Rotator cuff repair is a surgical procedure used to treat tears of the rotator cuff tendons, which play an essential role in shoulder movement and stability.
It is almost always performed arthroscopically (keyhole surgery).
These tendons can become torn due to injury, overuse, or age-related degeneration, often leading to pain, weakness, and difficulty lifting or using the arm.
Once formed, rotator cuff tears don’t heal. When non-operative treatments such as physiotherapy, activity modification, or injections no longer provide sufficient relief, surgical repair may be considered to repair the tear and improve shoulder function.
Surgical repair may be required as a priority in some cases where large-sized tears occur suddenly due to injury. Scarring and retraction of the tendon and withering of the muscles involved can make repair difficult or impossible if repair is delayed.
Careful consideration of individual circumstances is important to prioritise treatment options.
On this page, you will learn what rotator cuff repair involves, when it may be recommended, how the procedure is performed, and what to expect during recovery and rehabilitation. During your consultation, Dr Richard Dallalana will provide personalised advice based on your symptoms, personal needs and the extent of tearing.
The rotator cuff is a group of tendons and muscles that help stabilise your shoulder and allow you to lift, rotate, and control your arm. These tendons attach to the top of the upper arm bone (humerus) and work together to both move the shoulder in multiple directions and keep the humeral head positioned properly on the socket.. A rotator cuff tear occurs when one or more of these tendons becomes damaged – usually it detaches from the bone. This can develop gradually over time due to wear and degeneration or occur more suddenly following an injury. When a tear is present, the tendon cannot heal back to the bone on its own.
Arthroscopic rotator cuff repair is a minimally invasive (keyhole) procedure used to repair the torn tendon. Small incisions are made around the shoulder to insert a camera and specialised instruments, allowing the joint to be visualised and treated. During the procedure, the torn tendon is reattached to the bone using sutures and occasionally small plastic anchors. Restoring the tendon (or tendons) to its normal position allows it to heal and helps improve shoulder strength and stability over time.
The aim of surgery is to reduce pain, improve function, and support a gradual return to daily activities.
A rotator cuff tear can cause pain, weakness, and reduced function of the shoulder. Symptoms may develop gradually over time or occur more suddenly following an injury.
In some cases, pain may initially be mild but gradually worsen, especially with continued use of the shoulder. Larger tears may result in more noticeable weakness or difficulty lifting the arm, while smaller tears may present primarily with pain alone, mostly when reaching and raising the arm upwards..
Symptoms can vary depending on the size and location of the tear, as well as the amount of inflammation in the area.
Pain may not be in proportion to the tear size.
Rotator cuff repair surgery is usually considered when symptoms persist despite appropriate non-operative treatment and continue to affect daily activities.
Initial management typically includes:
Note that repeated corticosteroid injections can be harmful to torn rotator cuff tendon tissue and may in some cases contribute to an increase in tear size. Limited use only is appropriate.
Surgery cannot be performed within 6 weeks of a corticosteroid injection due to its tendency to inhibit healing.
Surgery may be recommended when:
Assessment of a rotator cuff tear focuses on understanding both your individual clinical picture and the condition of the tendon and surrounding structures.
mportant issues to discuss during consultation relate to the onset, duration and severity of symptoms, health and lifestyle factors. Physical examination will focus on :
Imaging is used to confirm the diagnosis and assess the size and pattern of the tear. This may include:
The surgery is almost always arthroscopic. Arthroscopic rotator cuff repair is performed using a minimally invasive (keyhole) technique under a general anaesthetic. Small incisions are made around the shoulder to insert a camera (arthroscope) and specialised instruments. This allows Dr Dallalana to visualise the joint in detail and assess the rotator cuff and surrounding structures.
During the procedure, the torn tendon is carefully prepared and reattached to the bone. The torn ends are often frayed and first need to be debrided back to better quality tissue. The tears are almost never within the tendon itself, and the goal is reattachment to bone.
The procedure usually takes 45 to 90 minutes, depending on the complexity of the tear and any associated findings.
Rotator cuff repair is usually performed with a single overnight stay in hospital. It can be performed as a day procedure if desired
You will be admitted to hospital and prepared for the procedure. This includes meeting the anaesthetist and nursing team, confirming the surgical plan, and completing pre-operative checks. A consent form for the surgery is signed and the limb in question is marked. Fasting instructions will have been given prior.
After the procedure, you will be monitored as you wake from anaesthesia before returning to your room.
