Rotator cuff tear is an extremely common pathology. Studies have shown that nearly 20% of the general population suffers from a full-thickness tear after the age of 60. Many remain asymptomatic (see symptoms below), meaning they have little or no pain. Surgery on shoulder tendons in case of a tear is not systematic. It depends on several factors such as age, occupation, location of the tear and, above all, pain.

The cuff tendons

The rotator cuff is made up of 5 tendons: the supraspinatus, the infraspinatus, the teres minor, and the upper and lower portions of the subscapularis.

They serve to hold the humeral head against the glenoid and so allow the arm to be raised (see video). In the event of damage (partial or full-thickness tear), bursitis (inflammation) of the shoulder may develop and cause pain.

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Rotator cuff tear

Symptoms

Shoulder joint pain is generalised, but more often felt in the arm and especially at night. It is rarely an acute shoulder pain but rather a chronic one. Most of the time, in cases of untreated rotator cuff tear, patients can carry out almost all daily activities, yet the shoulder becomes painful at night. The tendon tear may also — though not always — cause a loss of strength.

Full-thickness rotator cuff tear

In the vast majority of cases, the lesion or tear of the rotator cuff is full-thickness, meaning the tendon is completely detached from the bone (see photo 1) and specifically involves the supraspinatus. The lesion then spreads forward (subscapularis) or backward (infraspinatus).

A tear of the supraspinatus is not always full-thickness; in such cases we speak of a partial-thickness rotator cuff tear (photo 2), meaning the supraspinatus tendon is not completely detached from the bone. Partial tears can be just as painful as full-thickness tears, since the pain is essentially linked to shoulder bursitis.

Rotator cuff surgery

Surgical technique

The shoulder specialist begins by inserting a small camera (a procedure known as shoulder arthroscopy) to obtain a clear view of all the tendons and the tear. An acromioplasty is then performed, meaning a very small portion of bone is shaved. The shoulder tendons are then re-anchored to the bone using suture anchors. The video shows real-time rotator cuff surgery.

Course of the operation

Rotator cuff surgery is most often performed by an orthopaedic shoulder surgeon. The procedure takes place as a day case; you arrive in the morning fasting and, in most cases, you will not be put fully asleep. The rotator cuff repair can be performed under regional anaesthesia (only the nerves close to your shoulder are numbed). Hypnosis support is also available.

The shoulder operation lasts about half an hour. You can then rest for a few hours in a suitable lounge and have a snack. A booklet will be provided with all the information. It is important to take your shoulder pain medication even if you have no pain, so that pain does not return once the nerve block wears off.

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Rehabilitation exercises

Here are three videos produced by a physiotherapist to support you in self-mobilisation exercises at home, following your rotator cuff surgery. These exercises, in addition to physiotherapy sessions, are key to the success of your surgery. There are three phases of exercises that you can easily perform on your own at home, during the six months following your rotator cuff repair. It is important that this rehabilitation is carried out without pain, which varies from person to person.

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All these timeframes are indicative, and you will progress at your own pace. By scrupulously following this self-rehabilitation programme, in addition to your physiotherapy, you will maximise your chances of a successful outcome from rotator cuff surgery performed by Dr. Collin.

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Cuff tendon repair — Phase 1

A first phase (phase 1) will guide you during the first six weeks following your rotator cuff tear: three exercises mainly aimed at pain relief, to be performed gently without forcing at the end of range, to reduce muscular tension and loosen your shoulder.

Play video

Play video


Cuff tendon repair — Phase 2

A second phase (phase 2), from the end of the first six weeks to the end of the third month after your rotator cuff repair: the initial exercises are maintained and reinforced by three additional ones to recover full active shoulder mobility.


Cuff tendon repair — Phase 3

A third phase (phase 3), from three to six months after your cuff surgery: all exercises are maintained, plus an overall stretch, to recover a functional shoulder and rebuild muscle strength.

Play video

Play video


How to fit an elbow-to-body sling

Learn how to correctly fit an elbow-to-body sling to immobilise the arm and aid healing after injury. In this simple, practical guide, discover the steps to position the sling, adjust the straps and ensure comfortable, secure support for the elbow and shoulder. Ideal for patients, carers or healthcare professionals seeking to apply the sling effectively.

