Rotator Cuff Repair

Before you consider surgery

There are several ways you can resume an active lifestyle with significant pain relief before you consider having surgery.  This first section will discuss:

About rotator cuff tears and anatomy

Woman holding her fallen left shoulder with her right hand with mouth in a frown.

Rotator cuff tears can affect people of all ages, but are more common in the older population. 

Rotator cuff tears can be caused by:

The size and location of the rotator cuff tear can affect the severity of symptoms. 

Symptoms include:

The role of the tendons is to hold the powerful shoulder muscles to the shoulder and arm bones. The tendons can be torn from overuse or injury.

Rotator cuff anatomy

The rotator cuff consists of four muscles and tendons in your shoulder; the supraspinatus, infraspinatus, subscapularis and teres minor. These muscles and tendons connect your upper arm bone (humerus) with your shoulder blade (scapula). The rotator cuff also helps to hold the upper arm bone in place in the shoulder socket (glenoid). The rotator cuff allows for a wide range of motion of your arm and shoulder.

There are four muscle tendons that connect to the shoulder that make up the rotator cuff. Together these four tendons stabilize the upper arm bone to the shoulder socket and allow the wide range of motion in the shoulder.

Nonsurgical options

Explore nonsurgical ways to reduce your pain. Your pain can be dramatically decreased in several ways before you decide to have surgery. Discuss each nonsurgical option with your primary care doctor to determine which are best for your specific needs. 


There are a number of medications that can help with your pain. Discuss the risks and benefits of each pain medication with your doctor to determine which one is best for you.




Your doctor may recommend injections directly into your shoulder. The purpose of an injection is to reduce irritation and inflammation caused by your injury.

Corticosteroid Injections:

Physical therapy

Physical therapy is often the first option for treatment. It can help improve the flexibility and strength in your shoulder, and teach you the best way to move your shoulder and arm to prevent further injury.

Lifestyle changes

To have the best outcome or results from your surgery, it is important that you are as healthy as possible. There are several lifestyle changes that will help.

Smoking cessation

The American Academy of Orthopaedic Surgeons (AAOS) lists these positive changes when you stop using tobacco products:

How to get started:

Smoking Cessation Resources: 

Phone Numbers:


Mobile Apps:

Group Counseling:

Weight loss

Being a healthy weight will benefit you in many ways, both in your daily living and related to your surgery.

Being overweight increases your risk for:

Weight loss can be difficult and takes both healthy eating and increased activity, which can be as easy as increasing the amount of walking that you do daily.

To get started:

Remember, safe weight loss is a slow, gradual process, of 1 to 1 ½ pounds of weight loss a week and takes changing long time habits and your lifestyle. It can be an up and down process but will be worth it as you begin to feel better and become more active.

When should I consider having surgery?

The decision to have surgery is typically made based on your answers to the following questions:

Understanding the risks

As with any surgical procedure, there are risks and complications. Your surgeon will discuss each potential complication of rotator cuff repair surgery in detail.


Although uncommon, infections are one of the most severe complications. This can occur around the time of surgery or later in your recovery. The treatment is complex, but the incidence is quite low.

Nerve Injury

Nerve injuries to the shoulder, arm, and hand are uncommon. This injury is usually temporary but can be permanent.

Blood Clots

Blood clots are also known as deep vein thrombosis (DVT) and pulmonary embolism (PE). The formation of a blood clot is uncommon. Some patients are instructed to take medications (such as aspirin or a blood thinner) around the time of their surgery to decrease this risk. Your surgeon will let you know if this is necessary.

Stiffness and weakness

Stiffness can be a problem after your rotator cuff repair surgery. This can be minimized by fully participating in therapy after surgery.

Discuss with your doctor if surgery is right for you.

Once you have chosen surgery

If you and your doctor choose surgical repair, review this section to: 

Female patient consulting with female doctor next to computer screen with x-ray displayed.

Meet your surgical team

You are in good hands.

All of our surgeons are board certified and have completed orthopaedic subspecialty fellowships in the area of shoulder and elbow surgery.  

We work as a team.

An integrated, multidisciplinary approach combines a team of dedicated physicians, advance practice providers, orthopaedic nurses, clinical case managers, anesthesia teams, residents, medical students, and physical and occupational therapists dedicated to providing our patients with the highest quality care. 

This team is led by your surgeon and also includes advance practice providers. They communicate daily about your progress both before and after surgery. During your preoperative and postoperative period,  our advance practice providers, which consist of physician assistants (PA) and/or nurse practitioners (NP), will be involved in your care. They are licensed by the state and engage in ongoing education in the specialty of orthopaedics. They have advanced academic and clinical training that allows them to provide health care services including: 

Learn more about the Orthopaedic services we provide.

What will happen during your surgery

Rotator cuff surgery is usually performed using an arthroscope.  This instrument allows your doctor to repair your shoulder through very small incisions.

I’d like to tell you about rotator cuff repair, and I’m also going to show you an MRI scan which is a special study that we do in order to diagnose rotator cuff tears because they show us not only the bones but they also show us the deep tendons in the joint.

