Rotator cuff repair and getting your arm overhead again
Diagnosis and treatment of rotator cuff tears and impingement, from conservative care and guided injection through to arthroscopic repair, with a rehabilitation protocol that protects the repaired tendon while it heals.
When is shoulder pain a tendon tear?
Not all shoulder pain is a tear — impingement, tendinitis and frozen shoulder produce similar symptoms. Signs that point to a tear:
- Clear weakness or inability to lift the arm above shoulder level
- Severe night pain preventing sleep on the affected side
- Pain radiating down the outer mid-arm
- The arm dropping suddenly when lowering it slowly
- Clicking or catching with shoulder movement
- Weakness that does not improve despite ongoing physiotherapy
Distinguish the conditions: impingement causes pain on movement without true weakness, while a full-thickness tear is accompanied by real loss of power. Adhesive capsulitis restricts movement in every direction even when the shoulder is moved passively — and telling them apart completely changes the treatment.
What we treat in the shoulder
Diagnosis rests on clinical examination first, supported by plain X-rays and an MRI establishing tear size, tendon retraction and the state of the muscle.
Rotator cuff tear
A partial or full-thickness tear of the cuff tendons, treated conservatively or by arthroscopic repair depending on tear size, patient age and activity level.
Subacromial impingement
The tendon rubbing beneath the acromion causing pain on elevation; usually responds to physiotherapy and a guided injection.
Recurrent shoulder dislocation
Instability following a first dislocation, usually requiring labral repair to prevent recurrence and damage to the joint surface.
Frozen shoulder (adhesive capsulitis)
Painful stiffness restricting movement in all directions, usually treated with physiotherapy and injections rather than surgery.
Biceps tendinitis
Pain at the front of the shoulder that frequently accompanies rotator cuff problems and is addressed within the same plan.
Shoulder arthritis
Less common than knee arthritis, managed conservatively in most cases with surgical options reserved for advanced disease.
Your treatment pathway, step by step
Clinical examination
Specific tests to distinguish a tear from impingement and stiffness, identifying which cuff tendon is affected and the degree of associated weakness.
Imaging
Plain X-rays to exclude arthritis and assess acromial shape, and an MRI establishing tear size, tendon retraction and the degree of fatty change in the muscle.
Conservative treatment
A physiotherapy programme focused on the scapular stabilisers and rotator cuff, with anti-inflammatory medication and a guided injection where indicated — many partial tears improve at this stage.
Deciding on surgery
Considered for full-thickness tears in active patients, failure of adequate conservative treatment, or clear functional weakness. Timing matters, because delayed repair allows further retraction.
Arthroscopic repair
Reattaching the tendon to its footprint on the humerus with anchors through small portals, decompressing the subacromial space where required.
Graded rehabilitation
A sling for a defined period, then passive movement, then active movement, then strengthening — a measured progression, because loading the tendon before it heals is the commonest cause of repair failure.
What determines a successful repair?
Tendon healing after repair is not guaranteed in every case, and there are well-recognised factors that raise or lower the chance of success.
- Tear size and retractionSmall, recent tears heal at far higher rates than large tears that have been retracted for years.
- Muscle qualityFatty infiltration and muscle atrophy on MRI indicate poor healing potential even with a technically good repair.
- Age and smokingIncreasing age and smoking measurably reduce tendon blood supply and its capacity to heal.
- Diabetic controlUncontrolled diabetes raises the risk of post-operative stiffness and slows tendon healing.
- Adherence to rehabilitation limitsUsing the arm early, before the tendon has healed, is the commonest cause of re-tear after a technically successful repair.
- Treating mechanical causesLeaving a compressive acromion or abnormal scapular mechanics untreated exposes the repaired tendon to the same forces that tore it.
Why Prof. Dr. Ibrahim Shaarawi
- Assessment before any decision to operateSurgery is offered only after appropriate conservative treatment has been exhausted, because many patients improve without an operation.
- Academic backgroundMD and MSc in Orthopedic Surgery from Ain Shams University, with training in the Ain Shams University hospitals.
- International trainingVisiting professor and training at Ohio State University Hospital in the United States, applying the protocols used there.
- One plan from diagnosis to rehabilitationDiagnosis, surgery, physiotherapy and follow-up handled as a single pathway rather than split across separate providers.
Read patient success stories or review the full profile and credentials.
Cost and booking
The cost of rotator cuff repair depends on the number of anchors used (determined by tear size), whether the procedure includes subacromial decompression or labral repair, and the hospital and anaesthesia.
Whether surgery is needed at all is established only after examination and MRI, so no figure is quoted before assessment.
Important: bring all previous imaging and reports to your first visit, along with a list of your current medications, so an accurate plan can be made from the outset.
Frequently asked questions
Can a rotator cuff tear heal without surgery?
A full-thickness tear does not heal on its own, but many patients — particularly older and less active people — improve functionally with physiotherapy that compensates by strengthening the surrounding muscles, without repairing the tendon itself. Partial tears respond to conservative treatment at a higher rate.
How long is recovery after a repair?
Rehabilitation after cuff repair is relatively long: a sling for weeks, then passive movement, then active movement, then graded strengthening. Full return to overhead activity or lifting takes months rather than weeks.
What is the difference between impingement and a tear?
Impingement is friction causing pain on movement, especially elevation, with power relatively preserved. A tear is accompanied by genuine weakness in lifting or holding the arm. Clinical examination usually distinguishes them, and MRI confirms the diagnosis.
Does delaying surgery cause harm?
Yes, in full-thickness tears in active patients. Over time the tendon retracts and part of the muscle converts to fatty tissue; both reduce the chance of a successful repair and make the tendon harder to bring back to its footprint.
What are the risks of shoulder arthroscopy?
The commonest complaint is post-operative stiffness, which is usually temporary and responds to physiotherapy. There are lower risks of infection, nerve injury, or re-tear of the tendon, all reduced by good preparation and adherence to the rehabilitation protocol.
Are shoulder injections useful?
A guided injection helps reduce inflammation and pain, particularly in impingement and stiffness, and can allow a patient to perform physiotherapy effectively. It does not repair a torn tendon, however, and repeated injections may weaken tendon tissue.
Book a shoulder assessment
If you have night pain in the shoulder or weakness lifting your arm, an early assessment distinguishes impingement from a tear from stiffness — a distinction that changes the treatment plan entirely.
Related reading
References
- American Academy of Orthopaedic Surgeons (AAOS) — Patient guidelines
- Mayo Clinic — Orthopedic procedures
- NICE — Joint replacement and arthroscopy guidance
- Cochrane Musculoskeletal reviews
Medical disclaimer: the content on this page is provided for medical education only. It is not a substitute for consultation and clinical examination, and must not be used as a basis for self-diagnosis or self-treatment. Read the full medical disclaimer.