Rotator Cuff Repair Surgery: What to Expect

What Is Rotator Cuff Repair?

Rotator cuff repair is a surgical procedure to reattach a torn rotator cuff tendon — most commonly the supraspinatus — back to its insertion on the humeral head (the ball of the shoulder). The vast majority of repairs are performed arthroscopically (through tiny portals using cameras and small instruments), offering less tissue damage and faster recovery than open surgery.

Why Surgery May Be Recommended

Surgical repair is typically recommended when:

• You have an acute full-thickness tear (especially if young and active)
• A tear is large or massive
• Conservative treatment has failed after 3–6 months
• You have progressive weakness or functional limitation
• The tear is in the subscapularis (a functionally critical muscle)

Note: Larger tears and older patients with significant muscle atrophy (fatty infiltration) have less predictable repair outcomes. Your surgeon will assess the "reparability" of the tear on MRI.

Pre-Operative Preparation

• Discontinue blood thinners as directed (usually 5–7 days before)
• NPO (no food or water) from midnight before surgery
• Arrange a driver and someone to stay with you the first 2–3 nights
• Prepare your home for sling use — set up a comfortable sleeping chair or recliner
• Buy a sling pad/abduction pillow in advance if possible

Day of Surgery

Arrival

Check in 1–2 hours before surgery. IV placement, medical history review, vitals monitoring.

Regional Nerve Block

Most rotator cuff patients receive an interscalene nerve block — an injection near the neck that numbs the entire arm and shoulder for 12–18 hours post-operatively. This dramatically reduces post-operative pain. You will also receive general anesthesia.

Surgical Position

You will be positioned in either:

• Beach chair position: Seated upright (most common for shoulder surgery)
• Lateral decubitus position: Lying on the side with the arm in traction

Arthroscopic Repair Steps (45–120 minutes)

1. Small portals (5mm) are made around the shoulder — typically 3–4 portals
2. The arthroscope (camera) is inserted; the joint is irrigated with fluid to visualize structures
3. The surgeon inspects the entire joint — labrum, biceps tendon, articular cartilage, and the subacromial space
4. The torn tendon edge is freshened ("debrided") with a shaver
5. The bone at the tendon's insertion is prepared by removing the outer cortex (a "footprint") to promote healing
6. Suture anchors (small titanium or biocomposite screws loaded with strong sutures) are inserted into the bone
7. The sutures are passed through the torn tendon edge and tied, pulling the tendon back to bone
8. For larger tears, multiple rows of anchors may be used ("double-row repair") to maximize footprint coverage
9. Any other pathology (biceps tear, labral tear, bone spurs) may be addressed simultaneously
10. Portals are closed with 1–2 sutures each; shoulder is placed in an abduction sling

Recovery Room (PACU)

You will awaken with the nerve block still active — your arm may feel completely numb and heavy. This is expected. You will be discharged home in 1–3 hours once stable.

Risks and Complications

• Re-tear (10–20%): The most common complication; larger tears and older patients have higher re-tear rates
• Stiffness (adhesive capsulitis): Shoulder can become stiff if mobilization is delayed; uncommon with modern rehab protocols
• Infection (<1%)
• Nerve injury (rare): Axillary or suprascapular nerve injury
• Biceps tendon rupture: May occur if biceps was not separately addressed
• Anesthesia complications

What to Bring

• Loose-fitting button-front or very wide-neck shirt
• Slip-on shoes
• The nerve block will make your arm completely numb and useless — have someone dress and assist you
• Have your abduction pillow ready at home
• Ice machine or shoulder ice wrap prepared in advance