(Camera moves to close up of MRI scan) So this is a typical MRI of a shoulder that has a very small rotator cuff tear, but I think it shows it very nicely. This is the ball of your shoulder (gestures in a circular motion on the MRI scan), and this is the socket of your shoulder (gestures in a curved motion to the left of the ball area on the MRI). The rotator cuff muscles, you can see here nicely (gestures to a dark area of MRI scan between the ball and the socket), and they attach to a dark tendon (gestures to a dark curved line on the MRI scan.) I can move front and back on this MRI to really get a more 3-dimensional image of this tendon. This also allows me to diagnose the tear.

So what I’m going to do is start scrolling more forward on this shoulder and I’m going to point to the tendon so you can see it. This is the tendon (points to a dark curved line on MRI scan) and I’m moving forward, and as you see, some white there, we’re concerned that we’re starting to see a tear. And as we move more forward, we see more white, and then lo and behold, we start seeing a very bright white area (gestures to white patch on the MRI scan) and that’s the hole in the tendon.

(Camera moves back to Dr. Armstrong.) So for a rotator cuff repair, what we need to do is put that tendon back down onto the bone. So in a normal shoulder situation (she holds her hands up, one in a fist to represent the ball fitting under the other hand, which is curved like a socket), the tendon is attached nicely to that ball of the shoulder. So if this is the ball (rotates fist), and this is the socket (rotates curved hand), and the tendon is attached to that ball, that’s the normal situation for the tendon. (Places curved hand on top of the fist indicating how the tendon attaches to the ball of the shoulder.) But in a tear (lifts fingers to show the tendon not attached to the ball of the shoulder) the tendon pulls off. And so what we need to do is bring that tendon back down to the ball. In order to do that, we take a special little corkscrew and we screw that essentially into the bone, and then it has sutures attached to it, and those sutures we then bring up into the tendon to tie that tendon back down to the bone, so that anatomy is restored. And then that should help you with your pain.

How your pain will be controlled

Pain control is one of the most important considerations for our patients around the time of surgery. 

An IV fluid dispenser in focus in an out of focus operating room.

When can I go home after surgery?

Most times, rotator cuff repair surgery is scheduled as an outpatient procedure. This means that most patients can expect to return to their home the same day as surgery. 

Prepare in advance for your arrival at home after surgery.

Pain Medication 

You will receive a prescription for pain medication for you to have at home after your surgery. 

Medication for Constipation 

Constipation is a side effect of pain medication. Use the medications you typically use to help prevent constipation (fiber, Metamucil, stool softeners and Milk of Magnesia). If you have not had a bowel movement after 4 days following your surgery, contact the Bone and Joint Institute.

How to prepare for your surgery

Once you have made the decision to proceed with surgery, there is still much to do. Please review the following sections in detail. 

Preoperative checklist

Medical Optimization/Surgical Risk Assessment

Your surgeon will let you know if you need a surgical risk assessment from your family doctor and/or specialist. 

Schedule other exams and procedures

Dental exams

Invasive procedures


Preoperative appointments

Plan on spending 1-2 hours at the Milton S. Hershey Medical Center for your preoperative appointments.

The following will occur during the preoperative appointment with your surgeon and their team:

Many patients do not require an appointment with the anesthesia clinic, however, if necessary, the following will occur during this appointment:

Prepare your home for recovery

Prior to surgery it is recommended that you make the following preparations:

We recommend that you spend time doing your routine activities in your home without using your operative arm.  This will help you plan for your recovery period.

Pick up medications

You will want to have your medications on hand before having surgery:

Arrange for care and transportation 

Discharge usually occurs the same day as your surgery.

Physical therapy

When you start therapy will depend on what your physician finds during your surgery. Do not begin formal therapy until you are instructed to do so by your surgical team.

Rotator Cuff Surgery Guidebook

Read your Rotator Cuff Surgery Guidebook and contact our team with any questions. 

What to bring the day of surgery

Bring the following with you to the hospital: 

Do not bring:

The day before your surgery

Nurse on the telephone.

In the afternoon

An admissions nurse will call and tell you:

In the evening

It is important to prepare your skin before surgery to reduce the risk of infection at the surgical site. It is also crucial to follow proper diet restrictions. Please be sure to do the following the evening before your surgery: 

Dietary restrictions: 

Clear liquids include:

Clear liquids are NOT:

No smoking sign.

Tobacco restrictions (after midnight)

The morning of your surgery

Image of the admissions desk at the Penn State Health Milton S. Hershey Medical Center.

For surgery scheduled at the main hospital, Hershey Medical Center:

For surgery scheduled at the Hershey Outpatient Surgery Center (HOSC):

In the operating room

Once your surgery is complete, your surgeon will speak with your family and review the procedure.

In the recovery room - Post Anesthesia Care Unit (PACU)

Recovery after surgery

Rehabilitation begins almost immediately after surgery and there are certain things you need to watch out for. This section will discuss:

When should I call the doctor?

