Overview
Rotator cuff repair reattaches a torn tendon, most often the supraspinatus, to the top of the humerus so that it can heal back to bone. Dr. O'Donnell performs the repair arthroscopically through portals about 5 mm wide, using suture anchors to hold the tendon on its original footprint. The purpose is to restore the strength and pain-free overhead reach that a full-thickness tear takes away; for most patients with a repairable tear the result is a shoulder that no longer wakes you at night and works overhead again.
Healing tendon to bone is slow, and that slow healing sets the sling, the six weeks of passive-only motion, and the six-month return to sport. The procedure is outpatient at Bayside Surgery Center in Coconut Grove.
Who It's For
Repair is recommended for an acute full-thickness tear in an active patient, for a full-thickness tear causing weakness that has not improved with therapy, and for a tear that serial imaging shows is enlarging. Retracted tendon and fatty muscle do not recover once advanced, so a full-thickness tear in a patient under 65 is usually repaired within a few months rather than watched for years. Partial tears involving more than about half the tendon depth in an overhead athlete or manual worker are also candidates.
Not every rotator cuff tear needs an operation. Low-grade partial tears, small degenerative tears in lower-demand patients, and painful shoulders with an intact cuff usually respond to therapy and an ultrasound-guided injection. When the cuff is intact and the problem is a thickened bursa or a hooked acromion, a subacromial decompression without repair is the better operation (see impingement & bursitis). A massive tear retracted beyond the socket with arthritis is not repairable, and a reverse shoulder replacement restores overhead function more reliably.
A rotator cuff tear on MRI or ultrasound is not by itself an indication for repair; tears are common on scans of shoulders that do not hurt, and become more common with age. Dr. O'Donnell recommends surgery when the weakness on the Jobe and external rotation tests, the pain pattern and the tear on imaging match, and, for degenerative tears, when therapy and an injection have failed. See rotator cuff tears and impingement and bursitis.
What the Procedure Involves
Surgery is done under an interscalene nerve block plus general anesthesia; the block numbs the shoulder for 12 to 18 hours and keeps the first night comfortable. The joint is inspected with the arthroscope first, so the labrum, biceps and cartilage are checked before the cuff is addressed. The inflamed bursa is removed, and if the acromion has a hook rubbing on the tendon, its undersurface is smoothed.
The torn tendon edge is freed from scar so it reaches bone without tension, and the footprint on the humerus is prepared to bleeding bone. Suture anchors, small pegs preloaded with high-strength sutures, are placed in the bone. For small tears a single row is sufficient; for larger tears Dr. O'Donnell uses a double-row construct that compresses the tendon across the whole footprint. A frayed or unstable long head of biceps found at the same time is treated with a biceps tenodesis, because leaving it is a common reason for pain after an otherwise successful repair. Poor-quality tissue can be augmented with a collagen patch or a marrow-stimulation technique.
The operation takes about one to two hours depending on tear size. The arm goes into a sling with a small abduction pillow, and patients go home the same day with a therapy referral for the first week.
Risks & How They Are Minimized
The most important risk is that the tendon fails to heal, which is more likely with large or chronic tears, older patients, smoking and diabetes. Fixation is matched to the tear, active motion is withheld for six weeks so the repair is never loaded before it has healed, and smokers are asked to stop before surgery. Stiffness is the most common complication and the most avoidable: passive motion begins in the first week with a target of 120° of forward flexion by week six.
Infection is uncommon after arthroscopy because the portals are small; antibiotics are given before the first incision and the wounds stay covered for 48 hours. Numbness from the nerve block wears off within a day, and lasting nerve injury is rare with careful positioning and padding. Blood clots are unusual after shoulder surgery; patients walk the same day, and those with risk factors take low-dose aspirin for two weeks.
Recovery & Rehabilitation
Rehabilitation follows Dr. O'Donnell's rotator cuff repair protocol; phases are entered on criteria rather than dates, and larger or revision repairs are progressed more slowly.
| Phase | Timing | What happens |
|---|---|---|
| Maximum protection | Weeks 0–6 | Sling with abduction pillow at all times except exercises and hygiene. Pendulums, passive forward flexion to about 120°, passive external rotation to neutral. No active shoulder motion, lifting, pushing or pulling. |
| Active motion | Weeks 6–12 | Sling discontinued. Active-assisted then active motion in all planes, scapular strengthening, sub-maximal cuff isometrics late in the phase. Lifting limited to 1–2 lb. |
| Strengthening | Weeks 12–18 | Resistance-band rotation and scaption, deltoid and periscapular strengthening, closed-chain and rhythmic stabilization, endurance work. Advance at 70–80% of the other side's strength. |
| Return to activity | Months 4–6 | Advanced strengthening and plyometrics, sport- or job-specific program, interval throwing or overhead program where indicated. Return to sport is typically around 6 months, surgeon-cleared. |
Desk work is possible within one to two weeks, one-handed, driving at about six weeks once the sling is off, and golf, tennis, swimming and heavy manual work between four and six months once strength is symmetric.
Protocol summary
For six weeks the sling stays on except for hygiene and exercises, and the shoulder is moved passively only: no active elevation or rotation, no lifting, pushing, pulling or weight bearing through the arm, and no reaching behind the back or forced stretching. Phase I ends with passive flexion of at least 120° and external rotation to neutral.
From six to twelve weeks active motion is progressed with no resisted work and lifting under 2 lb; the shoulder must elevate without a shrug before strengthening begins. Strength of 70 to 80% of the opposite side opens the return-to-activity phase, and sport is cleared at about six months when strength and motion are symmetric.
Physical Therapy Protocol
Rotator Cuff Repair PDF ↗Frequently Asked Questions
How long does rotator cuff surgery take, and will I stay overnight?
Arthroscopic repair takes about one to two hours depending on the size of the tear and whether the biceps or acromion also need attention. It is an outpatient procedure at Bayside Surgery Center under a nerve block plus general anesthesia; you go home the same day in a sling, and someone must drive you and stay with you the first night.
How painful is recovery, and how do I sleep after rotator cuff repair?
The nerve block keeps the shoulder numb for the first 12 to 18 hours, so pain medication is started before it wears off. Most patients need prescription medication for a few days, then extra-strength Tylenol. Sleeping semi-upright in a recliner, sling on, with ice 20 minutes on and 20 off, is most comfortable for the first two to three weeks.
How long do I wear the sling after rotator cuff repair?
Four to six weeks, including while sleeping. It comes off only for showering and the passive exercises you are taught in the first week. The sling protects the anchors and sutures while the tendon heals to bone, which is why removing it early is the most common way a repair fails.
When can I drive after rotator cuff surgery?
Once the sling is discontinued and you can move the arm comfortably without prescription pain medication, usually at about six weeks. Driving one-handed in a sling is not safe, and an automatic transmission does not change the answer, because the repaired shoulder must not be loaded by a sudden steering correction.
When can I return to work and sport after rotator cuff repair?
Desk work within one to two weeks, working one-handed. Strengthening starts at three months. Golf, swimming, tennis, overhead sports and heavy manual work return between four and six months, once strength matches the other side and Dr. O'Donnell has cleared you. The rotator cuff repair protocol details each phase.
This page is for general education and is not a substitute for a medical evaluation. The right procedure depends on your individual diagnosis, anatomy, and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.