Rotator Cuff Repair – Frequently Asked Questions

Posted by Eric J. Sanders, MD | Shoulder & Elbow Specialist

1. What is a rotator cuff tear?

   
   The rotator cuff is a group of four muscles and tendons that stabilize the shoulder. A tear occurs when one or more of these tendons is damaged, either from injury or degeneration over time.

   
   

2. How do I know if I need surgery?

   
   Surgery is usually recommended if you have a full-thickness tear, ongoing pain or weakness that doesn’t improve with physical therapy, or if your lifestyle or activity level demands full shoulder strength and function.

   
   

3. What are the risks of not having surgery?

   
   Some rotator cuff tears can worsen over time, leading to increased pain, muscle weakness, or even irreversible damage. However, not all tears require surgery, and many can be managed with therapy and medications.

   
   

4. What does the surgery involve?

   
   Most rotator cuff repairs are done arthroscopically using small incisions and a camera. The torn tendon is reattached to the bone using sutures and anchors. Anchors create attachment points into the bone. The sutures coming from the anchors then compress the tendon to the bone to allow for healing. In general, anchors can be absorbable or nonabsorbable (permanent), however the suture is always nonabsorbable. In more complex cases, open surgery or tendon transfers may be necessary.

   
   

5. How long is recovery after surgery?

   
   Recovery is gradual. Most patients wear a sling for 4–6 weeks and begin physical therapy shortly after. Full recovery can take 4–6 months or longer, depending on the tear and individual healing.

   
   

6. Will I need physical therapy?
   Yes. Physical therapy is essential after surgery to regain motion, strength, and shoulder function. A structured rehab plan helps protect the repair while restoring use of the arm.

   
   

7. Is the surgery successful?

   
   Rotator cuff repair has a high success rate, especially when done early and in healthy tissue. Outcomes depend on factors like tear size, tendon quality, age, and following rehab instructions.

   
   

8. Are there alternatives to surgery?

   
   Yes. Physical therapy, anti-inflammatory medications, and corticosteroid injections can help manage symptoms for small or partial tears. Your surgeon will guide you based on your specific tear pattern and goals. Surgery should be encourage for certain large and or acute tears and tears that cause continued pain despite physical therapy.

   
   

9. Will the tear come back after surgery?

   
   Re-tears can happen, especially in larger or degenerative tears, but proper technique and rehab greatly reduce this risk. In some cases, biologic treatments or tissue augmentation may be used to support healing.

   
   

   Based off your tear characteristics and demographics, your surgeon can give you an estimated percentage of your rotator cuff not healing. It is important to realize that the rotator cuff failing to heal is the most common complication after surgery. This complication however is an predictable occurence in up to 40% of certain tear types.

   
   

10. When can I return to work or sports?

    
    This depends on your job or sport. Desk jobs may resume in a few weeks, while heavy labor or athletic activities may take 5 -6 months. Your care team will provide personalized guidance.

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