Shoulder
Rotator Cuff Repair
The rotator cuff is the group of four tendons that hold the shoulder in its socket and lift the arm. When one tears, reaching overhead becomes weak and painful, and lying on that side at night often becomes impossible. Repair reattaches the torn tendon to the bone through keyhole incisions.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
The symptoms that point to it
Night pain is the giveaway. Patients often describe months of sleeping in a chair or propped up on pillows because lying on the shoulder is unbearable. They often mention this long before any trouble with the arm itself.
Alongside that:
- Pain on the outside of the upper arm, not the top of the shoulder
- Weakness lifting the arm out to the side or overhead
- Difficulty reaching behind the back, or to a high shelf
- A catching or grating feeling through part of the arc of movement
- Sometimes a specific injury, such as a fall onto an outstretched hand or a heavy lift
Do you always need surgery?
No. Many cuff tears, particularly partial ones and degenerate tears in older patients, settle well with physiotherapy, activity change and sometimes a steroid injection. A well-run physiotherapy programme is the first treatment for most shoulder pain, tear or no tear.
Repair is usually advised for a complete, recent tear, especially in a younger patient or after a specific injury. It is also advised when weakness is a bigger problem than pain, or when several months of proper non-surgical treatment have not worked. Left long enough, a torn tendon pulls back and the muscle degenerates, and past a certain point it can no longer be repaired. So if a cuff tear is causing real weakness, have it assessed instead of waiting it out indefinitely. Once a tear is beyond repair, the operation that restores overhead movement is a reverse shoulder replacement.
What the operation involves
The repair is arthroscopic, with a camera and instruments passed through several small incisions instead of an open cut. The torn edge of the tendon is freed and the bone it attaches to is prepared. Anchors are placed in the bone, and the stitches they carry hold the tendon down against it while it heals.
It usually takes one to two hours and is often a day case or a single overnight stay. Anything else found inside the joint (a biceps tendon problem, a bone spur, a stiff capsule) is dealt with at the same time.
Dr. Ishan Khanna completed a shoulder surgery fellowship at Seoul National University Bundang Hospital in South Korea, where arthroscopic cuff repair is a large part of the caseload.
Recovery, and why it takes a while
Cuff repair surprises people. It hurts less than they expect early on, and takes longer than they expect overall. The tendon has to heal onto the bone, and no amount of effort will hurry that.
- Week 0 to 6. Sling almost full time, including at night, for four to six weeks depending on the tear. Passive movement only: the physiotherapist or your other arm moves the shoulder, and you do not move it with its own muscles. The repair is at its most vulnerable here.
- Week 6 to 12. Moving the arm yourself, gradually regaining range.
- Month 3 to 6. Proper strengthening begins. Most daily activity back to normal.
- Month 6 to 12. Full strength, heavy lifting and overhead sport. Improvement carries on for a full year.
The six-week passive phase is the part patients most often cut short. It is also the part that decides whether the repair holds.
Risks
The main risk is the repair failing to heal. This is more likely with large tears, in older patients, and in smokers and diabetics. Stiffness afterwards is common and usually resolves with physiotherapy, though occasionally it needs further treatment. Infection, nerve injury and ongoing pain are less common.
Smoking clearly lowers the chance of the tendon healing. If you change one thing before this operation, make it that.
Common questions
How long will I be in a sling?
Usually around four to six weeks, including at night. The exact period depends on the size of the tear and the quality of the tissue repaired.
Can I work during recovery?
Desk work is usually possible within a couple of weeks, one-handed at first. Manual work, driving and anything overhead take considerably longer, often three months or more.
Will the pain go immediately?
Night pain usually improves within the first few weeks, and it is the change most patients notice first. Strength takes months, not weeks.
What happens if I leave a cuff tear untreated?
Some tears stay stable for years and cause little trouble. Others get bigger: the tendon pulls back, the muscle degenerates, and eventually repair is no longer possible. At that point a reverse shoulder replacement may be the only way to restore overhead movement. It is better to find out early which kind of tear you have.
Not sure this is your problem?
These pages start from the symptom. They cover what else can cause it and what is usually tried first.
Not sure whether you need this?
Ask it at a consultation, and bring your imaging and any plan you have already been given. Second opinions on surgery advised elsewhere are routine. He sees patients by appointment only, in Kharar, Mohali, and on set days each month in Solan.