Pain that wakes you every night and makes it impossible to lie on that side.
You cannot lift your arm overhead, or it gives way when you try to reach a shelf.
An MRI shows a full-thickness tear, particularly a recent one in an otherwise healthy shoulder.
A tear caused by a specific injury — a fall, a lift, a pull — in someone active.
Weakness that is affecting your work or independence rather than only discomfort.
It is probably not right if…
A small partial tear that has responded well to physiotherapy and an injection.
A very large, long-standing tear where the tendon has retracted and the muscle has wasted — repair is unlikely to hold, and other options are better.
The shoulder is currently very stiff. Stiffness is treated before any repair.
You are not able to keep the arm in a sling and protected for six weeks — a repair that is loaded too early simply comes apart.
What the rotator cuff is
Four muscles wrap around the top and back of the shoulder blade and converge into a single sheet of tendon that grips the ball of the shoulder joint. That sheet is the rotator cuff. Its job is not brute strength — it is to hold the ball centred in its socket while the big muscles move the arm. When part of it tears, the ball loses its centring, and lifting the arm becomes both painful and unreliable.
Does every tear need repairing?
No — and this genuinely matters, because rotator cuff tears become steadily more common with age. By the seventies, a large proportion of people have some degree of tear and no symptoms at all. A tear on a scan is not by itself a reason to operate.
Aspect
Try physiotherapy first
Repair
Tear
Partial thickness
Full thickness, especially if recent
How it started
Gradually, over months or years
A specific injury — a fall or a heavy pull
Strength
Preserved; pain is the problem
Genuine weakness lifting or reaching
Age and demand
Older, lower demand
Younger, or physically demanding work
Response to treatment
Improving with exercises and an injection
No improvement after three months of proper work
Tendon quality on MRI
Retracted, wasted muscle, fatty change
Healthy tendon, minimal retraction
What actually drives the decision.
The counterpoint is that a full-thickness tear in a younger, active shoulder tends to enlarge over time, and a bigger tear is harder to repair with a poorer result. If you are in that group, waiting has a genuine cost — and you should be told so plainly rather than left to discover it.
How the repair is done
Everything is done arthroscopically, through three openings each under a centimetre. There is no need to detach the deltoid muscle, which is the single biggest reason keyhole repair recovers better than the open operation it replaced.
1
The joint is inspected
The camera goes in first to assess the whole shoulder — the cuff, the labrum, the cartilage and the biceps tendon. Other problems are often found and dealt with at the same time.
2
The tear is defined and mobilised
The torn edge is identified, freed from any scar tissue holding it back, and brought to the point on the bone where it originally attached.
3
The bone bed is prepared
The footprint on the ball of the shoulder is lightly cleaned to healthy bleeding bone. Tendon heals to bone, not to smooth cortex — this step decides whether the repair holds.
4
Anchors are placed
Small anchors carrying strong sutures are set into the bone. Depending on the tear pattern, sutures are configured in a single row or a double row that compresses the tendon flat against its footprint.
5
The tendon is drawn down and tied
Sutures are tensioned to hold the tendon against bone without strangling its blood supply. The repair is then tested through a full range of movement.
6
Anything impinging is addressed
If a bony spur has been rubbing on the tendon, it is shaved smooth so the repaired tendon has room to glide.
The part people underestimate: the sling
A repaired tendon is held to bone by stitches for a few weeks, then by biological healing that takes three months to become strong. In the first six weeks the repair is entirely dependent on you not loading it. This is why the sling is not a comfort measure — it is part of the operation.
During those weeks a physiotherapist moves the shoulder for you, and you move the elbow, wrist and hand freely. What you must not do is lift the arm using your own cuff muscles, reach behind you, or push up out of a chair with that arm. The commonest cause of a failed repair is a patient who felt well at four weeks.
Risks
The repair failing to heal, in roughly 1 in 10 small tears and considerably more in large ones. Age, tear size, smoking and diabetes all influence this.
Stiffness, which is the most common early problem and the reason physiotherapy begins immediately.
Infection, in well under 1 in 100 cases.
Persistent pain despite a healed repair, in a small minority.
Temporary numbness or weakness in the arm from the nerve block, resolving within a day.
A blood clot, which is uncommon in shoulder surgery.
What recovery actually looks like
Written as a plan, not a promise. Your own timeline will be adjusted to what is found during the operation and how you progress — but this is the shape of it.
Week 0–2
Sling, and someone else moving your arm
The sling stays on day and night, apart from washing and exercises. A physiotherapist takes the shoulder through gentle passive movement — the repair must not be loaded by your own muscles. Night pain often improves within days.
Sling worn constantly, including in bed
Passive movement started with a physiotherapist
Elbow, wrist and hand moved freely
Back to desk work if it does not need that arm
Week 2–6
Protecting the healing tendon
Passive range increases gradually. Still no active lifting. Most people sleep better from around week three, often propped semi-upright or in a recliner.
Passive movement close to full
Sleeping more comfortably
Stitches out and wounds reviewed
Sling discarded at four to six weeks
Week 6–12
Your own muscles take over
Active movement begins — lifting the arm under your own power for the first time. It will feel weak, and that is expected after six weeks of protection. Driving usually resumes around six weeks.
Active movement without the sling
Driving again
Reaching shoulder height
Light daily tasks with the arm
Month 3–4
Strengthening
The tendon is biologically healed enough to be loaded. Resistance work begins, progressing from bands to weights. Overhead use returns in this window.
Overhead reaching restored
Resistance training started
Return to physical work for many jobs
Swimming reintroduced
Month 6–9
Full function
Strength continues to build for up to a year. Overhead sport and heavy lifting are cleared once strength is close to the other side.
Strength approaching the other shoulder
Heavy lifting cleared
Return to overhead sport
No restrictions on daily life
Patients who had this
Two years of broken sleep ended in the first fortnight
“I had not slept a full night in nearly two years. I could not lie on that side and I could not reach the top shelf in my own shop. The six weeks in the sling were hard and I was warned they would be. But the night pain went within two weeks of the operation, and that alone was worth it.”
Ashok M., 58 · Textile business owner
Adajan · 9 months after treatment
Outcome. Arthroscopic repair of a full-thickness rotator cuff tear. Out of the sling at five weeks, overhead reach restored by four months, back to full work.
A consultation means your imaging on the screen, a plain explanation of what is actually wrong, and an honest opinion on whether you need surgery — including when the answer is no.