Should I have a rotator cuff repair?

Dr. David Colvin, trained in orthopaedic surgery in Perth. David’s specialty is knee and shoulder surgery and sports injuries.


Many patients struggle with the decision as to whether they should have a rotator cuff repair, and not without good reason. Although the risks of surgery are very low, rotator cuff repair comes with a very protracted recovery. Most patients will know someone who has had a rotator cuff repair and may already be discouraged by reports of significant post-operative pain and the long recovery. 

Let’s step through the decision making process.

Can I live with a rotator cuff tear?

Many older patients have rotator cuff tears and don’t even know about it. Medical research based on ultrasound scans suggest that perhaps 10% of people in their sixties, 20% of people in their seventies, and 40% of people in their eighties have rotator cuff tears on ultrasound. Many of those patients are pain free and functioning well. So the presence of a rotator cuff tear on ultrasound or MRI scan is not in itself a sufficient reason to justify surgery. 

I have seen many elderly patients whose shoulder has become painful due to injury, a scan has shown a rotator cuff tear, but over time and with rehabilitation, things have settled and they have regained normal function. So to answer this question – many people are living full and normal lives with a rotator cuff tear and do not know about it.

rotator cuff tear perth

A localised full thickness tear without retraction should do well with surgery

rotator cuff tear perth

A chronic retracted tear will not be repairable

How do I know if my rotator cuff tear requires surgery?

Firstly, do not rush your decision. We are not dealing with a life and death condition, and very few rotator cuff tears require urgent surgery. 

The decision-making process centres around two criteria, pain and function. Shoulder problems, more than any other condition, are notorious for causing night-time pain and interrupted sleep. If this goes on for long, it will test your sanity. In that situation, you won’t find it hard to make a decision to proceed with surgery.

In the same manner, a significant loss of function will make the decision for surgery easy. Large rotator cuff tears can cause an effective paralysis of the arm. This is functionally catastrophic. Smaller tears may still make it impossible to work overhead and that may mean you can no longer engage in your usual occupation or undertake basic day to day activities.

If the pain is not interfering with your sleep and you can still undertake most of your day to day activities and occupation, a period of non-operative rehabilitation may be more appropriate. In that situation, I would always recommend a follow up scan in six to twelve months.

When is it too late for rotator cuff repair?

There is a flip side risk to not operating. In a nutshell, the pain might continue, function may not improve, and we might “miss the boat” in terms of repair. Tendons retract, muscles waste away, and the fixable may become unfixable. This is a big problem and there are no good alternatives once the tear becomes irreparable. The “bail out” may be shoulder replacement. The result of a successful rotator cuff repair will be better than a shoulder replacement in general terms. 

It certainly can get to a point where it is too late for rotator cuff repair. MRI scans have been a major step forward in allowing us to decide what tears might be repairable and when we might have missed the boat. The tendon tears off the bone attachment and retracts over time. An MRI scan can assess that degree of retraction very accurately. Furthermore, the MRI allows us to quantify how badly wasted the muscle is. The greater the retraction and the more the muscle wasting, the less likely the tendon can be successfully repaired.

Am I too old for rotator cuff repair?

The first point to make here is that most rotator cuff tears are “degenerative” in origin, which means that it is age related tendon wear. So the vast majority of patients undergoing rotator cuff repair are in an older age group. 

From a medical point of view, doctors are concerned with your “biologic” age, rather than your “chronologic” age. That is to say, if you are eighty years old but you look sixty, we will make our treatment decisions on the basis that you are sixty.

Unfortunately, the opposite also applies. If you are sixty years of age but generally in poor health, we will make decisions based on an older biologic age. In medicine we talk about “co-morbidities”, which are other medical factors, which may impact upon the success of rotator cuff repair surgery. In that regard, there are two big ones, diabetes and smoking. Both of these impact upon new blood vessel growth which is critical for tendon healing. Obesity also has a significant impact upon surgical risks and outcomes from rotator cuff repair.

Should I have a rotator cuff repair?

To help you make the decision about rotator cuff repair surgery, go through the following checklist: 

  1. Are my symptoms bad enough to justify surgery? If you have night-time pain or significant functional loss, then surgery might be indicated.
  2. Is my rotator cuff tear repairable or is it too late? This is something your surgeon will advise you on based on the MRI scan. Be aware your surgeon might say: yes it is repairable, no it is not repairable or, it is in a grey zone which might be repairable.
  3. Am I in good enough health to have a rotator cuff repair? Don’t think so much about your actual age, but more about your general health and expectations.
  4. The final question, which no one else can answer for you is “can I commit to the rehabilitation?” There is no fudging this one. More than any other operation, success of rotator cuff repair surgery depends on good rehabilitation. It is an unforgiving operation with rehabilitation timelines and targets. With the right support team in place, I am confident that every patient can make that commitment.

Get new posts delivered to your inbox

Subscribe to our blog

Orthopaedic surgeon Perth

About Perth Orthopaedic Surgeon Dr David Colvin

Dr David Colvin, a Perth orthopaedic surgeon with a special interest in shoulder and knee injuries, understands that a painful joint or a joint that doesn’t function properly, can have a huge impact on your quality of life.