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 frequently describe months of sleeping in a chair or propped on pillows because lying on the shoulder is unbearable, long before they mention any difficulty with the arm itself.
Alongside that:
- Pain on the outer upper arm rather than 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 sensation 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.
Repair is usually advised when a tear is complete and recent, especially in a younger patient or after a specific injury, when weakness rather than pain is the main problem, or when several months of proper non-surgical treatment have not worked. Left long enough, a torn tendon retracts and the muscle degenerates, and past a certain point repair is no longer possible, which is why an untreated cuff tear with real weakness is worth assessing rather than waiting out indefinitely.
What the operation involves
The repair is arthroscopic: a camera and instruments through several small incisions rather than an open cut. The torn tendon edge is freed, the bone it attaches to is prepared, and anchors placed in the bone carry sutures that hold the tendon down against it while it heals back.
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. 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 is unusual: it hurts less than people expect early on, and takes longer than people expect overall. The tendon has to biologically heal onto bone, and that cannot be hurried by effort.
- Week 0 to 6. Sling almost full time, including at night. Passive movement only, the physiotherapist or your other arm moves the shoulder, you do not. The repair is at its most vulnerable here.
- Week 6 to 12. Out of the sling, moving the arm actively, gradually regaining range.
- Month 3 to 6. Strengthening begins in earnest. Most daily activity back to normal.
- Month 6 to 12. Full strength, heavy lifting and overhead sport. Improvement genuinely continues for a year.
The six-week passive phase is the part patients most often cut short, and it is the part that determines whether the repair holds.
Risks worth knowing about
The repair failing to heal is the main one, and it is more likely with large tears, older patients, 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 meaningfully reduces the chance of the tendon healing. If there is one thing worth changing before this particular operation, that is it.
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, which 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 enlarge, the tendon retracts and the muscle degenerates, and repair eventually stops being an option, at which point a reverse shoulder replacement may become the only thing that restores overhead function. Which of those applies is worth finding out early.
Not sure whether you need this?
That is the right question to bring to a consultation. Second opinions on surgery already advised elsewhere are a routine part of the practice. Bring your imaging and any plan you have been given.
Not sure this is your problem?
These start from the symptom rather than the operation, and cover what else can cause it and what gets tried first.