Rotator Cuff Repair

Rotator cuff repair is a surgical procedure that reattaches torn tendons in the shoulder back to the bone so the arm can move and lift normally again.

The rotator cuff is a group of four muscles and their tendons that wrap around the top of the upper-arm bone and hold it firmly in the shoulder socket. When one or more of these tendons tear — either from a sudden injury or from years of wear — the arm becomes weak and painful. During surgery, the surgeon cleans away damaged tissue, drills small anchors into the bone, and uses strong sutures (stitches) to pull the torn tendon back to where it belongs. The repair is most often done arthroscopically (through small keyhole incisions using a tiny camera), though some large tears need a more open approach.

Rotator cuff repair is recommended when a tendon tear causes significant pain or weakness that has not improved with non-surgical treatment such as physiotherapy or anti-inflammatory medicine. Your orthopaedic surgeon will review imaging — usually an MRI — to confirm the size and location of the tear before deciding on surgery.

• A partial or full-thickness tear (a tear that goes all the way through the tendon) of one or more rotator cuff tendons
• Acute tear caused by a sudden fall or direct blow to the shoulder
• Chronic (long-standing) degenerative tear in patients whose daily work or sport requires overhead arm use
• Persistent shoulder pain and weakness lasting several months despite non-surgical care
• Significant loss of shoulder strength that affects daily activities such as dressing, reaching, or lifting

Surgery may not be suitable in certain situations. Your doctor will carefully weigh the risks and benefits if any of the following apply:

• Very small partial tears that are still responding well to physiotherapy
• Patients who are not medically fit enough for general or regional anaesthesia
• Severe fatty degeneration (replacement of the muscle with fat tissue) visible on MRI, which can reduce the chance of a successful repair
• Patients who are unable or unwilling to commit to the lengthy rehabilitation required after surgery

Rotator cuff repair is generally considered safe, but like any surgery it carries possible risks that your surgeon will discuss with you beforehand.

• Shoulder stiffness and limited range of motion during recovery, which usually improves with physiotherapy
• Re-tear of the repaired tendon, more likely with large or complex tears, or if rehabilitation guidelines are not followed
• Infection at the incision site or, rarely, deep within the shoulder joint
• Nerve or blood vessel injury near the shoulder, which can cause temporary or, rarely, lasting numbness or weakness in the arm
• Anaesthesia-related reactions such as nausea, allergic response, or, very rarely, breathing difficulties
• Blood clots (deep vein thrombosis) in the arm or leg, which can travel to the lungs in rare cases
• Prolonged pain or incomplete pain relief after surgery
• Failure of the anchor or suture material, which may require a further procedure

Good preparation helps the surgery go smoothly and reduces the risk of complications. Your surgical team will give you specific instructions based on your health history, but the following gives a general picture of what to expect.

Regarding lifestyle before surgery: smoking reduces blood flow to tendons and slows healing, so most surgeons ask patients to stop smoking well in advance. Alcohol should be avoided in the days before the procedure. Some medications — including blood thinners, certain anti-inflammatory drugs, and herbal supplements — are usually paused before surgery because they can increase bleeding; your doctor will advise on timing. Fasting (no food or drink, including water) is typically required from midnight before the operation, though your team will confirm the exact cut-off time.

Pre-operative tests that are commonly requested include:

• MRI of the shoulder to map the exact size and location of the tear
• Blood tests to check general health, clotting ability, and infection markers
• Chest X-ray and ECG (electrocardiogram, a heart-tracing test) if you are older or have heart or lung conditions
• Anaesthesia assessment (pre-anaesthetic review) to choose the safest type of pain control for you

On the day of surgery, the procedure typically follows these steps:

• You change into a hospital gown and a nurse checks your vital signs (blood pressure, pulse, oxygen level).
• An intravenous (IV) line is placed in your arm to deliver fluids and medication.
• Anaesthesia is given — this is usually a combination of a nerve block (an injection that numbs the entire shoulder and arm) and either general anaesthesia (you are fully asleep) or sedation (you are deeply relaxed).
• The surgical team positions you carefully — most often sitting slightly upright in a 'beach-chair' position or lying on your side — to give the best view of the shoulder.
• For an arthroscopic repair, small incisions (usually less than a centimetre each) are made around the shoulder, and a thin tube with a camera (the arthroscope) is inserted to view the joint on a screen.
• The surgeon uses slender instruments passed through the other incisions to clean the torn tendon edges and prepare the bone surface.
• Small metal or bio-absorbable anchors are fixed into the bone at the attachment point, and sutures threaded through the anchors are passed through the tendon to pull it back into place.
• The sutures are tied firmly, the instruments are removed, and the small incisions are closed with stitches or surgical tape.
• A sterile dressing is applied, and your arm is placed in a sling before you are moved to the recovery area.

Recovery from rotator cuff repair takes time and depends on the size of the tear that was repaired. Most patients go home the same day or the morning after surgery, but full shoulder strength and function are usually regained over several months. Following your rehabilitation programme closely is the most important thing you can do to protect the repair and restore movement.

• Sling use: your arm will be kept in a sling for a period determined by your surgeon — usually several weeks — to protect the newly attached tendon while early healing takes place. Do not remove it without guidance.
• Pain management: some discomfort, swelling, and bruising around the shoulder are normal in the first days. Your doctor will prescribe appropriate pain relief.
• Wound care: keep the incision sites clean and dry until your surgeon says they are fully healed. Watch for signs of infection such as increasing redness, warmth, swelling, or discharge.
• Physiotherapy: structured exercises begin early and progress gradually over months — from gentle passive movements (where the therapist moves your arm for you) to active strengthening exercises. Attending all sessions and doing home exercises as instructed is essential.
• Driving: you will not be able to drive while wearing the sling. Your surgeon will advise when it is safe to return.
• Work and daily activities: desk work may be possible within a few weeks; jobs or activities involving lifting, reaching, or overhead use of the arm take much longer — your surgeon will give a timeframe based on your repair.
• Sport and heavy lifting: return to sport, manual work, or overhead activities is gradual and only when cleared by your surgeon and physiotherapist, typically after many months.
• Sleep position: sleeping with the arm elevated on a pillow or in a recliner chair is often more comfortable than lying flat in the early weeks.
• Follow-up appointments: your surgeon will schedule check-ups to monitor healing, review progress, and adjust your rehabilitation plan as needed.