Rotator Cuff Tears Surgery: Surgical Treatment Options – GetWellGo

Rotator Cuff Surgery

"Rotator cuff surgery" is a procedure to fix a torn tendon or tendons in the shoulder. The rotator cuff is a set of muscles and tendons that keeps the shoulder stable and enables you to lift and rotate your arm. When it's torn (due to injury, overuse, or degeneration), surgery can be necessary if nonsurgical methods such as physical therapy, rest, and injections fail.

Rotator Cuff Repair Techniques

Rotator cuff repair can be performed in several ways, based on the type and size of the tear, surgeon preference, and patient needs. Here's a straightforward summary:

Arthroscopic Repair

Surgeons create small (keyhole) incisions and place an arthroscope (camera) to see inside the shoulder. Small instruments are used to repair the tendon.

Pros:

• Minimally invasive
• Less pain and scarring
• Faster early recovery

Cons:

• Technically demanding
• Sometimes more difficult for very big or complicated tears

Mini-Open Repair

Arthroscopy begins surgery to clean and evaluate the tear, but a small cut (approximately 2–3 inches) is then made to directly fix the tendon.

Pros:

• Good visualization of the tear
• Combines advantages of arthroscopic and open repair

Cons:

• Somewhat longer healing compared to pure arthroscopy

Open Repair

Larger cut to directly expose the shoulder muscles. The deltoid muscle is pushed aside to fix the torn tendon.

Pros:

• Best for giant tears
• Strong fixation

Cons:

• More prolonged hospital stay
• Increased postoperative pain
• Slower postoperative recovery

Superior Capsular Reconstruction (SCR)

When the rotator cuff is severely damaged and cannot be directly repaired. A graft (donor or patient's own tissue) is inserted to serve as a spacer and aid in restoring function.

Pros:

• Alternative to irreparable tears
• May delay or prevent shoulder replacement

Cons:

• Relatively new; long-term outcomes being evaluated

Tendon Transfer

When the rotator cuff is not repairable, other tendons/muscles (such as the latissimus dorsi or pectoralis major) are transposed and attached to perform shoulder function.

Pros:

• Restores function when cuff is not repairable

Cons:

• Difficulty in recovery and rehab
• Results are variable

Reverse Shoulder Replacement (Arthroplasty)

In advanced cases, the ball and socket of the shoulder are replaced and reversed. The artificial joint relies on different muscles to raise the arm.

Pros:

• Good for end-stage arthritis + rotator cuff tear ("cuff tear arthropathy")

Disadvantages:

• Major operation
• Restricted lifetime of implant

Rotator Cuff Tears Treatment

Nonsurgical Treatments (First Line for Most)

Rest and Activity Modification:

• Modify activity to avoid painful activities (such as overhead motions).

Physical Therapy:

• Strengthen the muscles around the area.
• Enhance shoulder flexibility and posture.
• Emphasize rotator cuff and scapular stabilization exercises.

Medications:

• NSAIDs (such as ibuprofen or naproxen) to relieve pain and swelling.

Steroid Injections:

• Cortisone injections to shorten inflammation and pain.

Warning: Repeated use can weaken the tendon with time.

Cold Packs/Heat Therapy:

• Ice for inflammation; heat to relax muscles prior to stretching.

Surgical Procedures (If No Improvement or Massive Tear)

When surgery is warranted:

• Tear is big (>3 cm) or total
• Lifting/rotating arm weakness
• Severe pain after 3–6 months of treatment
• Heavy use for overhead activity (e.g., athletes, laborers)

Common Surgical Procedures:

• Arthroscopic rotator cuff repair (most common today)
• Mini-open repair (hybrid procedure)
• Open repair (for huge tears)
• Superior capsular reconstruction (for unrepairable tears)
• Tendon transfers (for failed repairs)
• Reverse shoulder replacement (for cuff tear arthropathy)

Factors Affecting Rotator Cuff Tear Surgery Cost

• Type of Surgery
• Hospital or Surgical Center Fees
• Surgeon’s Fees
• Location
• Anaesthesia Fees
• Implants and Surgical Materials
• Hospital Stay Duration
• Pre-Surgery Tests and Imaging
• Post-Surgery Physical Therapy

Rotator Cuff Tear Recovery Time

Nonsurgical Recovery (No Surgery)

• Pain control: 2–6 weeks
• Improved motion: 6–12 weeks (with physical therapy)
• Strengthening: 3–6 months
• Full recovery: 4–6 months (occasionally up to 9 months if tear was moderate)

Surgical Recovery (With Repair Surgery)

Immediate Post-Op: 0–6 weeks:

• Arm in sling (worn most of the time)
• Passive exercises (therapist moves your arm)

Early Rehab: 6–12 weeks:

• Begin active movement (you move the arm without weight)
• Gentle stretching

Strengthening Phase: 3–6 months:

• Light resistance exercises
• Build muscle strength gradually

Advanced Strengthening: 6–9 months:

• Back to heavier lifting and sports-specific activities

Full Recovery: 9–12 months:

• Complete strength and range of motion returned (for most individuals)

Rotator Cuff Tear Symptoms

• Shoulder Pain
• Weakness
• Limited Range of Motion
• Popping or Clicking Sensations
• Night Pain
• Sudden Sharp Pain

Rotator Cuff Surgery Procedure

Preparation

• You’ll change into a hospital gown.
• An IV line is started for fluids and medications.

Anaesthesia is given:

• Usually general anaesthesia (you’re fully asleep).
• Sometimes combined with a nerve block to numb the shoulder (for pain relief after surgery).

Positioning

You’re placed either:

• Beach chair position (like sitting in a recliner), or
• Lateral decubitus (lying on your side).

Incision(s)

Depending on the type of surgery:

• Arthroscopic: 2–3 small cuts (about ½ inch each)
• Mini-open: Small cut (2–3 inches)
• Open: Wider cut (5+ inches)

Viewing and Cleaning

• A small camera (arthroscope) is passed (in arthroscopic surgery).

The surgeon examines:

• Size and location of the tear
• Health of tendons, muscles, cartilage
• Damaged tissue, bone spurs, or inflamed bursa is cleaned out (debridement).

Repairing the Tendon

• Torn tendon edges are prepared.

The tendon is reattached to the bone (humerus) with suture anchors:

• Small screws (occasionally metal or dissolvable plastic) are inserted into bone.
• Stitches attach the tendon to the anchors.

Completion

• Camera and equipment are withdrawn.
• The sutures or staples are used to close the incisions.
• A bandage is placed, sterile.

Recovery Room

• You will be transferred to recovery to recover until the anaesthesia dissipates.
• Shoulder will have a sling on.
• Pain control will begin immediately (IV meds, then pills).