Rotator cuff repair: an OR 101 guide
Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice
Rotator cuff repair in one minute
What it is: usually keyhole surgery to reattach a torn rotator cuff tendon to the top of the arm bone.
Who it is for: people with a cuff tear causing pain or weakness that has not settled, or a sudden tear after injury.
Main risks: stiffness, re-tear, infection, nerve injury (rare).
Usually: under general anaesthetic with a nerve block, 1–2 hours, often home the same day.
On this page: What is rotator cuff repair? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in theatre? · FAQ
What is rotator cuff repair?
The rotator cuff is a group of tendons that cover the ball of the shoulder and help lift and rotate the arm. Tears can follow an injury or wear over time.
In a repair the surgeon:
- cleans the torn tendon edge and the bone where it attaches
- places small anchors into the bone, sizes per device and operator
- uses the anchor sutures to pull the tendon back onto the bone
Most are done by arthroscopy (keyhole); some use a small open cut. Bone spurs may be shaved at the same time (subacromial decompression).
New to the acronyms? See the Cath Lab Abbreviations A–Z.
Who is it for?
It may be considered for people with:
- a rotator cuff tear causing pain or weakness despite physiotherapy and injections
- a sudden traumatic tear, especially in younger people
The decision is made by your surgical team, who will talk through the reasons, the alternatives and the risks with you.
When is it done?
Most operations are planned; some are urgent. Before it, you usually have:
- an examination and X-rays, and sometimes a CT or MRI scan
- blood tests and, for bigger operations, an ECG
- a review of your medicines, especially blood thinners, as per centre protocol
- fasting instructions
- a chance to ask questions and give consent
Step by step
1. Getting ready
Team brief and WHO checklist first, including the implant check and confirming the site and side marking. The anaesthetic team and ODP give the anaesthetic (general, usually with a nerve block, as per centre protocol); antibiotics and blood-clot prevention are given as per centre protocol. The circulating practitioner checks positioning and pressure areas, the diathermy plate, warming, and radiation protection if X-ray is used. The scrub practitioner checks implant and instrument trays are complete and sterile, and does the first count. Theatre traffic is kept to a minimum, especially in laminar-flow theatres. The arthroscopy stack (camera, light, fluid pump and shaver) is checked. The patient sits up in the beach-chair position or lies on their side, with the head secured and pressure areas padded.
2. Access
Several small arthroscopy ports are made around the shoulder. A small open cut is used in some cases, per surgeon.
3. Repairing the tendon
- A. Tear seen. The camera shows the tear and the tendon edges.
- B. Bone prepared. The footprint on the bone is cleaned to help healing.
- C. Anchors placed. Anchors are inserted into the bone.
- D. Tendon tied down. Sutures from the anchors are passed through the tendon and tied.
4. Finishing
The ports are closed and the arm placed in a sling. Final counts are confirmed, implant details recorded, and the patient goes to recovery with a full handover, including limb checks (circulation and nerves), as per centre protocol.
Recovery and aftercare
- First hours: in recovery; the arm may be numb from the nerve block.
- Going home: often the same day.
- Sling: usually for about 4–6 weeks.
- Physiotherapy: gentle movement first, strengthening later; recovery takes months.
- Driving and work: ask your team; often not for several weeks.
- Follow-up: as per centre protocol.
Call 999 if you have chest pain or sudden breathlessness. Contact your team if you have increasing pain, a cold, numb or very swollen limb, calf pain, fever, or a wound that becomes red, hot or leaky.
Risks and complications
Your team will explain the risks that apply to you. Possible problems include:
- stiffness (frozen shoulder)
- re-tear of the tendon
- infection
- ongoing pain
- nerve or blood vessel injury (rare)
- blood clots (rare)
Theatre kit list (printable)
Example kit list
Every theatre has its own protocol, and sizes and doses vary.
- arthroscopy stack: camera, scope, light, fluid pump and shaver
- shoulder arthroscopy instruments, suture passers and knot pusher
- suture anchors, sizes per device and operator
- beach-chair positioner or lateral supports and arm holder
- radiofrequency device, per surgeon
- closure sutures, dressings and sling
Procedural steps
- Team brief, WHO sign in; side marked; implant check; anaesthesia and block
- Beach-chair or lateral position; head secure; prep and drape; count
- Ports; diagnostic arthroscopy
- Footprint prepared; decompression if planned
- Anchors placed; sutures passed and tied
- Final check; closure; sling; counts; implant log; sign out and handover
First time in theatre?
đź’ˇ First-time tip
- Implant check. Read back the implant type, side and size before opening, and record it in the implant log.
- Site and side. Check the marking at sign in and again before the cut.
- Counts matter. Swabs, needles, instruments and small implant parts are counted; speak up if one is missing.
- Positioning. In beach-chair, check the head is secure and the eyes and ears are free; watch blood pressure.
- Fluid and camera. Keep the fluid bags topped up and the camera focused.
FAQ
How long will I wear a sling?
Usually about 4–6 weeks.
Will my shoulder be strong again?
Many people regain good function; it can take up to a year.
Can all tears be repaired?
Not all; large, old tears may need other options.
Related guides
Sources
All checked on 14 October 2026. Each page's own date is shown where it gives one.
- StatPearls (NCBI Bookshelf), search: rotator cuff tear. ncbi.nlm.nih.gov/books
- StatPearls (NCBI Bookshelf), search: rotator cuff repair. ncbi.nlm.nih.gov/books
- British Elbow and Shoulder Society. bess.ac.uk
- World Health Organization. Surgical Safety Checklist. who.int
Disclaimer
Education only. This page is for general education for healthcare students, theatre staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, surgical team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a medical emergency, call 999.
Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.
All diagrams on this page are original illustrations created for rodnieoro.com.
