The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, providing stability and facilitating movement, such as lifting and rotating the arm. When these tendons tear, it can severely limit arm function and cause persistent pain. While non-surgical methods like physical therapy and injections are often the first approach, surgery becomes necessary when a full-thickness tear is present or when conservative treatment fails. The goal of the surgical procedure is to reattach the torn tendon securely to the upper arm bone (humerus) to restore the shoulder’s natural mechanics.
Selecting the Surgical Method
A surgeon’s choice of technique is determined by several factors, including the size of the tendon tear, the quality of the remaining tendon tissue, and the overall complexity of the injury. Three surgical approaches are used to gain access to the damaged area and perform the repair. The most frequently utilized method is arthroscopic repair, which is minimally invasive, using a small camera (arthroscope) and specialized instruments inserted through several small incisions, each typically about a centimeter long. This approach is favored for its reduced muscle disruption, which can lead to less post-operative pain and a quicker initial recovery period.
For larger tears, or those requiring slightly more direct visualization, the surgeon may select a mini-open repair. This technique combines the use of the arthroscope for initial assessment and preparation with a slightly larger incision, often 3 to 5 centimeters, to complete the final tendon reattachment. The mini-open method is an effective compromise, offering better access than a purely arthroscopic procedure while still minimizing the extensive muscle cutting required in a traditional operation.
The third option is traditional open repair, which involves a single, larger incision, providing the surgeon with a direct view of the entire shoulder joint. This method is reserved for the most complex cases, such as massive, retracted tears or when additional procedures like a tendon transfer are necessary. The choice among these three methods dictates how the surgeon accesses the joint, but the fundamental steps of repairing the tendon remain consistent.
Repairing the Tendon
Regardless of the surgical approach used to access the joint, the first phase of the actual repair involves preparing the site for reattachment. The surgeon must first perform a thorough inspection and debridement, which involves removing any frayed or damaged tendon tissue and smoothing the edges of the tear. This preparation also includes addressing any bony irregularities, such as removing bone spurs (osteophytes) from the underside of the acromion, a process called acromioplasty, to create more space for the repaired tendon.
The next step is securing the torn tendon back to the head of the humerus, which is achieved through the use of specialized medical devices called suture anchors. These small implants, often made from a strong, biodegradable plastic, are carefully placed into the bone at the site where the tendon naturally attaches. Each anchor is pre-loaded with high-strength sutures that act as the threads to pull the tendon back into place.
The surgeon uses specialized instruments to pass these sutures through the torn tendon. Once woven through, the sutures are pulled taut and tied, cinching the torn tissue back down against the prepared bone surface. This creates a secure mechanical fixation that holds the tendon in position while the body’s natural healing process takes place. If the biceps tendon is also damaged, a concurrent procedure like a biceps tenodesis may be necessary before final closure.
Immediate Post-Procedure Care
Immediately following the procedure, the patient is moved into a recovery area where the focus shifts to controlling pain and protecting the delicate repair. A significant component of pain management is the use of a nerve block, an injection of long-acting numbing medication near the nerves of the neck or shoulder that can provide profound pain relief for many hours after the surgery. As the nerve block gradually wears off, the patient transitions to oral pain medications, often a combination of narcotic and non-narcotic drugs, to manage the discomfort.
Protecting the healing tendon requires strict immobilization of the arm in a specialized sling, often with an attached pillow for positioning. Patients are instructed to wear this sling continuously for four to six weeks to prevent any active movement of the shoulder that could jeopardize the repair. During this initial period, patients must avoid any active lifting, reaching, or supporting their body weight with the operative arm.
Managing the incision sites is a priority to prevent infection. Patients are instructed on keeping the dressings clean and dry, and they are advised not to submerge the surgical site in water until approved. The first follow-up appointment usually occurs within seven to fourteen days, where the surgeon examines the wound, removes any non-dissolvable sutures, and transitions the patient toward the next phase of recovery.
Rehabilitation and Recovery Timeline
The journey back to full shoulder function follows a structured, phased rehabilitation program. The initial period, lasting approximately six weeks, focuses on passive range of motion, where a physical therapist gently moves the arm without the patient engaging the repaired muscles. This phase prevents stiffness while protecting the tendon-to-bone attachment.
Around six weeks after the procedure, patients progress to the active range of motion phase, where they begin moving the arm on their own, initiating muscle contraction. The final phase, typically starting at three to four months post-surgery, is the strengthening phase, which rebuilds the power and endurance of the rotator cuff muscles. While many patients regain adequate function within four to six months, full recovery and return to vigorous activities can take six months to a year, depending on the original tear size and individual healing factors.