Rotator Cuff Repair
The rotator cuff, formed by the tendons of four shoulder muscles, can tear through wear or injury. Physiotherapy or arthroscopic repair is planned according to the type of tear.
The rotator cuff is made up of the tendons of four muscles that surround the shoulder joint. It lets us lift and rotate the arm and keeps the head of the upper arm bone centred in the socket. Rotator cuff tears are among the most common causes of shoulder pain, especially after the age of 40.
Why does the rotator cuff tear?
- Wear: With age, the blood supply and elasticity of the tendons decrease; jobs and sports that involve lifting the arm overhead speed up wear.
- Impingement: Repeated rubbing of the tendon in the narrow space under the roof of the shoulder.
- Injury: A fall, a sudden heavy lift or a shoulder dislocation.
Symptoms
- Pain on the outer side of the shoulder, spreading down the arm
- Pain that gets worse at night, especially when lying on the affected side
- Difficulty lifting the arm and reaching behind the back
- Weakness in the arm and a crackling feeling during movement
Diagnosis
Each tendon’s strength is tested separately on examination. MRI shows the size of the tear, how far the tendon has retracted and the condition of the muscle. Ultrasound can also help.
Treatment options
Non-surgical treatment
Partial tears and tears in less active patients are treated with physiotherapy, exercises that strengthen the shoulder muscles, pain relief and, when appropriate, injections. Pain improves considerably in many patients.
Arthroscopic rotator cuff repair
Repair is recommended for full-thickness tears, especially in young and active patients and in tears caused by injury. The operation is done through a few small incisions with a camera and fine instruments. The torn tendon is reattached to the bone with small anchors and stitches. If needed, a bone spur under the roof of the shoulder is also smoothed.
Large tears left untreated for a long time can retract and the muscle can turn to fat, which makes repair harder. Early assessment of traumatic tears is therefore important.
Recovery
The tendon takes time to heal to the bone. After surgery, a sling is usually worn for a few weeks, with passive and then active movement exercises. Strengthening starts in the following weeks. Returning to heavy work and sport usually takes a few months. Following the physiotherapy programme closely shapes the quality of the result.
Rotator cuff tear or frozen shoulder?
Both cause shoulder pain and restricted movement, but their causes differ. In a rotator cuff tear, strength to lift the arm is usually reduced, while the range of motion is kept when someone else lifts the arm. In frozen shoulder, the joint capsule stiffens, so both active and passive movements are restricted. Telling them apart guides treatment.
Frequently asked questions
Does a rotator cuff tear heal on its own?
Full-thickness tears do not heal on their own, but pain and function improve with physiotherapy in many patients. The tear is monitored for growth.
When can I drive after surgery?
Once the sling is no longer needed and shoulder movement is safe, usually within a few weeks, with your surgeon's approval.
Can the repaired tendon tear again?
Re-tear can happen, especially in large and long-standing tears. Following the rehabilitation programme and avoiding heavy loads early reduce this risk.
Will I have trouble sleeping after surgery?
In the first weeks, sleeping on your back or semi-upright with the sling may be more comfortable. Suitable pain relief is recommended.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.