At a glance
Rotator cuff repair is a surgical procedure that reattaches torn tendons in the shoulder to restore strength and movement.
The rotator cuff is a group of four muscles and their tendons that wrap around the top of the upper arm bone (humerus) and hold it inside the shoulder socket. When one or more of these tendons tear, either from injury or gradual wear, the arm loses power and lifting it becomes painful. During surgery, the torn tendon is pulled back into position and anchored to the bone using small screws or stitches called suture anchors. The shoulder can then heal with the tendon in the correct place.
Medical Condition
Doctors recommend rotator cuff repair when a torn tendon has not responded to non-surgical treatments such as physiotherapy, anti-inflammatory medication, or steroid injections after several months.
- A full-thickness tear, where the tendon has torn completely through from top to bottom
- A large partial-thickness tear that causes persistent weakness or pain despite conservative treatment
- An acute tear caused by a sudden injury, such as a fall or heavy lifting accident, especially in an active person
- A tear in a younger patient where long-term shoulder function is a priority
- Weakness that prevents the patient from lifting the arm above shoulder height or performing daily tasks
- Significant pain at night that disrupts sleep even after weeks of rest and medication
Surgery is usually not the first choice when the tear is small and the patient is elderly with low physical demands, when there is severe arthritis (joint degeneration) in the shoulder that would limit recovery, or when the patient's general health makes anaesthesia high risk.
- Small, low-grade partial tears that are still manageable with physiotherapy
- Advanced shoulder arthritis where a different type of joint surgery may be more appropriate
- Serious heart, lung, or blood-clotting conditions that increase the risk of general anaesthesia
- Tendons that have retracted and scarred so severely that reattachment is no longer technically possible
Risks & Complications
Rotator cuff repair is generally safe, but like any shoulder surgery it carries recognised risks that your surgical team will discuss with you beforehand.
- Shoulder stiffness (frozen shoulder), where scar tissue forms and limits movement during healing
- Incomplete healing of the repaired tendon back to the bone, which is more likely with larger tears or in older patients
- Infection at the incision site or, rarely, deep inside the joint
- Nerve or blood vessel injury near the shoulder, which can cause temporary numbness, tingling, or weakness in the arm
- Blood clots in the arm or leg (deep vein thrombosis), a general risk after any surgery
- Reactions to anaesthesia, such as nausea, dizziness, or, very rarely, a serious allergic response
- Anchor failure, where the small screws or stitches used to fix the tendon pull away from the bone
- The need for a second operation if the repair does not hold or the shoulder does not regain adequate function
Preparation & Procedure
Preparation begins days to weeks before the operation and covers what you eat and drink, any medications you take, and your lifestyle habits.
Most hospitals ask patients to stop eating solid food six hours before surgery and to stop drinking clear fluids two hours before. Blood thinners and certain anti-inflammatory drugs are usually paused in the days leading up to surgery, as your surgeon instructs. Smoking slows tendon healing and increases the chance of infection, so the surgical team typically advises stopping well before the procedure. Alcohol is also usually avoided in the days before the operation.
Before the date is confirmed, you will usually undergo a set of pre-operative assessments. These help the team check that you are fit for surgery and anaesthesia.
- MRI (magnetic resonance imaging) of the shoulder to map the size and location of the tear
- Blood tests to check for anaemia (low red blood cells), infection, and clotting function
- An ECG (electrocardiogram, a heart tracing) if you are older or have a heart condition
- Chest X-ray in some cases to assess lung health
- Consultation with an anaesthesiologist (the doctor who manages sedation and pain control)
On the day of surgery, the procedure usually follows this sequence, though the exact steps depend on whether the approach is arthroscopic (keyhole) or open.
- 1. You change into a hospital gown and an IV (intravenous) line is placed in your arm to deliver fluids and medication.
- 2. The anaesthesiologist administers either general anaesthesia (you are fully asleep) or a regional nerve block (the arm is numbed while you remain lightly sedated), depending on the plan agreed beforehand.
- 3. You are positioned on the operating table, usually sitting slightly upright in what surgeons call the beach-chair position, or lying on your side.
- 4. In an arthroscopic repair, the surgeon makes two or three small incisions and inserts a tiny camera (arthroscope) and instruments to view and repair the shoulder from inside. In an open repair, a single larger incision is made over the shoulder.
- 5. The surgeon clears away any damaged tissue, prepares the bone surface where the tendon will be anchored, and places suture anchors into the bone.
- 6. The torn tendon is pulled back into position and sutured securely to the anchors so it sits against the bone.
- 7. The instruments are removed, the incisions are closed with stitches or surgical tape, and a sterile dressing is applied.
- 8. You are moved to a recovery area where nursing staff monitor your blood pressure, heart rate, and pain level as the anaesthesia wears off.
- 9. Your arm is placed in a sling before you leave the recovery area.
