A rotator cuff repair is an operation to reattach one or more of the tendons that form the rotator cuff — the group of muscles and tendons that stabilise the shoulder and control its movement. The procedure is usually performed arthroscopically (keyhole) or through a small open incision.
The surgeon makes two or three small incisions around the shoulder and inserts a tiny camera (arthroscope) to view the joint. The torn tendon is identified, prepared, and reattached to the bone using small anchors and strong sutures. Sometimes a ligament is released and bone is shaved to create more space for the repaired tendon. The operation typically takes one to two hours. In some cases, a larger tear may require a mini-open incision of around 3–5 cm.
Surgery may be recommended when a rotator cuff tear causes persistent shoulder pain, weakness, and difficulty with overhead activities or sleeping on the affected side. It is usually considered after non-operative treatments such as physiotherapy and injections have not provided adequate relief, or when the tear occurs after an acute injury and the tendon is at risk of further retraction.
Many rotator cuff tears can be managed without surgery. Options include physiotherapy to strengthen the surrounding muscles, corticosteroid injections for pain relief, activity modification, and pain medication. Physiotherapy can help the intact tendons compensate for the torn one. Not all tears cause symptoms, and some patients function well without surgery.
You will attend a pre-assessment clinic for blood tests, a heart tracing, and medical review. Inform your team about any blood-thinning medications. Smoking significantly impairs healing — stopping before surgery is strongly advised. You will need to arrange for someone to drive you home, and you should plan for being effectively one-handed for several weeks.
The aim is to reduce shoulder pain and improve strength and function. Approximately 70–80% of patients experience significant improvement in pain and movement. Recovery is gradual, with meaningful improvement at four to six months and continuing gains for 12–18 months. The repair aims to prevent the tear from enlarging and to preserve long-term shoulder function.
Shoulder stiffness is common in the early months and usually resolves with physiotherapy.
Around 10–20% of patients experience some ongoing discomfort, though usually less than before surgery.
The repaired tendon may not fully heal to the bone, particularly in larger tears. This is the most common complication.
Temporary numbness and heaviness of the arm from the nerve block, usually resolving within 24 hours.
Painful stiffness lasting many months. Occurs in approximately 1–2% of patients.
Occurs in roughly 1% of cases. May require antibiotics or further surgery.
Rare damage to surrounding structures.
DVT or pulmonary embolism is uncommon with shoulder surgery but remains a risk.
The tendon may re-tear, especially with premature heavy loading. Risk depends on tear size.
The procedure is usually performed under general anaesthesia combined with a nerve block — an injection of local anaesthetic around the nerves in the neck (interscalene block). This provides excellent pain relief for the first 12–24 hours. Your arm may feel numb and heavy as the block wears off. Your anaesthetist will discuss the best approach for you.
Your arm will be in a sling for four to six weeks to protect the repair. During this time, you will be essentially one-handed. Gentle assisted exercises begin early, guided by your physiotherapist. Active movement starts from around six weeks. Strengthening exercises begin at three months. Significant improvement takes four to six months, with full recovery at 12–18 months. Driving is not permitted while wearing the sling. Return to desk work is usually possible at two to three weeks; heavy manual work may take four to six months.
You will typically be seen at two to three weeks for wound review and by a physiotherapist. A follow-up with your consultant is arranged at six to eight weeks. Further appointments depend on your progress. Full rehabilitation usually involves regular physiotherapy for several months.
Most patients wear a sling for four to six weeks. Your surgeon may advise a shorter or longer period depending on the size of the repair.
You cannot drive while wearing a sling. Driving typically resumes at around six to eight weeks, once you have adequate control of the arm.
Most patients regain good functional movement. The range regained is somewhat unpredictable and may not match the uninjured shoulder, but it is rare to have less movement than before surgery.
Yes, re-tears can occur, especially with larger tears or if the shoulder is loaded too early. Following the rehabilitation programme carefully reduces this risk.