Rotator cuff repair: what happens, risks and recovery

The rotator cuff is a group of tendons that hold the ball of the shoulder in its socket and lift and rotate the arm. A tear can follow an injury or wear gradually with age. Pain at night, weakness lifting the arm and difficulty reaching overhead are typical.

Not every tear needs an operation. Many partial tears and some full-thickness tears in less active people settle with physiotherapy and sometimes injections, and a scan that shows a tear does not by itself mean surgery is required. Repair is more likely to be recommended after a recent injury in an active person, when weakness is marked, or when exercises have not helped.

The RNOH guide notes that the supraspinatus tendon at the top of the shoulder is the one most often affected.

Before the operation you will have a pre-assessment that covers medicines, previous anaesthetics and fasting times. If you smoke, stopping before surgery gives tendons a better chance of healing. Think ahead about the weeks in a sling: front-opening clothes, a plan for sleeping semi-upright, and help with cooking and washing.

• Practise one-handed tasks you will need to do, such as dressing and making a drink.

• Arrange a recliner or extra pillows for sleeping.

• Ask about who you will see for physiotherapy and when the first session is booked.

The RNOH guide describes a general anaesthetic combined with an interscalene block, an injection of local anaesthetic around the nerves that supply the arm, for pain relief over the first day. The aim is often a same-day discharge, though that varies.

The surgeon may work through keyhole cuts or an open incision and reattaches the torn tendon to bone. At Southampton, keyhole surgery leaves small wounds closed with sticking strips and waterproof dressings, whereas a mini-open repair may use dissolvable stitches.

You wake in a sling. Because the nerve block wears off, the leaflet advises you to start painkillers before it fades.

The RNOH guide lists re-tear during healing, stiffness needing therapy, infection, nerve or blood vessel damage (less than 1%), blood clots and anaesthetic complications. Re-tear is the risk specific to this operation, and the chance rises with larger or older tears. Ask your surgeon how those factors apply to you.

Stiffness is common early on and is managed through the physiotherapy plan. The sling and movement limits exist to protect the repair while it heals.

Southampton's leaflet describes using the sling at all times while the arm is numb, then for around five to six weeks after a major repair, gradually reducing, and not lying on the operated side for that period. Wound checks happen around days five and fourteen.

The RNOH guide describes no active arm use for six weeks, gradual sling weaning from six to twelve weeks and normal activities from about twelve weeks, with sport usually avoided until ten to twelve months. Exercises can continue for up to nine months, per Southampton.

Return to desk work is quoted at six to eight weeks and to manual work at three to four months at the earliest. Lifting is limited for eight to twelve weeks and heavy outdoor work for four to six months.

• Fever, rising pain, or a wound that is becoming red, hot or leaking: contact the hospital or NHS 111.

• A swollen, painful calf or chest pain with breathlessness: urgent care, 999 if severe.

• Pins and needles or colour changes in the hand that do not improve once the block has worn off.

• Sudden loss of the movement you had gained, which may signal a problem with the repair.

• How big is my tear and how likely is it to heal?

• Will you do it keyhole or open?

• How long will I need the sling and what can I do with the arm?

• When do I start physiotherapy and who leads it?

• When can I drive, work and swim?

The surgery is the same in either setting. The difference is mainly access: waiting time, choice of surgeon, imaging done in advance and how physiotherapy is bundled in. Because rehabilitation is long and decisive, ask whichever route you use how many physiotherapy sessions are included and who to contact if progress stalls.