Introduction
A rotator cuff repair is a surgical procedure performed to fix a torn rotator cuff, a group of four muscles and their tendons that stabilize the shoulder joint and allow you to lift and rotate your arm. Rotator cuff tears are a common cause of shoulder pain and disability, particularly in older adults due to gradual wear and tear (degenerative tears), or in younger individuals following a sudden injury or repetitive overhead sports (acute tears). Symptoms often include a dull ache deep in the shoulder, arm weakness, and pain that worsens at night or when lifting the arm. When rest, physical therapy, and steroid injections fail to relieve the pain or restore function, or if the tear is large and recent, surgery is usually recommended. The goal of the surgery is to reattach the torn tendon back to the head of the humerus (upper arm bone), thereby relieving pain and restoring shoulder strength and mobility.

Surgical Procedure
Rotator cuff repairs are typically performed under general anesthesia, often combined with a regional nerve block to provide post-operative pain relief.
The surgery can be performed using an open, mini-open, or fully arthroscopic technique. Arthroscopic repair is the most common method today.
During an arthroscopic repair, the surgeon makes several small incisions (portals) around the shoulder. An arthroscope (a small camera) is inserted into one portal to view the joint on a monitor. The surgeon first cleans out any inflamed tissue or loose bone fragments and may shave down bone spurs that are rubbing against the tendon (a procedure called subacromial decompression).
To repair the tear, the surgeon uses specialized miniature instruments inserted through the other portals. Small implants called suture anchors (made of metal, plastic, or a dissolving material) are drilled into the bone of the humerus. Sutures attached to these anchors are then passed through the torn edge of the tendon and tied securely, pulling the tendon tightly against the bone. Over time, the tendon will heal and reattach itself to the bone. The small incisions are closed with stitches or sterile tape.

Surgical Risks
While generally safe, rotator cuff repair carries risks such as adverse reactions to anesthesia, infection, and minor bleeding.

General Complications
Common complications during the lengthy recovery include:
– Significant shoulder pain, which is typically worst in the first few days and managed with prescribed medications and the nerve block.
– Shoulder stiffness, which is very common and requires months of dedicated physical therapy to overcome.
– Difficulty sleeping, as lying down often exacerbates shoulder pain.

Rare but Serious Complications
Serious complications can include:
– Re-tear or failure to heal: This is the most common significant complication. The tendon may tear again or fail to fuse to the bone, particularly in older patients with poor tissue quality, smokers, or those with very large tears.
– Frozen Shoulder (Adhesive Capsulitis): Severe stiffness and restricted movement that may require further treatment or a prolonged recovery.
– Nerve damage: Injury to the nerves surrounding the shoulder, causing weakness or numbness in the arm.
– Deep joint infection.

Pre-operative Preparation
– Medical Evaluation: An MRI is usually required to confirm the size and location of the tear. Routine blood tests and a physical exam ensure you are fit for surgery.
– Medication Management: Stop taking blood thinners and anti-inflammatory medications (NSAIDs) several days before surgery to minimize bleeding.
– Home Preparation: Because you will have limited use of one arm, prepare meals in advance, arrange clothing that is easy to put on (like button-down shirts), and ask someone to help you with daily tasks for the first few weeks.
– Fasting: No eating or drinking for 8 to 12 hours before the procedure.

Post-operative Care
This is usually an outpatient procedure, so you will go home the same day. Your arm will be immobilized in a sling, often with a small pillow (abduction pillow) to keep the arm slightly away from the body and reduce tension on the repair. Pain management is crucial; take medications as prescribed and use ice packs frequently.

Wound Care
– Keep the incisions clean and dry. Your surgeon will provide specific instructions on when you can shower (usually after a few days, keeping the wounds covered).
– Do not soak the shoulder in a bath or pool.
– Monitor for signs of infection, such as spreading redness, heat, increasing swelling, or pus.

Diet
Maintain a healthy diet to promote tissue healing. Avoid smoking entirely, as it severely impedes tendon healing.

Post-discharge Notes
Recovery from a rotator cuff repair is slow and requires patience.
– You will wear the sling for 4 to 6 weeks, removing it only for dressing, showering, and specific physical therapy exercises.
– Physical therapy is divided into phases: first passive motion (the therapist moves your arm), then active motion (you move your arm without resistance), and finally strengthening exercises (usually starting 8 to 12 weeks post-op).
– Full recovery and return to heavy lifting or overhead sports can take 6 to 9 months or longer.
– Contact your doctor if you experience a fever, severe pain not relieved by medication, or sudden loss of movement in the hand or fingers.