and limit arm movement to protect the repair. You’ll start gentle exercises or passive physiotherapy as guided by your care team. It’s important to avoid lifting or using the arm too soon.
Physiotherapy and Rehabilitation
As healing progresses, your physiotherapist will guide you through exercises to restore movement and strength. Range-of-motion work typically begins a few weeks after surgery, with strengthening introduced later as the tendon heals.
Experts
We are proud to provide patients with access to a wide range of clinicians, chosen specifically for their knowledge and reputation in their area of expertise. Our experts align with our values: putting you at the centre of your care and educating you on your options at each step of the journey. We encourage you to learn more about our clinicians and how they can help you below. As always, please contact our patient services team if you require any additional information.
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FAQs
Recovery time after rotator cuff surgery varies depending on the size and severity of the tear, the type of surgery performed, and individual patient factors. Generally, patients can expect an initial phase of a few weeks where the shoulder is immobilised to allow the tendon tissue to start healing. Passive exercises usually begin within the first few weeks to gently slide the tendon and prevent stiffness without stressing the repair. Active exercises and strengthening typically start after 6-8 weeks, progressing gradually under the guidance of a physical therapist. Full recovery, including regaining movement and strength in the operated shoulder, may take 4-12 months. Larger tears or open surgery may require a longer recovery period. Throughout recovery, patients are advised to avoid heavy lifting and strenuous domestic tasks to reduce pain and prevent complications such as re-tear or nerve damage.
Pain levels after rotator cuff surgery can vary based on the extent of the injury and the surgical technique used. Arthroscopic surgery tends to result in less postoperative pain compared to open surgery due to smaller incisions and less disruption of the deltoid muscle. Pain is typically managed with a combination of nerve blocks, local anaesthetics, and pain medications during and after the procedure. Some patients may feel numbness or heaviness in the operated arm due to the nerve block, which usually resolves within 24 hours. Pain usually decreases steadily during the first few weeks, but some discomfort during movement and physical therapy is normal. Proper pain management and following postoperative instructions are essential to reduce pain and promote healing.
After rotator cuff surgery, certain activities and behaviours can jeopardise healing and lead to complications. The worst things to do include:
- Engaging in heavy lifting or strenuous activities too soon, which can cause a re-rupture or damage to the repaired tendon
- Ignoring postoperative instructions regarding immobilisation and prematurely removing slings or velcro fastenings
- Skipping physical therapy sessions or performing exercises incorrectly can hinder recovery and lead to stiffness or weakness
- Smoking or poor nutrition can impair tendon healing
- Neglecting signs of complications such as increased pain, swelling, redness, or symptoms of blood clot or deep vein thrombosis, which require immediate medical attention
- Leaning forward or placing excessive strain on the operated arm during daily tasks
Following the surgeon’s and physiotherapist’s advice closely will help avoid these pitfalls and ensure a smoother recovery.
Determining whether a rotator cuff injury requires surgery involves a thorough assessment by an orthopaedic surgeon. Surgery is usually considered if:
- The patient experiences persistent pain and weakness despite conservative treatments such as physical therapy and pain management
- Imaging studies (like MRI or ultrasound) reveal a full-thickness tear, a large tear, or significant tendon damage that is unlikely to heal on its own
- There is an acute injury causing a sudden, complete tear of the rotator cuff tendon
- The patient has difficulty performing normal activities or experiences a significant loss of shoulder function
- Non-operated arm function is compromised, or the tear is worsening
The orthopaedic surgeon will consider factors such as the patient’s age, activity level, overall health, and the specific characteristics of the tear before recommending surgery.
Medically reviewed by Mr Nawfal Al-Hadithy - Consultant Trauma & Orthopaedic Shoulder, Elbow & Hand Surgeon on 28/05/2025