The Lister Hospital
Chelsea Bridge Road SW1W 8RH London
Rotator cuff repair surgery
Rotator cuff repair surgery is a procedure that repairs torn or injured tendons in the shoulder, with the aim of restoring function and reducing pain in the affected area.
With HCA UK, you'll receive:
- Appointments confirmed within 24 hours
- Shoulder cuff tear treatment and surgery at private hospitals across London and in Cheshire
- Expert care provided by specialist shoulder consultants
What is rotator cuff repair surgery?
Rotator cuff repair surgery reattaches tendons which have torn off the ball of the shoulder at the top of the arm bone. There are many techniques and variations.
This operation is needed if the tear is the result of an injury or if the pain and weakness in the area isn’t improved with injections and physiotherapy. During the procedure, injured tendons and muscles are repaired. This may include replacing damaged parts of the tendon with a graft tendon from another part of the body. Bone spurs, if present, will be removed.
The repair is done to relieve pain and improve shoulder strength. A period of physiotherapy is required in addition to the surgery.
What is the rotator cuff?
The shoulder joint itself is formed between the humeral head, which is the ball shape at the top of the upper arm bone, and the socket on the flat shoulder blade.
The rotator cuff is the name given to the group of four shoulder muscles and the tendons that surround the shoulder joint. Tendons are strong bands of tissue that connect muscles to bones.
In the shoulder joint, the muscles are attached to the shoulder blade and become the tendons attached to the top of the arm bone (humerus); these keep the humeral head and the glenoid stable so that the ball is centred in the socket. When you move your arm, the rotator cuff muscles contract. This stops the head of the humerus from sliding out of the socket, keeping it in place while allowing for a full range of motion and controlling those movements.
Symptoms of rotator cuff injuries
The main symptoms you will experience if you have a torn rotator cuff are pain and weakness. Pain could be a constant dull ache, but is usually worsened by movement. It's often felt down the side of the arm, not in the shoulder itself. If you tear your rotator cuff in an accident, though, you might find the pain is severe, sharp and sudden. Other symptoms of a rotator cuff injury include:
- A feeling of weakness when you raise your arm or move your arm from the shoulder
- Not being able to move your shoulder fully without experiencing pain
- A clicking, grating or cracking sound when you move your shoulder, which is caused by the uneven surfaces from the tear rubbing together.
Types of rotator cuff injury
Rotator cuff tears can be categorised in various ways.
It's possible to have a partial or full tear:
- Partial tear: This is where the tendon has been damaged but it's not a complete tear. This means that the tendon is still attached to the bone, but it’s weakened by the damage.
- Full tear: The tendon has torn completely and is completely detached (torn away) from the bone. This is known as a full-thickness complete tear.
It’s possible to tear some or all of the tendons:
- Small tear: A single tendon
- Large tear: Two or more tendons or more than 2cm
- Massive tear: Three tendons or more than 5cm
It’s possible to tear quickly or slowly:
- Degenerate tears occur over months or years as part of ageing
- Acute traumatic tears occur after a fall, crash or wrench
It’s also possible to have new and old tears:
- Acute tears are younger than six months old and can usually be repaired
- Chronic tears are older than six months and may be irreparable as the muscle shortens irreversibly.
The type of tear you have will often dictate the type of surgery your consultant recommends.
Treatment options
A rotator cuff tear operation is recommended if other types of treatment haven't delivered the desired results, or if surgery is the best option for your injury. Your consultant will probably initially suggest non-surgical treatments for your shoulder cuff tear, such as:
- Lifestyle changes and rest: Your doctor may recommend rest and changes in your daily activities to help reduce pain and swelling in the joint. This could include, for example, changing how you lift items.
- Pain management: The inflammation of the soft tissue surrounding the tear in your rotator cuff can cause pain and discomfort in the shoulder. You may be offered paracetamol or non-steroidal anti-inflammatory drugs. Stronger painkillers, such as codeine, may be recommended if suitable.
Icing the shoulder throughout the day may help to reduce pain and swelling, too.
