Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Practising at Mount Elizabeth Novena Hospital, Singapore
Appointments by prior arrangement
Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Mount Elizabeth Novena Hospital, Singapore
✔ Subspecialty Focus in Shoulder & Elbow, Sports Injuries
✔ Practising at Mount Elizabeth Novena Hospital
✔ Evidence-based treatment, Individualised Care
Arthroscopic Surgery for Rotator Cuff Tears
Rotator cuff repair is an operation to reattach a torn shoulder tendon to the bone. It is usually performed arthroscopically using keyhole surgery.
Not every rotator cuff tear requires surgery. Whether repair is appropriate depends on factors such as how the tear occurred, the size and pattern of the tear, tendon retraction and muscle quality, the degree of weakness or loss of function, response to non-surgical treatment, and the patient’s activities and goals.
Dr Puah Ken Lee is a fellowship-trained orthopaedic surgeon with a subspecialty focus in shoulder and elbow surgery and sports injuries. He assesses and treats rotator cuff tears at 360 Orthopaedics, Mount Elizabeth Novena, Singapore.
What Is a Rotator Cuff Tear?
The rotator cuff is a group of four tendons that surrounds the shoulder joint. These tendons help lift and rotate the arm while keeping the shoulder stable during movement.
A rotator cuff tear may occur suddenly after an injury or develop gradually as the tendon degenerates over time.
Symptoms may include:
- Shoulder pain, particularly when lifting the arm
- Pain at night or when lying on the affected shoulder
- Weakness
- Difficulty with overhead activities
- Difficulty reaching away from the body
- Reduced ability to exercise, work or participate in sport
Some rotator cuff tears cause relatively few symptoms. The presence of a tear on an ultrasound or MRI therefore does not automatically mean that surgery is required.
→ Learn more about Rotator Cuff Tears
When Does a Rotator Cuff Tear Need Surgery?
Many rotator cuff tears can initially be treated without an operation.
Treatment may include activity modification, physiotherapy, medication and selected injections where appropriate.
Rotator cuff repair may be considered when there is:
- A traumatic rotator cuff tear, particularly with significant weakness
- A symptomatic full-thickness tear in an active patient
- Persistent pain and functional limitation despite appropriate non-surgical treatment
- Significant weakness affecting work, daily activities or sport
- A tear that is increasing in size or causing progressive loss of function
- A repairable tear where restoring tendon function is considered likely to provide meaningful benefit
The decision is individualised.
An MRI showing a rotator cuff tear does not by itself mean that surgery is necessary.
Your symptoms, examination findings, imaging, age, activity level, occupation and treatment goals should all be considered before deciding whether surgery is appropriate.
When Can a Rotator Cuff Tear Be Treated Without Surgery?
Non-surgical treatment may be appropriate when pain and function can be managed satisfactorily without repairing the tendon.
This may include patients with:
- Smaller or degenerative tears with relatively preserved function
- Partial-thickness tears
- Symptoms that improve with physiotherapy
- Medical or personal factors that make surgery less appropriate
- Imaging abnormalities that do not correlate well with the patient’s symptoms
Physiotherapy cannot physically reattach a full-thickness torn tendon to the bone, but it can improve shoulder mechanics, strength and function. Some patients are therefore able to function well despite the presence of a structural tear.
The aim of treatment is not simply to make an MRI look normal. It is to achieve the best balance of pain relief, function and long-term shoulder health for the individual patient.
Can My Rotator Cuff Tear Be Repaired?
Not all rotator cuff tears are the same.
Several characteristics can influence whether a tear can be repaired and how likely the tendon is to heal after surgery.
These include:
Tear size
Larger tears generally involve more tendon tissue and may be more difficult to repair than small tears.
Tendon retraction
After a tendon tears, it may retract away from its normal attachment to the bone. The degree of retraction can influence repairability.
Duration of the tear
Long-standing tears may undergo progressive changes that make repair more difficult.
Muscle quality
Chronic rotator cuff tears can lead to muscle atrophy and fatty change. These changes may influence both repairability and the ability of the tendon to heal.
Tendon quality
Degenerated or thin tendon tissue may not hold sutures as reliably as healthier tissue.
These factors are considered together rather than in isolation.
What Does an MRI Tell Us Before Rotator Cuff Repair?
MRI can provide useful information about the rotator cuff and surrounding structures.
When considering surgery, the scan may help assess:
- Which rotator cuff tendon is torn
- Whether the tear is partial or full thickness
- Tear size
- Tendon retraction
- Muscle atrophy and fatty change
- Long head of biceps tendon abnormalities
- Associated cartilage, labral or other shoulder pathology
However, treatment should not be determined by the MRI report alone.
