Shoulder pain that limits how you reach, lift, or sleep is hard to ignore - and for many people, a rotator cuff tear is the reason behind it. If you've been told you have a rotator cuff injury and surgery has been mentioned as a possibility, it's reasonable to have questions about what that actually involves, what recovery looks like, and whether it's the right path for you.

This post covers the basics: what the rotator cuff is, how tears are assessed and treated, and what to expect if surgery is recommended.

What is the rotator cuff?

The rotator cuff is a group of four muscles and their tendons that wrap around the shoulder joint. Together, they hold the ball of the upper arm firmly in the shoulder socket and allow you to raise and rotate your arm. When one or more of these tendons are torn - either through an acute injury like a fall, or gradually through wear over time - the shoulder can become painful, weak, and difficult to use overhead.

Tears range from partial to full thickness, and not all of them require surgery. An orthopaedic assessment, combined with imaging such as an MRI or ultrasound, helps establish the extent of the tear and what treatment is appropriate.

When is rotator cuff repair surgery considered?

Surgery is not the first option for every rotator cuff tear. Many people improve with a structured physiotherapy program, activity modification, and time. However, surgery may be considered when:

Conservative management over several months has not produced meaningful improvement. The tear is large or involves complete tendon detachment. Pain is significantly affecting sleep, work, or day-to-day function. The patient is active, relatively young, or has high physical demands from their lifestyle or occupation.

The decision to proceed with surgery is made on an individual basis, taking into account the size and type of the tear, your age and activity level, your goals, and how the shoulder is responding to non-surgical management.

What does rotator cuff repair surgery involve?

Most rotator cuff repairs are performed arthroscopically - using small incisions and a camera inserted into the shoulder joint rather than a large open incision. This approach allows the torn tendon to be reattached to the bone using small anchors, while also allowing the surgeon to assess and address any other issues in the joint at the same time.

The procedure is typically performed under general anaesthetic and takes one to two hours, depending on the complexity. Most patients go home the same day or after one night in hospital.

What does recovery involve?

Recovery from rotator cuff repair takes time, and understanding this from the outset is important. The repaired tendon needs to heal back to the bone before the shoulder can be loaded again - a process that takes several weeks. The general recovery pathway looks like this:

Weeks 1-6: The arm is kept in a sling. Movement is limited to gentle, guided exercises to prevent stiffness without stressing the repair. Weeks 6-12: As healing progresses, the sling is gradually phased out and physiotherapy focuses on restoring range of motion. 3-6 months: Strengthening work begins in earnest. Most patients notice meaningful improvement in pain and function during this period. 6-12 months: Return to heavier activities or sport typically occurs within this window, depending on individual progress and the nature of the original tear.

Recovery varies between patients and is influenced by the size of the repair, the quality of the tendon tissue, and how consistently physiotherapy is followed.

Considering rotator cuff surgery in the South West?

Dr Ryan du Sart consults regularly in Bunbury and Busselton and manages a range of shoulder conditions, including rotator cuff tears. If shoulder pain is affecting your quality of life and you would like an orthopaedic assessment, speak with your GP about a referral. Your GP can assess your symptoms, arrange appropriate imaging, and refer you if specialist input is warranted.

For personalised advice about rotator cuff repair, speak with your orthopaedic specialist.