- Physiotherapy: Exercises designed to strengthen the shoulder joint and reduce pain can be tailored to suit you. Our physiotherapists can help you build strength in the shoulder, stabilising the joint and preventing further tearing.
If these treatments are unsuccessful or your pain becomes more severe, your consultant may then recommend the following:
- Steroid injections: In some cases, steroid injections may be applied to the shoulder joint. These contain an artificial version of the natural hormone cortisol. They can help reduce inflammation and pain caused by tendonitis or tear in the rotator cuff.
When will rotator cuff repair surgery be recommended?
Choosing rotator cuff surgery is a complex decision made by you and your specialist. If your pain does not improve with non-surgical methods, your doctor may offer surgery as an option for a torn rotator cuff.
Also, if you are very active and use your arms for overhead work or sports, you might need a rotator cuff operation to ensure that your shoulder can support these activities that affect the area.
Other factors that make surgery the right treatment option include:
- Your symptoms have lasted six to 12 months
- Your tear was caused by a recent, sudden accident
- You have weakness and loss of function in your shoulder
- You have a large tear that's more than 3cm in size
To confirm that a rotator cuff operation will be the most effective way to treat your symptoms, your consultant will carry out a full medical assessment. They'll also ask about any activities that make the pain worse. Your consultant will assess your shoulder's range of movement, strength and stability during a physical examination.
They may recommend imaging tests such as an X-ray and an MRI scan. These can confirm the level of damage to the joint. A specialist musculoskeletal radiologist will report on the results, providing your consultant with the full picture before discussing your treatment options with you.
What happens during torn shoulder cuff surgery?
A rotator cuff repair involves freeing up the detached tendon and securing it back where it belongs. It then heals back to the bone over about three months. Attaching the tendon is commonly done with ‘suture anchors’, often made of dissolvable material, to hold the tendon down onto the bone. Other methods can involve permanent sutures through tunnels in the bone.
There are two types of rotator cuff operation: arthroscopic or open. What kind you have will depend on how advanced the tear is. It's likely that, whichever type of surgery you have, it will be performed under general anaesthetic, although regional anaesthetic is possible.
Arthroscopic rotator cuff repair surgery
Most rotator cuff repair operations are carried out arthroscopically. This is a minimally invasive procedure that's a form of keyhole surgery. Surgeons make small cuts around your shoulder so that they can then pass equipment that includes a small surgical camera (arthroscope) into the shoulder.
The camera projects images of the inside of your shoulder onto a monitor and your surgeon uses these images to locate the damaged part of your rotator cuff. They use specialised equipment to reattach the tendon to the upper arm bone.
Open rotator cuff repair surgery
In some cases, open surgery is required. This will be recommended if you have a large tear in your rotator cuff.
The surgeon makes an incision through the deltoid muscle to gain access to the torn tendon. Sometimes this muscle is partially detached.
Reattaching the torn tendon is just the same as the keyhole operation. Stitches or staples are used to close the skin incision.
Other variations
For partial tears a ‘trans-tendon’ repair can be carried out to reinforce the damaged part, or the tear can be completed and repaired as a normal full-thickness tear.
A thin degenerate tendon can be thickened by adding a patch of material to the repair.
Sometimes massive irreparable tears are best treated by shoulder replacement.
How do I prepare for torn shoulder cuff surgery?
Your consultant will explain how the procedure works and tell you what to expect on the day of your rotator cuff repair operation and the days that follow. You can also ask any questions you have about the procedure.
It's worth taking the time before your surgery to prepare for your return home after your operation. You'll need to arrange for someone to pick you up from the hospital, as you won't be able to drive, and it's worth seeing if someone can assist you while you recover.
What is the typical rotator cuff repair recovery process?
You should be able to go home the same day. The incision made during your operation will be covered post-surgery with a dressing. After leaving hospital, you'll be advised on ways to reduce the risk of any infection.
Any stitches or clips are usually removed after one to two weeks. We'll invite you to a clinic for a follow-up assessment around six weeks after your operation. It can take up to a year to get back enough strength in your shoulder to return to normal activities.
Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask your healthcare team or your consultant for advice. It's important to be aware that you may not get back the same strength that you had before you damaged your shoulder.
