Shoulder pain that limits movement or daily activities can sometimes be linked to a rotator cuff injury. The rotator cuff is a group of muscles and tendons that keep the shoulder joint stable and allow smooth arm movement. When one or more of these tendons are torn, repair may be required to restore shoulder function.
This article explains what typically happens before, during, and after rotator cuff repair surgery.
Understanding the Rotator Cuff
The rotator cuff consists of four muscles — the supraspinatus, infraspinatus, teres minor, and subscapularis — and their connecting tendons. Together, they help lift and rotate the arm while keeping the shoulder joint secure within its socket.
Injuries can occur gradually from wear and tear or suddenly from trauma, such as a fall or lifting a heavy object. Common symptoms include:
- Shoulder pain that worsens with overhead movements or at night
- Weakness when lifting or rotating the arm
- Limited range of motion
When rest, medication, and physiotherapy do not relieve symptoms, surgery may be recommended to repair the torn tendon.
When Is Rotator Cuff Surgery Considered?
Rotator cuff repair is generally discussed when:
- Pain persists despite several months of conservative treatment
- Shoulder weakness affects daily activities such as dressing or reaching overhead
- Imaging (such as MRI or ultrasound) confirms a large or complete tear
- The injury results from acute trauma or repetitive stress
The decision for surgery takes into account the severity of the tear, overall health, and the patient’s activity level.
Preparing for Surgery
Before surgery, patients undergo a medical evaluation that includes:
- Physical examination and imaging: To confirm the type and extent of the tear.
- Discussion with the surgeon: Covering the procedure, anaesthesia options, possible risks, and expected recovery timeline.
- Preoperative instructions: Such as fasting before surgery, adjusting medications, and planning assistance at home for the recovery period.
Arranging support at home is helpful, as certain tasks may be difficult during the first few weeks after surgery.
What Happens During the Surgery
Rotator cuff repair is performed under regional or general anaesthesia. The approach may be:
- Arthroscopic repair: Small incisions are made, and a camera with surgical instruments is used to reattach the torn tendon to the bone.
- Open repair: A larger incision is made to access the tendon directly, sometimes used for more complex or extensive tears.
The orthopaedic surgeon typically reattaches the tendon to the top of the upper arm bone (humerus) using sutures or small anchors. The procedure duration varies, depending on the size and location of the tear. After the repair, the incisions are closed and the arm is placed in a sling to support healing.
After the Surgery: Recovery and Rehabilitation
Immediate Postoperative Period
Following surgery, patients usually spend some time in recovery until the effects of anaesthesia wear off. The arm is immobilised in a sling or brace to protect the repaired tendon.
Pain and swelling are managed with medication and cold therapy. Rest is important in the early phase to prevent stress on the repair.
Physiotherapy and Exercise
Rehabilitation is a gradual process that progresses through stages:
- Initial stage: Focuses on gentle, passive movement to prevent stiffness.
- Intermediate stage: Introduces active-assisted and later active exercises as healing progresses.
- Strengthening stage: Builds shoulder strength and control once the tendon has sufficiently healed.
A physiotherapist provides tailored exercises to restore flexibility and strength while minimising the risk of re-injury.
Return to Daily Activities
Patients can usually resume light daily activities, such as desk work, after several weeks, depending on their recovery progress. More demanding activities, such as driving, lifting, or sports, are delayed until advised by the doctor. Full recovery often takes several months.
Possible Risks and Complications
All surgical procedures carry some degree of risk. For rotator cuff repair, possible complications may include:
- Infection or wound irritation
- Shoulder stiffness or limited motion
- Re-tear of the repaired tendon
- Reaction to anaesthesia
These risks are uncommon and are managed through careful postoperative care and physiotherapy. Patients should promptly inform their doctor of any persistent pain, swelling, or reduced mobility.
Long-Term Outlook
Most patients experience improvement in shoulder comfort and function following successful rehabilitation. Regular physiotherapy and ongoing exercises help maintain strength and flexibility.
To protect the shoulder joint long-term:
- Avoid repetitive overhead lifting or sudden jerking motions
- Maintain shoulder and core strength through guided exercises
- Keep up with follow-up appointments to monitor healing
Consistent care supports recovery and helps preserve shoulder function over time.
Rotator cuff repair surgery aims to restore shoulder movement and reduce pain caused by tendon tears. Understanding what happens before, during, and after the procedure can help patients prepare for recovery with realistic expectations.
Adhering to medical advice, attending physiotherapy sessions, and allowing time for healing all play a part in achieving the best possible outcome.