The imaging findings need to be interpreted together with the history and clinical examination.
Not every patient requires an MRI. Ultrasound or other investigations may sometimes provide the information required, depending on the clinical situation.
How Is An Arthroscopic Rotator Cuff Repair Performed?
Most rotator cuff repairs can be performed using shoulder arthroscopy, also known as keyhole surgery.
A small camera called an arthroscope is introduced into the shoulder through a small incision. Additional small incisions allow specialised instruments to be used during the operation.
The rotator cuff tear is assessed directly.
Where repair is appropriate, the tendon is mobilised and the attachment area on the bone is prepared. Sutures and specialised anchors are then used to secure the tendon back to its normal attachment on the upper arm bone.
The exact repair technique depends on the:
- Tendon involved
- Size and shape of the tear
- Degree of tendon retraction
- Tendon and bone quality
- Associated shoulder pathology
Other problems identified within the shoulder may sometimes be treated during the same operation where appropriate.
→ Learn more about Shoulder Arthroscopy
Are Additional Procedures Sometimes Required?
Rotator cuff tears can occur together with other shoulder conditions.
Depending on the individual findings, additional treatment may occasionally include management of:
- Long head of biceps tendon disease
- Significant stiffness
- AC joint pathology
- Other associated shoulder abnormalities
For example, biceps tenodesis may sometimes be performed together with rotator cuff repair when there is significant disease of the long head of the biceps tendon.
The need for any additional procedure should be based on the individual patient’s findings rather than performed routinely.
Is Biological Augmentation Used for Rotator Cuff Repair?
Most rotator cuff tears do not require biological augmentation.
In selected patients, however, additional biological or structural support may be considered where tendon quality, tear characteristics or healing potential are concerns.
One option is a bioinductive collagen scaffold, such as the REGENETEN Bioinductive Implant. It is designed to encourage the formation of new tendon-like tissue and may be considered for selected partial-thickness tears or as an adjunct to repair in appropriate cases.
Other forms of augmentation may occasionally be considered for larger or more complex tears.
These technologies are not necessary for every patient, and their potential benefits, limitations and available evidence should be considered when deciding whether they are appropriate.
→ Learn more about REGENETEN Bioinductive Implant
What Are the Risks of Rotator Cuff Repair?
Rotator cuff repair is commonly performed, but no operation is without risk.
Potential complications include:
- Infection
- Bleeding or wound problems
- Shoulder stiffness
- Persistent pain
- Failure of the tendon to heal
- Re-tear of the repaired tendon
- Residual weakness
- Nerve or blood vessel injury
- Complications related to anaesthesia
The likelihood and significance of these risks vary between individuals.
The expected benefits and potential risks of surgery should be discussed before deciding to proceed.
Will the Rotator Cuff Heal After Repair?
Rotator cuff healing occurs gradually after surgery.
The tendon needs time to biologically heal back to the bone. This is why rehabilitation after rotator cuff repair is deliberately progressive rather than simply trying to regain strength as quickly as possible.
Factors that can influence healing include:
- Tear size
- Tendon quality
- Muscle atrophy and fatty change
- Age
- Duration of the tear
- Smoking
- Certain medical conditions
- Rehabilitation and protection of the repair during the early healing period
Larger and more chronic tears generally have a greater risk of incomplete healing or re-tear than smaller tears.
Even with technically successful surgery, recovery is a biological process and cannot be guaranteed.
Rotator Cuff Repair Recovery Timeline
Recovery varies according to the size of the tear, strength of the repair, associated procedures and individual healing.
A typical rehabilitation programme progresses through several phases.
First 6 weeks: protecting the repair
A sling is usually worn for a period after surgery to protect the repaired tendon.
Shoulder movement is introduced according to the type and size of the repair. Patients are usually encouraged to maintain movement of the elbow, wrist and hand.
Approximately 6–12 weeks: restoring movement
As healing progresses, the emphasis gradually shifts towards recovering shoulder movement.
The timing and progression of exercises depend on the repair and individual recovery.
Around 3 months onwards: rebuilding strength
Strengthening is generally introduced progressively once sufficient healing has occurred.
Exercises are advanced according to shoulder movement, strength and functional requirements.
Later recovery: returning to higher-level activity
Return to heavier work, gym training and sport occurs progressively.
A small tear in a lower-demand patient may follow a different rehabilitation pathway from a large or complex tear in an athlete or manual worker.
Full recovery after rotator cuff repair commonly takes several months.
Trying to accelerate rehabilitation excessively can place unnecessary stress on a tendon that is still healing.
When Can I Return to Work After Rotator Cuff Repair?
