Updated November 2, 2026
Many shoulder injuries involve the rotator cuff, one of the most common sources of shoulder pain and dysfunction. The rotator cuff is the set of muscles and tendons that position your arm in your shoulder socket, allowing your arm to swing, rotate and move in different directions. Overuse or trauma to this area can result in a tear in the tendons that connect your shoulder muscles to your skeletal system, causing limited mobility and pain. If you are in need of a rotator cuff repair, surgery may bring hope to people suffering from this condition but also may seem daunting.
What is a rotator cuff tear?
These tears, when the rotator cuff separates from the bone, are among the most common types of shoulder injuries, accounting for 4.5 million doctor visits each year, and become more common as we age. There are two types of tears:
- Degenerative tears
- Acute tears
Degenerative tears occur most frequently and happen gradually. They’re caused by wear and tear over time or repetitive motions like the swinging of a tennis racket or in jobs like painting or window cleaning. Acute tears are sudden, and might follow a mishap or trauma, like a nasty tumble on the ski slope.
What are the symptoms of a rotator cuff tear?
If you have pain when you reach for something on a high shelf or brush your hair, this can be a sign of a torn rotator cuff. Other symptoms include having difficulty extending your arm behind your back and weakness in your arm. Arm pain typically begins at the front of the shoulder and radiates down. It’s important that you get checked by a physician, who will perform a series of functional tests, asking you to lift, rotate, and carefully drop your arm in certain ways. Imaging tests like an MRI or ultrasound may also be used to confirm a diagnosis.
What happens after a diagnosis?
Before your doctor recommends a treatment course, several factors will be considered, including your general health, age, activity level, and the severity of the tear. As with many orthopedic injuries, there is a wide range of operative and non-operative treatments. Your doctor may suggest resting the shoulder and taking anti-inflammatory medication like ibuprofen to bring down the swelling as a first line of defense. Physical therapy might also be considered as well as a cortisone injection or other steroid injections which can be very effective in some cases. If the pain persists, however, your physician may recommend surgery.
What is the goal of rotator cuff repair?
The objective of rotator cuff repair is to gain both pain relief and regain functionality to the shoulder. In most cases of a rotator cuff tear, surgery may be the best option. The surgery involves reattaching torn tendons to the bone and anchoring them in place, giving the body a chance to heal.1 Surgery is typically recommended if pain and lack of function remain following attempts at conservative solutions such as shoulder rest, application of ice and heat, anti-inflammatory medications, or physical therapy.
Who may be eligible for rotator cuff repair?
While surgery is not the only option for rotator cuff repair, it is typically recommended for:
- People who have a partial or full thickness rotator cuff tear
- Those experiencing continuous pain with no improvement despite other treatments
- People suffering from rotator cuff pain who play sports or engage in regular physical activities
If you are experiencing these symptoms, talk with your doctor to learn if rotator cuff surgery is right for you.
I need rotator cuff surgery. What happens next?
Do your research.
If surgery is your next step, it is important to do your research. Find a surgeon that you trust and learn about your surgical options. Ask questions to ensure you have a good understanding before making a decision.
One of those options is worth asking about by name because it is done in addition to the repair itself rather than instead of it.
What is rotator cuff augmentation?
Sometimes a torn tendon needs more help than a typical repair, commonly performed with anchors and sutures, can give on its own. Especially when a tear is large, the tendon has thinned over the years, or there is a repeat injury, a surgeon may place a layer of material over the repair site to support your body’s natural healing process. That step is called rotator cuff augmentation.
The Integrity Implant is one option surgeons use for rotator cuff augmentation. It is made with hyaluronic acid, which your body already produces on its own. Its woven design leaves space for your body’s own healing cells to move in and rebuild tendon tissue at the repair site, and it is reinforced with medical grade polyester, the same material many sutures are made of, so the surgeon can place it precisely in the spot where healing is needed.
Not every repair calls for it, but if surgery is on the table, rotator cuff augmentation is worth asking your surgeon about.
The surgical journey: A brief overview
Prior to any operation, your surgeon will perform a thorough evaluation of your personal situation and create a treatment plan. This plan sets the groundwork for a smooth and successful recovery. Common parts of the assessment plan and surgery experience are included below. Your doctor will make a plan that is personalized for you.
The Evaluation
In order to make a full recovery after surgery, your surgeon will do a baseline evaluation of your shoulder injury (understanding what the injury and your symptoms are like today). This goes beyond an MRI and X-ray, as the medical team will assess the gravity of your injury in relation to your day-to-day life. Knowing a tear is present is the first step and knowing how it affects you helps shape a plan for healing.
Medical History Review
The medical history review is a key part of the pre-operative process. Your surgeon will inquire about the details of your current medications, your vaccination history, prior surgeries or hospitalizations, and any allergies or adverse reactions to previous treatments. Your surgeon will also be mindful of safety precautions, marking any past symptoms, episodes, drug interactions, or conditions that might affect the surgery or healing after the operation. Preparing for all potential outcomes is paramount to your treatment plan so be as thorough as possible when discussing your medical history.
Setting Expectations
When setting expectations regarding your rotator cuff surgery, clear communication is key. Your surgeon will be open about what he/she can and cannot accomplish given your individual situation. From there, you can jointly determine an expected outcome that is not only beneficial for your health, but possible and realistic. Any questions or concerns regarding potential results should be addressed at this stage.
During the surgery: The main event
It is the day of your operation, and you are at the center of the surgery team’s focus. The aim is for everything to operate like clockwork in a safe and comfortable space.
Anesthesia: Ensuring comfort
Anesthesia ensures a comfortable experience throughout the surgical procedure. There are two types most frequently available for patients: general and regional. General anesthesia will induce sleep for the duration of the surgery. Regional anesthesia, however, involves numbing a single part (or region) of your body while you remain awake. In the end, both options achieve the same goal: to guarantee you’re free of pain during the procedure.
