Overview
The rotator cuff is a group of four tendons that wrap around the ball of the shoulder (the humeral head) and keep it centered in the socket as the arm moves. One lifts the arm away from the side (supraspinatus). Two rotate the arm outward (infraspinatus and teres minor). One rotates it inward (subscapularis). Without them, the much larger deltoid muscle pulls the ball upward instead of guiding it in a smooth arc. The result is pinching (impingement), weakness, and pain with overhead activity.
Tears most often begin in the supraspinatus, the tendon that takes the highest load, and can spread over time into the tendon next to it. Sudden tears happen when a strong force overwhelms the tendon: catching a fall, catching a heavy object, or a shoulder dislocation. Wear-related tears build slowly, from years of small strains and from changes in the tendon's blood supply with age.
A partial tear that loses less than half the tendon thickness may respond to physical therapy and a steroid injection. A full-thickness tear leaves the muscle with no attachment to bone, and it will not regain strength on its own. Left unrepaired, full-thickness tears tend to grow. The muscle shrinks and fills with fat. The shoulder can then develop a pattern of arthritis called cuff-tear arthropathy, which only a joint replacement can treat.
How the Procedure Works
A rotator cuff repair is done through a camera (arthroscope), and it is more than simple stitching. The steps below show how the torn tendon is anchored back to its home on the bone, so the repair heals flat, free of tension, and built to last.
Arthroscopic Setup and Diagnostic Survey
We enter the shoulder through three or four small openings. Before touching the cuff, we look around the whole joint and the space above it. We confirm the tear pattern and judge the quality of the tendon. We also check for biceps tendon, labral, or AC joint problems that should be fixed under the same anesthetic. The nearby muscles are moved aside, never cut.
Tear Characterization and Tendon Mobilization
We grasp the torn edge of the tendon and test how far it will move. We release any scar tissue holding it back. The goal: the tendon reaches its original spot on the bone with your arm resting at your side, not just when the arm is lifted. A repair that only holds together under tension will not heal reliably.
Footprint Preparation
The attachment area on the upper arm bone is cleaned and lightly roughed up until the surface bleeds. This biological step matters as much as the mechanical one. A tendon stitched onto bare, dry bone heals poorly. A fresh, bleeding surface gives the tendon a living base it can grow into.
Anchor Placement and Suture Passage
Suture anchors are placed in a pattern chosen for the tear. Smaller tears close reliably with a single row of anchors. Wider tears get a double row that presses the tendon down along its full width. The stitches pass through healthy tendon, well back from the frayed edge.
Tensioning and Final Fixation
The stitches are tensioned and tied, or locked into anchors, so the tendon sits flat without bunching or gaps. We then test the repair through gentle range of motion to confirm it stays put. If other work is needed, such as a biceps tenodesis or a subacromial decompression, we finish it before closing.
When to Consider Rotator Cuff Repair
We offer rotator cuff repair when the symptoms, the imaging, and a trial of non-operative care all point the same way. The typical picture includes:
Symptomatic Full-Thickness Tear
A complete tear with weakness or pain limiting daily or work activity.
High-Grade Partial Tear
A partial tear that has not healed after a course of therapy and injection.
Failure of Non-Operative Care
Structured physical therapy and a corticosteroid shot have not relieved the pain.
Conditions This Treats
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a tear that tends to grow, with the muscle shrinking and filling with fat and the shoulder ending in cuff-tear arthropathy that only a reverse replacement can treat. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The risks we discuss before rotator cuff repair include:
- bleeding and infection
- anesthesia risk
- stiffness
- re-tear, more likely with larger tears, poorer tissue quality, or early overuse
- suture-anchor irritation or failure
- blood clot (rare in upper-extremity surgery)
- short-term nerve irritation from positioning or from the nerve block
Surgery makes sense for a painful full-thickness tear with good tissue quality, in a patient ready to commit to the rehab program. If you don't need this operation, we won't recommend it.
Frequently Asked
questions we hear in clinicCan a rotator cuff tear heal on its own?
A partial tear that loses less than half the tendon thickness may respond to physical therapy and a steroid injection. A full-thickness tear leaves the muscle with no attachment to bone, and it will not regain strength on its own.
What happens if I put off surgery?
Left unrepaired, full-thickness tears tend to grow. The muscle shrinks and fills with fat, and the shoulder can develop a pattern of arthritis called cuff-tear arthropathy, which only a joint replacement can treat.
Is this open surgery?
No. The repair is done through a camera (arthroscope) using three or four small openings. The nearby muscles are moved aside, never cut.
How is the tendon reattached?
The attachment area on the bone is cleaned and lightly roughed up until the surface bleeds, so the tendon has a living base to grow into. Suture anchors are then placed in a pattern chosen for the tear, with stitches passing through healthy tendon, and the repair is tensioned so the tendon sits flat without bunching or gaps.
What is the chance of a re-tear?
Re-tear is one of the risks we discuss. It is more likely with larger tears, poorer tissue quality, or early overuse.
Who is a good candidate?
Surgery makes sense for a painful full-thickness tear with good tissue quality, in a patient ready to commit to the rehab program. A high-grade partial tear that has not healed after a course of therapy and injection can also qualify.
Further Reading
External patient-education references and related OSI pages for additional background:
