Rotator Cuff Tear

Overview

The rotator cuff is a group of four muscles that surround the shoulder joint, providing stability and enabling movement. A rotator cuff tear occurs when one or more of these tendons becomes partially or completely torn.

Rotator cuff tears are common, particularly in middle age and beyond. They can develop slowly from wear and tear (chronic tears) or suddenly from a specific injury such as a fall or lifting incident (acute tears). Some people have a combination of old and new injuries.

When Is It Needed?

Rotator cuff tears may be treated conservatively (non-surgically) or surgically, depending on the tear size, type and your symptoms.

Conservative (non-surgical) treatment may be appropriate for:

• Partial thickness tears
• Smaller tears without significant functional loss
• Pain and weakness that improve with physiotherapy, anti-inflammatory medication and steroid injections over several months

Surgery may be recommended when:

• Pain and weakness persist for several months despite conservative treatment
• The tear is large (typically 2–3 cm or larger)
• The tear is from a recent, acute injury
• Imaging shows the tear is enlarging over time
• You are active and use your arm for overhead work or sports, and conservative treatment has not resolved your symptoms

The Procedure

Rotator cuff repair is performed via minimally invasive arthroscopic surgery. During the procedure, Dr Markham will:

• Reattach the torn tendon to the bone of the humerus using suture anchors
• Remove any bone spurs if present (acromioplasty) to reduce pressure on the repaired tendon and promote healing

Arthroscopic surgery is less invasive than open surgery, resulting in smaller incisions and often less post-operative pain. The procedure is commonly performed as day surgery.

Recovery & Rehabilitation

Recovery from rotator cuff repair requires protection of the repair whilst the tendon heals, combined with gradual rehabilitation.

• 0–6 weeks: A sling is worn continuously to protect the repair as it heals. Gentle range-of-motion exercises begin within prescribed limits to prevent stiffness.
• 6–12 weeks: Sling use gradually reduces. Strengthening exercises are introduced under physiotherapy guidance.
• 3–6 months and beyond: Progressive return to normal activities and sport, guided by your surgeon and physiotherapist.

Swelling and bruising are normal in the first 1–2 weeks and can be managed with ice packs. Discomfort usually improves within a few days with pain medication.

Adhering strictly to the sling protocol and physiotherapy instructions is essential to protect the repair and optimise your outcome.

Risks & Complications

Most rotator cuff repairs heal successfully with appropriate post-operative care. However, as with all surgery, complications can occur:

Common side effects (usually minor and temporary):

• Pain and discomfort for the first few days
• Swelling and bruising

Less common complications:

• Stiffness (frozen shoulder), minimised with early prescribed exercises
• Retear of the repaired tendon, minimised by adherence to sling protocol and activity restrictions
• Nerve damage, which can cause temporary or rarely permanent changes in sensation or weakness
• Infection
• Reaction to anaesthesia

Contact your surgeon promptly if you develop fever, redness or drainage from the incision sites, or if pain worsens after 5 days.

Frequently Asked Questions

Is rotator cuff repair painful? You may experience discomfort after surgery, especially as the local anaesthetic blockade wears off on the first day. Pain is usually manageable with prescribed medication and typically subsides within a few days. Arthroscopic repair is generally less painful than open surgery.

Can I shower after surgery? You can generally shower within 1–2 days of surgery, keeping the surgical dressing intact and dry. Your surgeon will advise when the dressing can be removed or replaced.

When can I return to normal activities? Most patients can resume light daily activities after 2 weeks, though the sling is typically worn for 6 weeks. Return to sport and overhead activities usually takes 3–6 months, depending on the tear size and your progress in physiotherapy.

What if my rotator cuff tears again after repair? Retears occur in a small number of cases. Risk is reduced by wearing the sling for the prescribed 6 weeks, avoiding heavy lifting, and following physiotherapy instructions carefully.

Will I need physiotherapy after surgery? Yes. Physiotherapy is essential for optimal recovery. It prevents stiffness, strengthens the repaired tendon, and supports your return to function. Your surgeon will provide specific guidance on the rehabilitation program.