You will wake up with a sling on
The sling will be loosened when in bed on the ward to allow both hands to be used for eating, using a device and self-care
Iceor a cryotherapy pack will be applied
Pain control measures – local anaesthetic into the wounds at the end of the surgery and tablets later.
Pain is usually worse on the first day and strong analgesics are generally required. These can be tapered off over ensuing days, with a preference for regular paracetamol and an anti-inflammatory. It is normal for night pain to be persistent.
Before discharge, you will be provided with:
Recovery after rotator cuff repair is more gradual than many other procedures, as the tendon requires time to heal securely back to the bone. Biologically this takes around 3 to 4 months. A structured rehabilitation program is important to support healing, allowing increase in movement and activity as the healing progresses. This is not necessarily directed by pain – precautions are still needed even at a time when the shoulder is no longer particularly painful.
Recovery varies between individuals, but as a general guide recovery it takes around 6 months, with continued improvement in strength and function in some cases beyond this, up to 1 year.
Rotator cuff repair is a commonly performed procedure. As with all surgery, there are potential risks and complications that should be understood before proceeding.
Steps are taken before, during, and after surgery to help minimise these risks.
Complications related to rotator cuff repair may include:
Uncommonly stiffness and pain can be severe due to onset of frozen shoulder. Symptoms can be treated. It will eventually fully resolve and does not impact on the success of the repair surgery.
This is uncommon and if it occurs may be due to alternate sources of pain referring to the shoulder e.g. neck problems, polymyalgia or unrecognised arthritis.
Nerve injury
Injury to surrounding nerves may affect skin feeling or muscle function. Serious injury is very rarely seen. A small patch of numbness can occasionally occur just below the wounds, as with any surgical incision around the body
The likelihood of complications can vary depending on:
You should seek medical review if you experience:
Rotator cuff repair is performed to improve pain, strength, and shoulder function when a tendon tear is affecting daily activities. It can improve the longer term prognosis of the shoulder.
Many patients experience:
Results can vary depending on several factors, including:
Most patients notice meaningful improvement by 3 months, with continued gains in strength and function beyond this, up to 6 to 12 months
By 3 months movement related pain is resolving and many simple activities are possible
The aim of surgery is to improve comfort and restore function. Many patients are able to return to daily activities with reduced pain and improved shoulder use.
Maintaining shoulder strength and flexibility through ongoing exercise may help support long-term outcomes.
In some cases, particularly with larger tears or reduced tendon quality, there may be a risk of re-tear or incomplete recovery. Strength levels may not return to normal in these cases. Persistent untreated large tears can lead to the development of arthritis in the shoulder, occasionally requiring a shoulder replacement.
Surgery is considered if you have ongoing pain and reduced function in the shoulder that has not improved with physiotherapy or other non-operative treatments, and imaging confirms a significant tear. Surgery is usually needed in the case of a sudden tear occurring with injury and when there is weakness raising or rotating the arm.
The procedure typically takes 45 to 90 minutes, depending on the size of the tear and whether additional procedures are required.
The procedure typically takes 45 to 90 minutes, depending on the size of the tear and whether additional procedures are required.
Yes, a sling is usually required for 6 weeks when walking to protect the repair. It may be removed in most cases within the home and at night time.
Driving is possible when adequate control of the arm is present, usually judged by the ability to raise the hand out forwards to face height. This varies between individuals however is usually at 3 to 4 weeks. A sling must not be worn while driving.
Return to work depends on the type of work you do. Office-based roles may be resumed earlier, particularly if working from home. This may be within days of surgery. Physically demanding work requires a longer recovery period, from 2 to 6 months depending on the tasks required.
Patients with small repairs and of younger age will have no perceived loss in strength. With large, long standing tears in people of more advanced age full strength is not expected, however improvement from prior is usually seen.
Potential risks include shoulder stiffness, re-tear of the tendon or ongoing pain.
There is a risk of re-tear, particularly in larger or more complex repairs. It does not always require a repeat injury to happen, as the re-tear is often a biological failure of the repaired tendon. Blood flow in the area is limited, and this is contributory to the occurrence of weakened tendon in the first instance.
Non-surgical options such as physiotherapy, activity modification, and injections may help manage symptoms in some cases. Suitability depends on the tear size and your symptoms.
Costs vary depending on hospital fees, surgeon and anaesthetic fees, and your private health insurance. A detailed cost estimate is provided prior to surgery.
You may benefit from assistance with daily tasks such as cooking, cleaning, and transport during the early recovery period, particularly during the first 6 weeks.
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