Rehabilitation
Functional recovery from rotator cuff repair is quite a long process with distinct phases.
First three months
The tendon takes three months to heal back to the bone. During this time you should not try to use the repair, as it is not strong enough. You need physiotherapy to help you protect the repair. The physio will also help you recovery the range of movement in your shoulder in a safe manner.
Second three months
Once the tendon is healed you can start to rebuild the muscles that have not been able to exercise for many weeks. Strength can be regained. It is important to relearn the muscle patterns with physio supervision, to avoid the complications of poor co-ordination.
Third three months
By now you should have a fairly ‘normal’ shoulder, and you can start to train for your chosen work and leisure activities
Up to and over a year
Data shows that shoulders continue to improve a little even this long after rotator cuff repair repair surgery
When should I see a shoulder specialist?
If you're experiencing pain in your shoulder and would like to get a medical opinion, book an appointment with one of our specialist shoulder consultants. If you have private medical insurance, you'll need a GP referral letter and a reference from your private medical insurer.
They'll request any necessary imaging tests, which can usually be carried out on the same day. All treatment routes will be discussed with you before surgery is considered. If surgery is suggested, you'll be given all the information you need to make an informed decision.
You can browse the profiles of our expert orthopaedic surgeons with vast experience of performing a private rotator cuff surgery service.
Torn shoulder cuff surgery FAQs
The type of repair you receive depends on several factors, including the size of your tear, your anatomy, and the quality of the tendon tissue and bone. Many surgical repairs can be done on a day-case basis and don’t require an overnight stay in the hospital.
This depends on many factors including:
- Where you live
- The journey you intend
- Your car
- The injured side
- How severe your injury is
- What treatment you have
- How your shoulder heals
Your consultant can advise you. Legally you must be in complete control of the vehicle. Sensibly, start with short journeys and have someone accompany you in the car.
As with any type of surgery, there are risks to consider. These include:
- Bleeding
- Infection
- Nerve injury
- Stiffness in the shoulder
- Tendon re-tear
The cost of private rotator cuff surgery depends on the tests and treatment you require. Payment can be made through your medical insurance provider or by yourself. If you're a self-pay patient, please ask your consultant for information on treatment prices for peace of mind.
Please get in touch for more information about pricing and the estimated cost of private rotator cuff surgery.
To discuss your shoulder pain with an orthopaedic consultant who specialises in shoulder treatments:
- Complete our online form.
- Have your GP referral letter to hand as this can help speed up the booking process.
- We'll confirm your appointment via phone or email within 24 hours.
Why choose HCA UK for rotator cuff repair surgery?
At HCA, we have a breadth and depth of knowledge about shoulder conditions that equips us to assist in all manner of cases. Our orthopaedic team includes expert shoulder consultants. Their experience means your care is personalised to your symptoms.
Other reasons to choose us include:
- Be seen quickly: We aim for one of our shoulder consultants to see you within 48 hours of initial contact. We can also perform any required imaging tests on the same day as your consultant appointment.
- Technologically advanced imaging: We have the latest imaging technology at our disposal, so we can accurately diagnose your condition and recommend the most effective treatment.
- Trusted: In our 2023 patient satisfaction survey, 97% rated our orthopaedic care as very good or excellent. Additionally, 99% were likely or very likely to recommend us.
Book an appointment with a shoulder consultant
We have the experience and knowledge to diagnose the cause of your shoulder pain, provide leading treatment and support the management of your condition. If you require a torn rotator cuff operation, we'll support you with expert care. Complete our online booking form today.
Our rotator cuff repair surgery locations
London Bridge Hospital
27 Tooley Street SE1 2PR London
The Princess Grace Hospital
42-52 Nottingham Place W1U 5NY London
The Wellington Hospital
Wellington Place St John's Wood NW8 9LE London
The Harborne Hospital
Mindelsohn Way B15 2FQ Birmingham
The Wilmslow Hospital
52-54 Alderley Road Wilmslow SK9 1NY Cheshire
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This content is intended for general information only and does not replace the need for personal advice from a qualified health professional.