● Wear an abduction cushion day and night (except for dressing, washing, meals, physiotherapy sessions and self-rehabilitation exercises)

● Physiotherapy 3 times/week

● Self-rehabilitation exercises 1 & 2 to be done 5 times/day (1 minute per exercise)

● No walking for more than 30 minutes

● Wear an abduction cushion day and night, weaning at the 4th week (1h morning/1h afternoon then increase very gradually)

● Self-rehabilitation exercises 1, 2 & 3 to be done 5 times/day (1 minute per exercise)

● Physiotherapy 3 times/week

● No prolonged or excessive walking

● No more abduction cushion

● Minimal use of the arm (= simple daily activities)

● Lifting light objects

● Nothing heavy, nothing repetitive, no housework, no washing-up

● Resuming driving around 1.5 months

● Physiotherapy 3 times/week

● Self-rehabilitation: start exercises at weeks 4–6, 5–8, 6–10, 7–12

● Maximum 45 minutes walking

● Authorisation to gradually resume housework, road / indoor cycling, swimming and walking

● Physiotherapy 2 times then once a week

● All self-rehabilitation exercises

Physical activity, lifting, DIY, gardening

Nutritional advice

Shoulder tendons are metabolically active living tissues that need appropriate nutrition to function properly. To allow good healing and a good recovery of joint function, particular attention must be paid to the quality of the diet. This will help limit inflammation and pain.

Inappropriate rehabilitation can also contribute to poor tendon nutrition by encouraging the destruction of the small channels through which nutrients pass into the synovial sheath. To allow good healing and a good recovery of joint function, particular attention must be paid to the quality of nutrition. This will help limit inflammation, pain and prevent necrosis and stiffness.

Here are some simple recommendations to take care of your shoulder:

Many inflammatory proteins, the eicosanoids, are produced from dietary fats. This is the case for those found mainly in sunflower or corn oils and margarines. Other fats, omega-3, conversely have anti-inflammatory effects and protect the cartilage and tendons. This is the case for the fatty acids predominant in rapeseed, walnut, soybean and linseed oils, and in the fats provided by walnuts, linseed and oily fish. Change your oil and eat fish. Plants should provide the largest share of daily calories: vegetables, raw vegetables (cooked and raw tomatoes), tubers, leafy plants, pulses, fresh and dried fruit. They provide the minerals and vitamins essential to the joint (vitamins A, C, Zinc, magnesium, lycopene). They have a powerful antioxidant effect which limits inflammation.

Prefer wholemeal or semi-wholemeal pasta, rice and bread: richer in fibre, with a lower glycaemic index, they support antioxidant and anti-inflammatory defences.

Eat 2 dairy products per day (no more than 3), and prefer water rich in calcium and magnesium.

● Shower: From the day after surgery, provided waterproof dressings are used.

● Work: If your work is sedentary, your sick leave will be at least 3 months. If your work requires physical effort, it will be at least 6 months.

● Drive my car: From 1.5 months.

● Sport: From 6 months.

● DIY: From 6 months.

● Gardening: From 6 months.

● Housework: From 3 months.

They will remain in place permanently.

In principle, the operation does not cause pain. Furthermore, rehabilitation and self-rehabilitation should be carried out at an intensity below the pain threshold.

If pain persists despite the medical treatment prescribed, please review the matter with your physiotherapist, and above all consider whether you have strictly followed the instructions. Reasons for this pain can often be identified.

No, it is by no means essential. It is true that if your physiotherapist offers hydrotherapy, recovery of range of motion will be easier. Moreover, if recovery of range of motion lags behind at the various assessments, we may suggest hydrotherapy alternating with your usual physiotherapy.

Yes, the failure rate varies from 5% to 30%. Factors associated with a poorer prognosis include: tobacco use, marked tendon retraction, involvement of several tendons, and poor muscle quality.

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Need more information?

Contact Dr. Collin
Consultation locations
  • Clinique Drouot Molitor – Sports & Arthritis
    37 rue Molitor, 75016 Paris
    +33 1 88 40 20 30
  • American Hospital of Paris
    55 Bd du Château, 92200 Neuilly-sur-Seine
    +33 1 88 40 20 30
Surgical venues
  • American Hospital of Paris
    55 Bd du Château, 92200 Neuilly-sur-Seine
  • Clinique Victor Hugo
    5 Bis Rue du Dôme, 75116 Paris
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