Arthroscopic rotator cuff repair

It depends on the tear, your age, how active you are, and how much it affects daily life. Smaller or wear-related tears often do well with physiotherapy, activity changes and sometimes an injection. Surgery is more often considered for larger tears, tears from a sudden injury, younger or more active people, and when good non-surgical treatment has not settled things.

In trials of full-thickness tears, surgery and structured non-surgical care gave broadly similar shoulder scores at two years, with a modest advantage for surgery at one year. There is no single right answer for everyone, which is why a specialist assessment matters.

Some tears, particularly larger ones in younger people or tears from a clear injury, can enlarge over time, and a tear that retracts a long way or where the muscle wastes can become harder or impossible to repair. Many degenerate tears, though, stay stable for long periods, and a sensible trial of non-surgical treatment does not automatically ruin a later repair.

This is a timing decision best made with a surgeon who has seen your scan. If the shoulder is getting weaker or more painful, that is a reason to be reviewed sooner.

This is a developing area rather than pure marketing. Bioinductive collagen implants (such as Regeneten) are placed over a repair to encourage new tendon tissue. A systematic review and several trials suggest they can reduce re-tear rates, and a recent US guideline now supports their use to augment a repair in selected cases.

The nuance is that patient-reported pain and function so far tend to be similar to standard repair, and longer-term comparative data are still building, so they may help healing in the right situation rather than guaranteeing a better result. Whether one suits you is a decision for your surgeon based on your tear.

A steroid injection can give short-term pain relief, particularly in the painful phase of a frozen shoulder. For rotator cuff-related pain the benefit is more modest, tends to last weeks rather than months, and works best alongside an exercise programme.

On repeated injections, caution is reasonable: there is no strong evidence behind the common "rule of three", and steroid around the cuff tendons can, with frequent use, weaken tendon tissue. In diabetes it can also raise blood sugar for a day or two. They are a useful tool used thoughtfully and in limited numbers.

The honest, evidence-based answer is "not proven". Platelet-rich plasma (PRP) has laboratory rationale but limited, inconsistent clinical evidence for the rotator cuff and is not a standard treatment. Stem cell injections are similarly experimental, with wide variation between providers.

Peptides such as BPC-157 and TB-500 deserve a clear warning: almost all the evidence is from animal studies, they are not approved for human use by any medicines regulator, they are banned in sport by the World Anti-Doping Agency, and products sold online are unregulated. We would not recommend them; discuss any of these with a qualified doctor first.

A bit of preparation makes the first weeks much easier: get as fit and well as you reasonably can, set your home up so things are within reach of your good arm, sort loose front-opening tops and slip-on shoes, and arrange help for the first week or two if you live alone. If you have diabetes, flag it early, as it affects healing and the response to any steroid used around the operation.

Good questions to take to clinic include: exactly what is being done and why; how long in the sling and what type; when physiotherapy starts; what to expect at six weeks, three months and a year; the pain-relief plan and whether you will have a nerve block; when you can shower, drive, work and return to your sport; and the main risks, including the chance of re-tear.

A nerve block numbs the nerves to the shoulder and arm, usually alongside a general anaesthetic, and gives excellent pain relief for roughly the first 10 to 24 hours. The arm often feels heavy and numb during that time, which is expected.

As it wears off, usually the evening or night after surgery, pain can return quite suddenly ("rebound pain"). This is well recognised and not a sign anything is wrong. Start your prescribed pain relief on schedule before the block fully wears off, so you stay ahead of it. A hoarse voice, a drooping eyelid, or a feeling of breathlessness can occur as the block spreads to nearby nerves; these settle as it wears off, but tell your anaesthetist beforehand if you have significant lung disease, asthma or sleep apnoea.

Sleep is one of the hardest parts of early recovery. Many people sleep semi-upright in a recliner or well propped up, supporting the operated arm on pillows, and keep the sling on at night for as long as the surgeon advises. Expect broken sleep for several weeks and try not to measure recovery by it.

Sling time varies with the operation, commonly around the first six weeks for a repair. Neck and upper-back ache from the strap is very common; easing and padding the strap helps, as do gentle hand, wrist and elbow movements. Do not stop the sling early just to get comfortable; wait until your surgeon clears it.

Pain is usually managed with a combination: the nerve block, regular paracetamol, an anti-inflammatory if safe for you, a short course of a stronger painkiller for the first few days, and ice. Using several milder approaches together often works better, with fewer side effects, than one strong drug.

If opioids make you sick, or you cannot take anti-inflammatories (stomach, kidney, heart or stroke history), this is common, so tell your team in advance to plan around it. One point that causes confusion: ketorolac (Toradol) is an anti-inflammatory given by mouth, muscle or drip, not an injection into the shoulder joint. Your prescriber decides what is safe for you.

Showering depends on your dressings and your surgeon's advice, so follow the instruction you were given. Keyhole wounds are small, but the skin around them can feel dry, tight or crispy and catch on clothing; a loose dressing stops it rubbing, and once fully healed a plain moisturiser can settle the dryness.

The incision points can stay tender for several weeks, which is normal. Once healed, gentle scar massage (your physiotherapist can show you) reduces sensitivity over time, and it is worth protecting healing scars from strong sun. Do not put creams on a wound that is not yet closed, and report spreading redness, heat, discharge or fever.

There is no single fixed date, and it is ultimately your responsibility to be safe and legal. As a rough guide, UK services often suggest driving around six to eight weeks after a repair, when you can control the car and perform an emergency stop confidently without significant pain, and you are not taking medication that affects alertness. It is also sensible to check your motor insurance position first.

Desk work is often possible around six to eight weeks, and heavier manual work around four to six months, depending on the job and the operation. Your surgeon's specific advice always takes priority.

Yes, and it is talked about far too little. Frustration, low mood, isolation and poor sleep are common while you are in a sling and reliant on others, and it does not mean recovery is going badly. Keeping gently active within your limits, staying connected to people, and marking small milestones all help.

If low mood is persistent, deepening, or affecting daily life, please speak to your GP. Effective support is available and asking early is a strength.

Yes. Wanting to understand your diagnosis and feel heard is reasonable, and a second opinion is a normal part of healthcare, not a criticism of anyone. You are entitled to ask your clinician to explain your scan and the reasoning, what the alternatives are, and what happens if you do nothing.

If you are still unsure, another shoulder specialist's view is a legitimate next step. Bring your imaging and a written list of questions, and be specific about your goals and what the shoulder stops you doing.

Most shoulder problems are not dangerous, but a few warning signs deserve prompt attention: an unexplained lump that is enlarging, deep or larger than a few centimetres; constant pain at rest and at night that is steadily worsening; feeling generally unwell with weight loss, fevers or night sweats; a sudden inability to lift the arm after an injury; signs of wound infection after surgery (a firm, warm, enlarging or increasingly tender area, spreading redness, discharge or fever); signs of a possible blood clot (new calf pain or swelling, or chest pain or breathlessness); or pain not relieved at all by your prescribed medication.

If you are worried, contact your GP or, after surgery, your surgical team. If you are acutely unwell, use NHS 111 or urgent care.