Surgery for rotator cuff problems

The group of muscles and tendons that stabilise the shoulder joint is called the rotator cuff. It allows a wide range of motion. Injuries or degenerative changes to the rotator cuff are common and can result in significant pain, weakness and reduced function. While many cases respond to non-surgical treatment, surgery may be recommended for more severe or persistent rotator cuff problems.

What is a rotator cuff injury?

Rotator cuff problems include inflammation (tendinitis), partial tears and full-thickness tears of the tendon. These can develop gradually due to wear and tear, especially in older adults, or suddenly following trauma or overuse.

Common symptoms include:

Shoulder pain, particularly when lifting or reaching overhead
Weakness in the arm
Disturbed sleep due to shoulder discomfort
Difficulty performing routine tasks

If symptoms do not improve with rest, physiotherapy or injections, surgery may be required to restore shoulder function.

When is surgery considered?

Surgery is typically considered if:

There is a full-thickness tear of the rotator cuff
Symptoms have not improved after several months of conservative treatment
The injury significantly limits daily activities
The patient is active and wishes to return to sports or manual work

A detailed clinical assessment and imaging, such as MRI or ultrasound, help determine whether surgery is appropriate.

What surgical options are available for rotator cuff problems?

There are several procedures that may be used to treat rotator cuff problems, depending on the extent of the damage.

Common surgical options include:

Arthroscopic rotator cuff repair: A minimally invasive technique using small incisions and a camera to reattach torn tendons to the bone using sutures and anchors.
Mini-open repair: Combines arthroscopic and traditional approaches, suitable for larger or more complex tears.
Open rotator cuff repair: A traditional surgical method used for extensive tears, involving a larger incision.
Tendon transfer: If the rotator cuff is irreparable, nearby tendons may be repositioned to restore function.
Shoulder replacement (reverse total shoulder arthroplasty): Considered in older patients with massive, non-repairable tears and shoulder arthritis.

What to expect after surgery

Rotator cuff surgery recovery can take several months. Patients usually wear a sling for the first few weeks, followed by a structured rehabilitation programme to regain strength and mobility.

Postoperative care typically includes:

Wearing a sling for 4–6 weeks
Physiotherapy to restore range of motion and strength
Pain management with medication
Avoiding heavy lifting and overhead activities during recovery

Outcomes are generally good, especially if the surgery is performed early in the course of the condition.

Is rotator cuff surgery always necessary?

Not all rotator cuff problems require surgery. Many patients with partial tears or inflammation can recover with physiotherapy, rest and injections. However, if symptoms persist or the tear is complete, surgery may offer the best chance of restoring normal shoulder function and reducing pain. A specialist shoulder surgeon can help determine the most appropriate treatment based on individual circumstances.