What is the rotator cuff?
The rotator cuff is a group of four muscles and their tendons (supraspinatus, infraspinatus, teres minor, and subscapularis) that surround the shoulder joint. They work together to stabilise the humeral head in the glenoid socket and power shoulder movement — particularly rotation and elevation. Rotator cuff tears range from small partial-thickness tears (involving only part of the tendon thickness) through to large full-thickness tears where the tendon is completely detached from the bone. Tears can occur acutely (from a fall or injury) or gradually (from degeneration and repetitive loading over time). Not all rotator cuff tears require surgery — many, particularly in older patients with partial tears and mild symptoms, can be managed effectively with physiotherapy and activity modification.
Who needs surgery?
Surgery is generally recommended for: acute full-thickness tears in active patients, particularly those under 60; large or massive rotator cuff tears with significant weakness; partial-thickness tears that have failed to improve with at least 3–6 months of conservative management; and tears associated with significant functional limitation that affects daily activities or sport.
What happens during surgery
Arthroscopic rotator cuff repair is performed under general anaesthesia in the beach chair or lateral decubitus position. Dr Mooney uses keyhole incisions to inspect the shoulder joint and bursa in detail, confirms the tear pattern, and then repairs the tendon back to its footprint on the greater tuberosity using bone anchors and strong sutures. Associated pathology — such as biceps tendon tears, subacromial impingement, or acromioclavicular joint arthritis — is addressed at the same time. The procedure typically takes 60–120 minutes depending on tear size and complexity. A sling is required after surgery for 6 weeks.
Tear size and repairability
Smaller tears (less than 1–2 cm) can usually be repaired with a single row of anchors. Larger tears require a double-row technique to maximise the contact area between the repaired tendon and bone, which improves healing. Very large (massive) tears that have been present for a long time may become retracted and fatty and may not be fully repairable. In these cases, Dr Mooney will discuss the available options, which may include partial repair, tendon transfer, or joint replacement.
What to expect after surgery
Frequently asked questions
Partial-thickness tears in some patients can improve significantly with physiotherapy and time. Full-thickness tears do not heal spontaneously — the tendon does not grow back to bone — so if surgery is recommended, it is to repair a structural defect.
Most patients are in a sling for 6 weeks following repair. This protects the repair during the early healing phase.
Driving is typically possible from 6–8 weeks after surgery, once the sling is removed and you have adequate arm control. Dr Mooney's team will advise you based on your individual progress.
Return to gym and upper body strength work is usually possible from around 4–6 months, depending on the size of the repair. Your physiotherapist will guide you.
Risks include infection, bleeding, stiffness (frozen shoulder), failure of the repair, re-tear, and anaesthetic risks. Large tears have a higher re-tear rate than small tears. Dr Mooney will discuss the specific risks relevant to your tear at your consultation.