Rotator Cuff Repair: A Comprehensive Overview

The rotator cuff isn’t a single muscle, but a group of four that cradle the top of your upper arm—holding it in the shoulder socket and letting it rotate smoothly. When one of these tendons tears, either through sudden trauma or slow degeneration, you’ll notice. Not just when you lift your arm, but when you try to sleep on it or reach behind your back. Sometimes it’s subtle, other times it’s sudden. Either way, a torn rotator cuff doesn’t fix itself.

At Ortho Westmount, a leading orthopedic clinic in Montreal, we see rotator cuff injuries across the spectrum—from partial tears in weekend warriors to full-thickness tendon disruptions in aging shoulders that have worked hard for decades. One thing remains consistent: timely treatment changes the game. A recent study confirmed that early surgical repair of traumatic cuff injuries leads to better range of motion, reduced pain, and significantly lower rates of re-tear compared to delayed intervention (Liu et al., 2024). 

What Happens When the Cuff Tears?

Think of the rotator cuff as both stabilizer and initiator. It holds the humeral head—the ball of your shoulder—in place while helping your arm move up, out, and around. When a tear occurs, it disrupts that coordination. The tendon tissue pulls away from the bone, like a rope fraying and snapping under tension. The longer it stays detached, the more it retracts and thins, making surgical repair harder—and outcomes, less predictable.

Some patients try to power through. They adjust their movements or take anti-inflammatories. And for a while, that might work—especially for smaller, partial tears. But over time, compensation turns into limitation. The shoulder muscles weaken, and fine movements degrade. Bone spurs may develop, further aggravating the tendon. Eventually, you’re not just dealing with a tear—you’re dealing with a deteriorating system.

Is Surgery Always the Answer?

Treating rotator cuff pathology doesn’t always require surgery. Some rotator cuff injuries respond well to conservative care: physical therapy, rest, perhaps a corticosteroid injection if inflammation is in the driver’s seat. For partial-thickness tears or isolated overuse injuries, this may be enough. But when dealing with full-thickness rotator cuff tears, or when the shoulder becomes functionally unreliable—say, you can’t lift a coffee cup without bracing your arm—surgery becomes less of a choice and more of a necessity.

People often ask: Is rotator cuff repair a major surgery? Technically, yes—it’s a surgical reattachment of tendon to bone. But thanks to minimally invasive techniques, the experience is far removed from the “big open surgeries” of decades past. Most shoulder joint procedures are done arthroscopically, through small incisions. You go home the same day. The incision is small, but the impact isn’t.

One Diagnosis, Three Paths to Repair

There are three primary approaches to rotator cuff repair, and each has its place.

Arthroscopic repair is our workhorse. It uses a tiny camera and specialized tools to repair the torn tendon inside the joint. This method minimizes tissue trauma, speeds up recovery, and offers excellent visualization.

When more direct access is needed, we may opt for a mini-open repair—a hybrid approach that starts arthroscopically but involves a small incision to directly access the tear.

And then there’s the open repair, which, despite its name, isn’t old-fashioned. It’s reserved for massive or complex tears where visibility and tendon mobilization are critical. In some cases, particularly where the original tendon can’t be salvaged, a tendon transfer may be required. This is delicate work—more reconstruction than repair—but it can restore motion in otherwise irreparable shoulders.

We tailor the approach to the patient, not the other way around.

Recovery After Rotator Cuff Surgery

Here’s where honesty matters: rotator cuff repair doesn’t give you back your shoulder overnight. Healing is biological. The tendon has to reattach to the bone, and that takes time—usually months. Most patients wear a sling for four to six weeks, start passive motion early, and begin strengthening exercises around the three-month mark. But full recovery? Expect six months. Sometimes more.

There’s a rhythm to recovery. Early stiffness is normal; so is occasional discomfort as motion returns. What we worry about are red flags: sharp pain, loss of progress, or signs of re-tear in the rotator cuff tissue. These are rare but real—especially if post-op protocols aren’t followed or if the original injury was extensive.

And while the vast majority of patients regain excellent shoulder function, there are downsides. Re-tears, while uncommon, do happen—particularly in cases of poor tendon quality or delayed repairs. Some stiffness may persist. And in rare cases, nerve irritation can occur. This is why surgical timing, technique, and rehabilitation must be meticulously planned—and expertly delivered.

Why Ortho Westmount?

At Ortho Westmount, shoulder repair surgery is a core part of our orthopedic practice. Our surgeons perform hundreds of rotator cuff procedures annually, including revisions and complex reconstructions. We’ve invested in the latest arthroscopic platforms, surgical anchors, and biologic augmentation tools to give your shoulder every advantage in healing.

But what really sets us apart is continuity. From your first consultation to your final rehab session, you're under the care of a unified team that knows your name, your goals, and your shoulder history. It’s personal. That’s how we keep outcomes high and complications low.

Rotator cuff repair, done right and done at the right time, restores more than just motion. It restores confidence—in your body, your independence, and your future.

Contact us today to learn more or book a consultation. 

‍

References:

• American Academy of Orthopaedic Surgeons. (n.d.). Rotator cuff tears: Surgical treatment options. OrthoInfo. Retrieved May 7, 2025, from https://orthoinfo.aaos.org/en/treatment/rotator-cuff-tears-surgical-treatment-options/
• HealthLink BC. (n.d.). Rotator cuff repair surgery. Government of British Columbia. Retrieved May 7, 2025, from https://www.healthlinkbc.ca/healthwise/rotator-cuff-repair-surgery
• Ignite Healthwise, LLC Staff. (2024, July 31). Rotator cuff repair surgery. MyHealth Alberta. Retrieved May 7, 2025, from https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=hw62048
• Johns Hopkins Medicine. (n.d.). Rotator cuff repair. Johns Hopkins Medicine. Retrieved May 7, 2025, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/rotator-cuff-repair#:~:text=If%20your%20rotator%20cuff%20is,the%20head%20of%20the%20humerus‍
• Liu, A., Zhang, B., Lai, T., Wang, M., Wu, G., Liu, S., & Zhang, T. (2024). Comparison of functional outcomes following early and delayed arthroscopic repair for traumatic and non-traumatic rotator cuff injuries. Journal of Orthopaedic Surgery and Research, 19(1), 368. https://doi.org/10.1186/s13018-024-04858-x