The Rotator Cuff Repair Process
With precision and great care, your surgeon will likely fix the torn rotator cuff tendons using suture anchors.1 These anchors may be permanent or may dissolve over time. The surgeon will reattach the torn tendon by placing the anchors in the shoulder bone (humerus) and then use the suture that is connected to the anchor to hold the tendon in place. This will ensure the tendon attachment to the bone is properly restored.
Some surgeons may choose to add more products to help strengthen the rotator cuff repair, such as the Integrity Implant. If the surgeon uses Integrity to augment the repair, they will place Integrity on top of the tendon that was just repaired and secure it in place. The Integrity Implant is designed to support your body’s natural healing process at the repair site.
After the surgery: The road to recovery
When the surgery is over, your recovery begins. This is a critical phase in the healing process where discipline and determination are crucial to regaining range of motion and strength.
The Healing Process
Recovery is not a passive process but one of active participation. At first, you may experience some pain and discomfort, but rest assured that this is a natural sign of healing. Leverage surgeon-approved pain management practices to help you cope with this phase of recovery. Another important part of the healing process is physical therapy. Through a series of regular, targeted exercises you can gradually reestablish your shoulder’s mobility and strength.
Common examples of post-operative activities are below, but your doctor and physical therapist will create a plan that is personalized for you.
Initial recovery
In the first weeks following surgery, aim to give your shoulder what it needs the most, i.e., rest. This time is key to restoring the repaired tendons and often determines the final outcome.
Rest and immobilization
The use of a sling will give your arm the necessary support to keep the repaired areas intact. Resting your shoulder promotes the healing process while ensuring no further damage is done to the affected area.
Pain management
As with any surgery, you may experience discomfort as you start to heal. Your surgeon will include pain management in his/her treatment plan for your individual case. This may include a variety of tools including prescriptions or over-the-counter anti-inflammatory medications.2 Your surgeon will select the best course of treatment while taking your current drug regime, allergies, lifestyle, etc. into consideration.
Preventing strain
Be mindful of workouts and activities that may strain your shoulder. Make modifications to daily tasks as needed and ask for help if you face roadblocks.
Early exercises
As you get back into exercising, don’t do too much too soon. At first, focus on gentle exercises and movements rather than muscle development. These will keep your range of motion and encourage staying limber. Follow your physical therapist’s recommendations to regain strength and range of motion as you heal.
Physical therapy and your rotator cuff repair recovery
You can typically start physical therapy 2-3 weeks after your surgery with your surgeon’s approval. This is crucial to remedying the injury and working to regain lost functions and abilities.
Your physical therapy plan
Your physical therapist will design a customized program for you, which will be based on the specifics of your injury, your lifestyle, and any job requirements pertinent to your shoulder repair. Early stages begin with passive range of motion exercises, encouraging healing to complete basic tasks such as bathing and dressing. From there, the exercises gradually advance toward increasing range of motion and strengthening the muscles around the shoulder, with the eventual goal of returning to sports, work, and other recreational activities.3 This is a progressive outcome consisting of several weeks of physical therapy to make a lasting and meaningful recovery.
Returning to the activities you enjoy
Recovery is an individualized journey that does not follow a linear path. This is a week-by-week process of progression, and each new accomplishment should be celebrated. Late stages of physical therapy include gradually stepping back into the activities you did pre-surgery. You can begin to use your shoulder for gardening, playing pickleball, or exercising your back muscles as you carry groceries. While the shoulder joint can be significantly better than before, you should be mindful of your limits and need for accommodations, thus preventing future injuries.
Tips for a good recovery
A few habits carry you through every stage of it:
- Maintain an open dialogue with your surgeon and physical therapist. They can advise you on the best way to move forward and progress as you heal from rotator cuff surgery.
- Don’t push yourself to the point where you may reinjure your shoulder or worsen your progress.
- Stay committed to physical therapy. It provides support for regaining strength and mobility as well as returning to the activities you enjoyed before your injury occurred.
Check out some examples of rotator cuff exercises in our video below.
Common questions about rotator cuff repair and augmentation
What is the difference between rotator cuff repair and rotator cuff augmentation?
Rotator cuff repair reattaches the torn tendon to the bone, usually with suture anchors. Rotator cuff augmentation adds an implant over that repair to support the tendon while it heals. Augmentation happens alongside a repair, not instead of one.
Who might need rotator cuff augmentation?
Surgeons may consider it for larger tears, when tendon tissue has thinned, in the case of a repeat injury, or in any cases where the tendon could use additional biological support for healing including partial tears. The decision comes down to your tear, your tendon, and your overall health, and your surgeon will make that call during planning or during the procedure itself.
How long does recovery from rotator cuff repair take?
Recovery is gradual and personal to you. Physical therapy typically begins two to three weeks after surgery with your surgeon’s approval and progresses over several weeks from gentle range of motion work toward strengthening and a return to normal activity.
Moving forward
Rotator cuff surgery can bring hope to those dealing with an uncomfortable, painful, or limiting rotator cuff tear. By having a clear idea of your options, the surgical process, and the recovery, you’ll be set up for success. Remember, it’s not a sprint. Recognize that every triumph through the recovery process is a step toward your end goal.
For more information on shoulder health and other related topics, see the Integrity page on our website.
References
1. https://www.mountsinai.org/health-library/surgery/rotator-cuff-repair
2. https://www.sciencedirect.com/science/article/abs/pii/S1058274616000653
3. https://bostonshoulderinstitute.com/wp-content/uploads/2020/04/PT-Rotator-Cuff-Reconstruction-Final.pdf