Aftercare
Recovery from rotator cuff repair is gradual and typically takes several months, because a tendon healing to bone is one of the slowest processes in the body.
- Most patients spend one night in hospital after surgery, though some arthroscopic repairs are done as day procedures depending on the hospital and the patient's health.
- The arm is kept in a sling for several weeks, usually four to six, to protect the repair while early healing takes place. The sling must be worn as instructed, including during sleep.
- Pain and swelling in the first days are managed with prescribed pain medication, ice applied over a cloth to the shoulder, and keeping the arm elevated when resting.
- Physiotherapy (physical therapy) is the core of recovery. It typically begins with gentle passive movements guided by a physiotherapist, then progresses to active exercises and finally strengthening, over a period of months.
- Driving is not permitted while the arm is in a sling, and your surgical team will advise when it is safe to return to driving based on which arm was operated on.
- Lifting anything heavier than a light cup is restricted until the tendon has had time to heal securely, which the surgeon monitors through follow-up appointments.
- Wound checks are usually scheduled one to two weeks after surgery. Sutures or staples, if used, are removed at this visit.
- Return to desk work or light duties may be possible within a few weeks for some patients, while physically demanding jobs or overhead sports typically require six to twelve months of rehabilitation.
- Follow-up imaging, such as an MRI or ultrasound (USG), may be arranged if the surgeon wants to confirm how the repair is healing.
- Smoking delays tendon healing significantly, so continuing to avoid it after surgery gives the repair the best environment to succeed.
Cost & What Determines It
The cost of rotator cuff repair varies widely because it depends on the complexity of the tear, the surgical approach chosen, the hospital setting, and the country where the procedure takes place.
- Tear size and complexity: a small single-tendon repair takes less operating time and fewer implants than a large multi-tendon reconstruction
- Surgical approach: arthroscopic (keyhole) repair typically requires more specialised equipment than open surgery, which can affect the total cost differently depending on the hospital
- Hospital class: a tertiary specialist centre charges differently from a district general hospital, and private hospitals charge differently from public ones
- Country of treatment: hospital costs, surgeon fees, and anaesthesia fees differ significantly across countries
- Length of stay: each additional night in hospital adds to the bill, and complications that extend the stay increase costs further
- Implants: suture anchors and any specialised fixation devices are billed separately in many hospitals and their cost varies by brand and quantity used
- Anaesthesia type: a regional nerve block combined with sedation may be priced differently from full general anaesthesia
- Physiotherapy: the number of sessions needed is substantial and may or may not be included in the surgical package
- Post-operative imaging: follow-up MRI or USG scans to assess healing are often charged separately
- Medications: take-home pain relief, antibiotics, and any blood-thinning agents prescribed after surgery are usually billed in addition to the procedure
Hospital packages for rotator cuff repair usually cover the surgeon's fee, anaesthesia, the operating theatre, the overnight hospital stay, standard nursing care, and the suture anchors used during surgery. Items that are commonly billed separately include pre-operative investigations such as MRI and blood tests, the anaesthesiologist's personal fee, take-home medication, physiotherapy sessions, and any follow-up outpatient visits or imaging.
BPJS Kesehatan does not cover surgical procedures performed outside Indonesia, and most Indonesian private health insurance policies do not either unless the plan specifically includes overseas treatment. Patients travelling abroad for rotator cuff repair generally pay out of pocket or through a private international health insurance plan that explicitly covers elective overseas surgery. Before confirming any travel arrangements, ask the hospital for a written itemised cost estimate that covers the surgery itself, the expected stay, implants, physiotherapy, and follow-up consultations. This document protects you from unexpected charges and gives you a clear basis for comparing options.
Frequently Asked Questions
How long does rotator cuff repair surgery take?
The operation usually takes between one and three hours, depending on how badly the tendons are torn and whether the surgeon works through small keyhole cuts or one larger opening. A more extensive tear with multiple damaged tendons will naturally take longer to fix than a small, partial tear.
How much does rotator cuff repair cost?
The cost varies based on several factors specific to this procedure, including the severity of the tear, whether arthroscopic (keyhole) or open surgery is used, the length of your hospital stay, and any implants such as the small anchors used to reattach the tendon to the bone. A written estimate from your chosen hospital is the most reliable way to understand the full price before you commit.
Will I be asleep during the surgery and how bad is the pain afterwards?
Most patients receive general anaesthesia, meaning they are fully asleep, though some centres also use a nerve block around the shoulder to reduce pain in the hours right after surgery. Pain in the first few days is usually managed with prescription pain relief, and most people find it becomes much more bearable within one to two weeks as the swelling settles.
What warning signs should I watch for after rotator cuff surgery?
Contact your medical team promptly if you notice increasing redness, warmth or swelling around the wound, a fever, numbness or tingling that spreads down the arm, or if the pain suddenly gets worse instead of slowly improving. These signs can point to infection, a nerve issue, or a problem with how the repair is healing, and catching them early makes a real difference to the outcome.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
