Rotator Cuff Repair
A fibre-optic scope and small, pencil-sized instruments are inserted through small incisions instead of a large incision. The arthroscope is connected to a television monitor and the surgeon performs the repair under video control.
About the Procedure
Arthroscopic rotator cuff repair is a minimally invasive surgery to repair torn tendons in the shoulder. A small camera (arthroscope) and specialized instruments are used to:
- Examine the shoulder joint
- Remove damaged and inflammatory tissue
- Smooth the bone (subacromial decompression)
- Reattach the torn rotator cuff tendon using bio-absorbable or metal anchors.
Prof. Singh's Approach
- Uses a knotless technique for smooth repairs, minimizing irritation
- Dissolvable sutures and splash-proof dressing are applied after surgery.
The aim of the operation is to examine your shoulder thoroughly followed by a full debridement, where any frayed tendon tissue is removed and any inflammatory tissue, that might be restricting movement, is also removed. A subacromial bursectomy and decompression is usually then performed so that a full assessment of the tear is undertaken. The surgeon will reattach the torn rotator cuff to its ‘Foot Print’ i.e. where it was originally attached.
The anchors are usually bio-absorbable, meaning the body absorbs them over time. Sometimes, a metal anchor is used, which does not need to be removed. Prof Singh uses a knotless system which means that the repair is smooth and less likely to cause any irritation.
At the end of surgery, the wound is closed with dissolvable sutures under the skin. Butterfly stitches, splash proof dressing and a pad is applied, and the arm rested in a sling.
Frequently Asked Questions
What if I don’t have surgery for a torn rotator cuff?
The tear may enlarge, causing persistent pain, reduced strength, and limited shoulder movement over time.
Are there anaesthesia-related complications?
These are rare but can include allergic reactions, breathing difficulties, or other adverse effects. Your anaesthetist will discuss specific risks based on your health.
What is the risk of infection?
Occurs in fewer than 1 in 1000 cases due to strict surgical sterility protocols. Treated effectively with antibiotics if it arises.
Will there be stiffness?
Mild stiffness is common post-surgery and improves with physiotherapy.
Complete re-stiffening is rare but can occur, especially in diabetic patients, prolonging recovery by a few months.
Will I get much pain?
Initial Pain: Expected for the first few weeks post-surgery and managed with simple painkillers.
Persistent Pain: Some patients may experience discomfort at 2–3 months, often resolved with a steroid injection.
Could it fracture?
Extremely rare complication if excessive bone is removed during acromion shaving. This may require surgical fixation if it occurs.
Might there be failure to improve?
Expected outcomes are:
- 80–85% of patients achieve good to excellent recovery with improved function
and pain relief. - 15% experience mild discomfort but remain satisfied.
- 5% may have persistent issues like pain or stiffness, potentially requiring further surgical intervention.
Could there be re-tear and need revision surgery?
MRI studies indicate a high rate of re-tears post rotator cuff repair, but most are asymptomatic and do not require treatment.
Clinically relevant re-tear rates are low (<5%), and revision surgery is seldom necessary.
What kind of anaesthesia is used?
A combination of general anaesthesia and a nerve block for effective pain relief lasting 12–36 hours.
How long will I be in the hospital?
Most patients go home the same day.
Before Surgery
- Fasting:
No food for 6 hours and no drinks for 2 hours before surgery. - Smoking:
Avoid smoking for at least 12 hours before surgery to aid healing. - Medications:
Continue taking prescribed medications as advised by the pre-assessment team
What happens on the day of surgery?
You will need to report to the main reception on arrival. You will be shown to your room where you will be checked in by the nurse and also see Prof. Singh and the anaesthetist. This will give you chance to ask any questions before surgery. You will also be given an approximate time of your procedure. Please read the instructions on Preparing for Surgery.
What happens after surgery?
Please review the Post-Operative Instructions After Shoulder Arthroscopy
Sling
After your surgery, you will be fitted with a high arm sling, which is for your comfort, you can discard this as soon as you feel comfortable. Most patients find that they use it for between 2-4 weeks depending on their pain levels and activity.
Pain Management
You will be given a prescription for pain medication. Pleasestart your regular medication as soon as possible after the operation.
At Home
Ice Therapy: Use ice on your shoulder for 15 minutes, 2 times per day or after exercise and therapy. Gel packs, frozen peas or a plastic pack of ice can be used. These must be wrapped in a moist towel as direct contact with the skin can cause burns (cover your dressings with cling film or a plastic bag to prevent them getting wet).
Sleeping
Sleeping can be uncomfortable if you try and lie on your operated arm. We would recommend that initially you lie on your back or on the opposite side. If you lie on your back support the operated arm with a folded pillow under your lower arm. Make sure that your elbow is above your shoulder. If you are on your side then a folded pillow supports your operated arm from your elbow to your wrist.
Removal of Stitches & Wound Care
Usually there are no stitches to be removed. You will have a thick dressing over your wound on your shoulder. The ward staff will advise you when and how it should be removed. This is usually changed at 24 – 48 hours after surgery. The butterfly stitches can be inspected by the practice nurse at your GP surgery. You can shower after 3 days with the dressings on and leave the wound free to air after 10 days. If any stitches need to be removed, the team will inform you.
Return to Work
The time that you can return to work will depend on the nature of your work. If you are in a relatively sedentary job you may be able to return as early as 2-4 weeks after surgery. If your job involves heavy lifting or sustained overhead positions it may take up to 6-8 weeks before you can return. Your doctor and physiotherapist will discuss this with you and advise you accordingly.
Leisure Activities
You should avoid sustained repetitive overhead activities for up to 12 weeks. You can usually start swimming when you are out of the sling – usually 6 to 8 weeks after surgery breast-stroke is advisable initially. Patients generally return to activities such as Golf at about 8 – 12 weeks. You should avoid physical contact sports like rugby or football for 6 months. For specific guidance regarding sport or DIY please speak to your consultant / therapist.
Driving
When you feel comfortable and have a good range of movement you can begin driving, typically at approximately the 6-8 weeks’ post-operative stage, after your sling has been removed. It is advisable to check this with your Doctor or Physiotherapist if you are unsure. It is important to advise your Motor Insurance Company that you have had Shoulder Surgery.
Follow-up Care
Follow-up Orthopaedic Clinic
You will need to be reviewed in clinic by Prof Singh after your operation to monitor your progress. This is usually 2-4 weeks after surgery.
Physiotherapy After My Operation
A physiotherapist will assess you at the time of your operation and will give you exercises to do before you go home. You will be referred to physiotherapy either in the community or an outpatient department. Rehabilitation typically takes 4 to 6 months and in some cases, may take up to a year.
For specific advice about activities or concerns, please contact Prof. Singh or your physiotherapist.