Return to work depends heavily on occupational demands.
Patients performing predominantly desk-based work may be able to return considerably earlier than those whose jobs require:
- Repetitive lifting
- Overhead activity
- Carrying heavy loads
- Forceful pushing or pulling
- Manual labour
The timing should therefore be individualised rather than determined by a fixed number of weeks.
When Can I Return to the Gym or Sport?
Return to exercise and sport is progressive.
Lower-body exercise and activities that do not stress the repaired shoulder may sometimes resume earlier, while heavy upper-body strengthening and overhead sport require substantially more healing and rehabilitation.
Return to sports such as swimming, tennis, golf, racquet sports or throwing activities depends on:
- Tendon healing
- Shoulder movement
- Strength
- Control
- The size and complexity of the original tear
- The demands of the particular sport
The objective is not simply to return as quickly as possible, but to return when the shoulder is sufficiently recovered for the intended activity.
Frequently Asked Questions
Does every rotator cuff tear require surgery?
No.
Many rotator cuff tears can be treated without surgery. The decision depends on symptoms, weakness, tear characteristics, activity level, response to non-surgical treatment and individual goals.
Is rotator cuff repair keyhole surgery?
Most rotator cuff repairs can be performed arthroscopically using small incisions and a camera.
The appropriate surgical technique depends on the individual tear.
Can physiotherapy heal a rotator cuff tear?
Physiotherapy does not physically reattach a full-thickness torn tendon to the bone.
However, physiotherapy can improve shoulder movement, strength and function, and some patients achieve satisfactory function without surgery.
Do I need an MRI before rotator cuff surgery?
MRI is commonly useful when surgical repair is being considered because it provides information about tear size, retraction and muscle quality.
However, investigations should be selected according to the individual clinical situation.
What happens if a rotator cuff tear cannot be repaired?
Treatment depends on the patient’s symptoms, age, function and characteristics of the tear.
Options may include continued non-surgical management or alternative surgical strategies in selected patients. The appropriate treatment is determined individually.
How long do I need to wear a sling?
A sling is usually required during the early period after repair, but the duration depends on the size and type of tear and the repair performed.
How painful is rotator cuff repair?
Pain is expected after surgery but generally improves progressively. A post-operative pain-management plan may include medication and other anaesthetic or pain-control measures as appropriate.
Can a rotator cuff tear again after surgery?
Yes.
A repaired tendon can fail to heal completely or may re-tear. The risk varies according to tear size, tissue quality, age and other patient factors.
How long does full recovery take?
Recovery commonly takes several months.
Patients with larger or more complex tears may require a longer rehabilitation period before returning to demanding work or sport.
About Dr Puah Ken Lee
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore whose clinical practice focuses on shoulder, elbow and sports injuries.
His professional background includes:
- Fellowship training in shoulder and upper-limb surgery
- Former Consultant with the Sports Service at Singapore General Hospital
- Chair, Singapore Shoulder & Elbow Society
- Chair, Chapter of Orthopaedic Surgeons, Academy of Medicine, Singapore
- Corresponding Member of the American Shoulder and Elbow Surgeons
- Published research in shoulder and elbow surgery
- Invited faculty teaching shoulder arthroscopy and rotator cuff repair at regional and international courses
Dr Puah’s approach is to first establish the diagnosis and understand the patient’s functional requirements before recommending treatment.
Surgery is not automatically recommended because a rotator cuff tear is present on imaging.
When surgery is appropriate, the surgical technique and rehabilitation plan are tailored to the tear and the individual patient.
Related Rotator Cuff and Shoulder Resources
Rotator Cuff
- Rotator Cuff Tear
- Rotator Cuff Tendinopathy
- Frozen Shoulder vs Rotator Cuff Tear
- REGENETEN Bioinductive Implant
Shoulder Assessment
Shoulder Surgery
Rotator Cuff Assessment at Mount Elizabeth Novena
If you have been diagnosed with a rotator cuff tear, or have persistent shoulder pain or weakness, an assessment can help determine the cause of your symptoms and whether physiotherapy, other non-surgical treatment or rotator cuff repair is appropriate.
360 Orthopaedics
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #07-24
Singapore 329563
Dr Puah Ken Lee
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Book an appointment or contact the clinic via WhatsApp.
Book a Consultation
If you have been diagnosed with a rotator cuff tear or are experiencing persistent shoulder pain, a specialist assessment can help determine whether surgical treatment is appropriate.
Rotator cuff tears can affect function, performance and quality of life. Early diagnosis and appropriate treatment can improve outcomes.
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore specialising in shoulder, elbow and sports injuries, and patients are encouraged to seek evaluation for persistent symptoms.