Rotator Cuff Repair

Rotator cuff repair is a minimally invasive shoulder surgery that reattaches a torn tendon to the bone, helping patients reduce pain, restore shoulder function, and return to the activities that matter most.

A rotator cuff tear can make everyday shoulder movements painful, weak, and frustrating. While many rotator cuff tears can improve with rest, medication, activity modification, injections, and physical therapy, some tears need surgery to restore the tendon’s attachment to the bone.

Rotator cuff repair is used when a torn tendon needs to be reattached to the upper arm bone in order to preserve the shoulder's normal function. Dr. Romeo performs rotator cuff repair arthroscopically, using a small camera and surgical instruments inserted through small incisions around the shoulder. This minimally invasive approach allows him to repair the tendon without making a large open incision, which can injure surrounding healthy tissue and take longer to heal.

“The goal of rotator cuff repair is to help the torn tendon heal back down to the bone.”

Why treatment is required

Not every rotator cuff tear needs surgery. Tears that develop slowly over time may improve with nonsurgical care, including rest, ice, anti-inflammatory medication, avoiding aggravating activities, physical therapy, steroid injections, or orthobiologics. However, if symptoms do not improve after three to six months of nonsurgical treatment, surgery may be recommended.

Rotator cuff repair may also be the best option for active patients who experience a sudden tear. In these cases, surgery is often the most reliable way to allow the tendon to heal back to the bone and restore strength and function.

Patients may consider rotator cuff repair if they have:

• Ongoing shoulder pain despite nonsurgical treatment
• Weakness with lifting or rotating the arm
• Night pain that interferes with sleep
• A traumatic or sudden tear
• A larger tear that may worsen over time
• Difficulty returning to work, sports, or daily activities

Larger tears can become more difficult to treat if they continue to enlarge. When a tear extends into a second or third tendon, shoulder function may become permanently limited, even if surgery is performed later.

How treatment is performed

Dr. Romeo performs rotator cuff repair arthroscopically. During the procedure, he inserts a tiny camera into the shoulder joint through a small incision, allowing him to see the torn tendon and surrounding structures in detail. Small surgical instruments are then used to prepare the tendon and bone so the tendon can be repaired using strong sutures.

The exact repair depends on the size and location of the tear. The most common rotator cuff repair involves reattaching the supraspinatus tendon to the top of the upper arm bone, known as the humerus.

Rotator cuff repair is usually performed as an outpatient procedure in an ambulatory surgery center, unless a patient’s medical condition requires a different surgical setting.

Risks and benefits

As with any surgery, rotator cuff repair has risks. These may include infection, bleeding, stiffness, blood clots, anesthesia-related complications, incomplete healing, re-tear of the tendon, or ongoing pain or weakness. Some patients may also have limitations in strength or overhead function after recovery, especially if the original tear was large or involved more than one tendon.

The potential benefits of rotator cuff repair include:

• Reduced shoulder pain
• Improved sleep
• Better shoulder motion
• Improved strength and function
• A greater chance of returning to work, sports, and daily activities
• Repairing the tendon before the tear becomes larger or more complex
• Decreased risk of osteoarthritis developing due to shoulder instability

“Ignoring a large tear can have significant consequences. Unfortunately, larger tears get worse over time.”

Physical therapy protocols

Recovery after rotator cuff repair is gradual because the tendon needs time to heal back into the bone. Physical therapy is an important part of the process, but it must be introduced carefully to protect the repair.

Pain control

Pain control after rotator cuff repair may include an interscalene nerve block, oral pain medications, anti-inflammatory medicine if allowed, ice, and careful activity modification. The nerve block typically provides 8 - 24 hours of pain relief, although this varies from person to person.

Patients are often prescribed a combination of medications that work in different ways. These may include Tylenol and ibuprofen for moderate pain, and Oxycodone for severe pain if other medications are not controlling discomfort. Patients should take all medications only as directed and should not drive or drink alcohol while taking narcotic pain medication.

Ice can also help reduce pain and swelling. Patients may use ice packs or an ice machine, always keeping a barrier between the cold source and the skin. Sleeping slightly reclined, such as in a recliner or with pillows, can also help reduce discomfort during the early recovery period.

Recovery time

Rotator cuff repair recovery takes time. After surgery, patients go home wearing a sling or immobilizer to support and protect the shoulder. Some swelling and bruising are normal, and ice can be used several times a day to help manage discomfort.

Patients generally begin with protected home exercises, followed by formal outpatient physical therapy. The early phase is focused on protecting the repair. Later phases focus on restoring motion, rebuilding strength, and gradually returning to daily activities, work, and sports.

Return to work depends on the patient’s job responsibilities. Patients with jobs that do not require use of the surgical arm may return when they feel comfortable. Jobs that involve greater strain, especially overhead work, may require up to 3 months before returning to full duty.

Patients with light or medium physical demands may often return to that level of activity between 6 and 8 months. Full recovery and maximum medical improvement may take up to 12 months.

Results

Most patients experience significant or complete pain relief after recovering from rotator cuff surgery and no longer need pain medication. Many patients maintain or improve their pre-operative range of motion.

Strength recovery depends on the size of the tear. Patients with smaller tears are more likely to return to a similar activity level. When two or more tendons are repaired, patients may be less likely to regain full strength and may have more difficulty with overhead activities such as reaching or throwing.

People with light-to-medium physical work demands are often able to return to the same level of work after recovery. Patients who regularly lift more than 50 pounds may need ongoing restrictions, especially for overhead lifting.

FAQs

How do I know if I need rotator cuff repair?
You may need rotator cuff repair if your tear has not improved after several months of nonsurgical treatment, if you have significant weakness or pain, or if the tear happened suddenly and you are active. Dr. Romeo will consider your symptoms, exam findings, imaging, activity goals, and the size and location of the tear.

Is rotator cuff repair done open or arthroscopically?
Dr. Romeo performs rotator cuff repair arthroscopically using a tiny camera and tools inserted through small incisions. This allows him to repair the tendon without making a large open incision.

How long will I be in a sling?
The physical therapy protocol notes that patients remain in a sling during the first 6 weeks after surgery. However, individual instructions may vary depending on the tear and repair.

When does physical therapy start?
Patients begin home exercises soon after surgery, including elbow, wrist, hand, and gentle pendulum exercises. Formal outpatient physical therapy typically begins after surgery based on Dr. Romeo’s instructions and the specific repair.

When can I return to sports?
Sports-related rehab may begin around 4½ months, with sports-specific activity around 6 months. Collision sports may be delayed until around 9 months.

Can a rotator cuff tear get worse if I ignore it?
Yes, especially if the tear is large. Larger tears can progress over time, and once a tear extends into additional tendons, shoulder function may be permanently affected even if surgery is later performed.

Will I get all my strength back?
It depends on the size and severity of the tear. Patients with smaller tears are more likely to regain a similar level of activity. Patients with larger tears or multiple tendon repairs may have some lasting strength limitations, especially with overhead activity.