Some patients do have complications after surgery. Call us if you experience any of the following:

Emergency department entrance of the Penn State Health Milton S. Hershey Medical Center

What are the do's and don'ts after your surgery?

You have the most important role in caring for your shoulder. To have the best surgical outcome, follow the Do's and Don'ts listed below:


Certain movements place stress on your shoulder and should be avoided until your surgeon instructs you to do otherwise. 


When and how to wear your sling

You must wear your sling at all times, including night time (6 to 10 weeks in the sling depending on the extent of your tear). The only times you may take it off are:

There are two ways you can learn to put on and take off the sling:

Option 1:

  1. Place the sling on a high table or countertop with the trough open.
  2. Place your surgery arm into the trough and fasten the two trough straps to secure your arm in trough
  3. Fasten the waist belt.
  4. Reach behind with nonsurgical arm and move arm through loop in the remaining strap. (This will be a similar motion to putting on a backpack).
  5. Fasten the buckle in front to secure the strap.
  6. Fasten the thumb strap.
  7. Ensure the sling is positioning the operative arm directly in front of you.
  8. When removing the sling, be sure to just release the quick-clip buckles at the waist and shoulder straps and the short straps over the trough and thumb - Do not remove the Velcro from the long straps.

Option 2:

  1. Place the sling on a high table or countertop with the trough open.
  2. Insert your non-operative arm through the only “loop” in the straps
  3. Rotate your body to allow you to place your surgery arm into the trough of the sling.
  4. Use the hand of the non-operative side to fasten the two straps over trough, and fasten the waist and shoulder buckles. Fasten the thumb strap.
  5. Ensure the sling is positioning the operative arm directly in front of you
  6. When removing the sling, be sure to just release the quick-clip buckles at the waist and shoulder straps and the short straps over the trough and thumb - Do not remove the Velcro from the long straps.

Bathing instructions


You may take the neutral wedge brace off once a day to bathe. Please make sure you have someone to assist you with transfers into the shower or tub. If you feed unsteady, using a shower seat for bathing will increase safety. When bathing your upper body, try leaning forward, allowing some space between your body and operated arm to wash under your armpit and upper arm. The operated arm should only be extended out by 10-15 degrees. Dry yourself in this position. Drying under your armpit is important to prevent skin breakdown or rash.

How to dress

Man reaching non-operated arm behind back to pull the other sleeve of a button-down shirt on.

Wear a loose t-shirt or button-down shirt.


  1. Put your operated arm into your sleeve.
  2. Pull your t-shirt up as far as possible to your upper arm without moving your elbow away from your body. You may need assistance with positioning your operated arm away from your body by bending toward your operated side or forward, making sure you do not put weight on your operated arm. The operated arm should only be extended out by 10-15 degrees to assist with putting your arm into your sleeve.
  3. Position your t-shirt so that you can put your non-operated arm into your sleeve.
  4. Put your head through the opening for your neck.
  5. Put the sling on as per the instructions in the guidebook or from your therapist.

Button-Down Shirt

  1. Insert your operated arm into your sleeve.
  2. You will need to walk the collar over to your non-operated arm.
  3. Put your non-operated arm through your sleeve.
  4. You may need assistance with your buttons.
  5. Adjust your shirt at the back and front with your non-operated arm.
  6. Put on your sling as per the instructions in the guidebook or from your therapist.


Wear pants or shorts with an elastic waist. To dress while wearing the sling, follow these instructions:

  1. While sitting on a chair or the edge of a bed, use your non-operated arm to hold the waistband of your pants.
  2. Place your leg into your pants by crossing your leg and bringing your ankle up to knee height.
  3. Pull your pants up to upper thigh height.
  4. Using your non-operated arm, push up from your chair/bed and pull your pants up.


  1. While sitting on a chair or the edge of a bed, cross your leg and bring your ankle up to knee height.
  2. Bend slightly forward with the sock in your non-operated hand, and place the sock over your toes.
  3. Pull up your sock while bending your knee toward you.


Try to wear slip-on shoes or use elastic shoelaces or velcro closures so you do not have to tie your shoes.

  1. While sitting in a chair, slip your feet into your shoes.
  2. Use your non-operated hand to secure the velcro closures, if applicable.

Exercises to do after surgery

It is important to do the exercises recommended by your therapist after your rotator cuff repair surgery.

You can begin with hand, wrist, and elbow exercises immediately after surgery.  Your therapist, as directed by your surgeon, will instruct you on which exercises to do and when to begin as you progress after surgery. 

Click each image for a video demonstration of the exercise.

Exercises to be done immediately after surgery: 

Exercises to perform only when directed by your surgeon, with instructions from your therapist: 

Thank you for visiting

Thank you for taking the time to view this resource! We hope you, your family, and your caregivers find this resource convenient and helpful in making informed decisions about your course of care.

If you have other questions or would like to discuss rotator cuff repair surgery further, we would be happy to meet with you.

Best wishes from the Shoulder and Elbow Division at Penn State Health!

Aerial photograph of the Penn State Health Milton S. Hershey Medical Center