UNC Health Talk

How to Prepare for Rotator Cuff Surgery

If you’re scheduled for rotator cuff surgery, you might think there’s nothing to do but wait—but actually, now is a great time to make preparations that will help your recovery.

A rotator cuff is a collection of four muscles and their tendons that form a cuff around the shoulder joint to help lift and rotate the arm. The muscles also help stabilize the ball of the shoulder joint in the socket of the shoulder blade, especially when the arm is raised overhead.

People can injure their rotator cuffs in many ways, but most injuries affect the tendons that attach the four rotator cuff muscles to the arm and shoulder bones. Tears may cause pain, weakness or a lack of function.

Frequently, injuries to the rotator cuff tendons do not require surgery and can be treated with physical therapy, steroid injections, anti-inflammatory medication and activity modifications that help reduce pain.

“I’ve had a partial rotator cuff tear since I was in college,” says R. Alexander Creighton, MD, chief of orthopedic sports medicine for UNC Orthopaedics. “It’s been stable for 30 years, and I’ve never needed surgery.”

However, some rotator cuff injuries do require surgery to repair. Usually, these injuries are caused either by a traumatic event such as dislocating a shoulder or by degeneration, a natural aging process that thins and weakens the rotator cuff tendons. Injuries from degeneration are more common and increase in frequency with age.

Rotator cuff surgery is usually done with arthroscopic techniques. A small fiber-optic tube (arthroscope) fitted with a camera and a light is guided into the shoulder joint through a small incision. Surgeons can evaluate the full joint and look at what needs to be repaired. Then instruments are inserted into the incision to repair, reconstruct or remove damaged tissue.

Almost all patients go home the same day as the surgery. Full recovery can take up to a year, although 80 percent of the progress is made within the first six months after surgery.

Ask Yourself These Questions Before Rotator Cuff Surgery

“Before your surgery, it’s good to think ahead to what you will need after surgery,” Dr. Creighton says. “Get a support system in place so that the days following surgery go as smoothly as possible.”

Here are the things you should be thinking about in the weeks leading up to your rotator cuff surgery:

1. Who will take me home after surgery?

Rotator cuff surgery is performed under general or regional anesthesia, or a combination of the two, and most people don’t need to spend the night in the hospital. That means you’ll need help getting home and taking care of yourself while the medication wears off. Make arrangements for someone to drive you home and take care of you immediately after your surgery.

2. Who will help me in the weeks after surgery?

“Logistically, you will only be able to use one arm for a while,” Dr. Creighton says. “Because the shoulder that we operated on will need time to heal, you’ll need to restrict and protect shoulder movements, which means you’ll need help with some common tasks.”

You might need help preparing food, dressing yourself or caring for children or pets. If you have friends or family members who can help you, or if you plan to hire help, make those arrangements in advance and set expectations for loved ones about what you’ll need. Talk to a social worker at your hospital if you need help finding or paying for assistance.

3. Am I practicing my “T. rex” arm?

Dr. Creighton says it’s good to use a “T. rex arm” for several weeks after surgery. This means keeping your upper arm close to your side, without rotating your shoulder or fully extending the arm to the front, side or back. He says it’s good to start doing this a couple of weeks before the surgery to make sure you don’t overuse your shoulder before the procedure.

4. Which physical therapist will I use for rehabilitation?

It’s important to establish a relationship with a physical therapist before your first rehabilitation appointment. Select a therapist before your surgery and do a pre-surgery visit with him or her, if you can.

“Postoperative therapy is such a key component of recovery, and it’s helpful to not be meeting your physical therapist for the first time at your first post-op visit,” Dr. Creighton says.

5. How will I sleep?

Many people with rotator cuff injuries have a difficult time finding a comfortable sleeping position. Surgery can make that even more challenging. Think about how you might sleep after your surgery, and spend a few nights beforehand getting used to it. You might try sleeping on the uninjured shoulder or in a recliner.

6. Do I understand what will happen during and after surgery?

Don’t be afraid to ask your doctor all the questions you have about your surgery and recovery process.

“Education is really important. We strive to help patients understand everything that will happen during and after surgery,” Dr. Creighton says.

It also can help to talk to people who have had a similar experience. They might have advice, and you can see what a successful surgery looks like months or years later.

7. Do I have the right mindset for recovery?

“Rotator cuff surgery is a delayed-gratification type of surgery,” Dr. Creighton says. “Have the mindset going into it that this will not be a quick fix. The goal of the surgery is to improve pain and function, but it doesn’t happen right away.”

It takes most people up to a year to fully recover from rotator cuff surgery. There’s a healing phase, a stretching and range-of-motion testing phase, then a strength-gaining phase. Mentally preparing yourself for the long road after surgery is just as important as any other preparation you can make.


If you’d like to learn more about rotator cuff surgery or see if it’s a good option for you, make an appointment with UNC Orthopaedics.