What is a rotator cuff tear?
The rotator cuff is a group of four tendons around the shoulder. They hold the ball of the shoulder in the socket and help you lift and turn your arm.
A cuff tear is a tear in one or more of these tendons. A partial tear goes part way through. A full-thickness tear goes all the way through, leaving a gap in the tendon.
Some tears happen in a single injury, such as a fall. Many others build up slowly as the tendon wears with age. The two types often need different plans.
What does a rotator cuff tear feel like?
Many people have pain on the outside of the shoulder or upper arm. It is often worse at night or when lifting the arm. Some notice weakness, trouble reaching overhead, or pain when lying on that side.
If you lost strength suddenly after a fall or injury, it makes sense to be seen soon. A clear exam can show whether a new tear is likely.
Do I need surgery for a rotator cuff tear?
Not always. For many tears that came on slowly, physical therapy is a good place to start.
In one study, 452 people with full-thickness tears that were not caused by an injury began a structured therapy program. Their reported scores improved at 6 and 12 weeks. Fewer than 25% chose surgery over the next two years, and those who did tended to decide early (Kuhn, 2013).
A Cochrane review pooled randomized trials comparing surgery with non-surgical care. At one year, surgery may have provided little or no clinically important benefit for pain and function. The authors said they remain uncertain, and the trials had weaknesses. They also noted that most people in these trials had small, wear-related tears of one tendon. The results may not apply to tears from an injury, large tears, or younger people (Karjalainen, 2019).
Non-surgical care usually includes physical therapy to strengthen the muscles around the shoulder, activity changes, and pain control. Sometimes it includes an injection.
When does surgery make sense?
Surgery is more often discussed when:
- A tear came from a clear injury, especially with a new loss of strength
- You are younger or very active, and the tear is a full-thickness tear
- Pain and weakness continue after a fair trial of therapy
- The tear is large or involves more than one tendon
- Your work or sport demands a strong shoulder
Long-term data add to the picture. In a trial of 103 people with small to medium tears, those who had early repair had better shoulder scores and less pain at 15 years than those who started with therapy. Fifteen of the 51 people in the therapy group later had surgery. Among 26 tears treated with therapy alone, the average tear size grew from about 16 mm to about 32 mm (Moosmayer, 2024).
That finding does not mean every tear needs repair. Scores on a general health survey did not differ between the groups, and this is one modest-sized trial. It does mean a tear left alone should be followed, and that the decision can be revisited if symptoms change. Your age, tear size, and goals all matter. The decision is one you make together with your surgeon.
What happens in surgery?
A rotator cuff repair is usually done by arthroscopy, through small incisions with a camera. The surgeon brings the torn tendon back to the bone where it belongs and holds it there with small anchors and stitches.
Some tears are too old or too large to be fully repaired. In these cases, the options are different, and Dr. Pareek will review them with you.
Risks include infection, stiffness, ongoing pain, nerve injury, and a repair that does not heal.
Can a repaired tendon tear again?
Yes. A tendon has to heal back to bone, and it does not always hold. A review of high-quality studies found retear rates between 15% and 21% across different follow-up times. These tears were confirmed on imaging. Age, larger tears, and fat buildup in the muscle all affected healing, as did the surgical technique and the rehabilitation plan (Longo, 2021).
This is why the slow pace of recovery matters. Protecting the repair early gives the tendon time to heal. Results vary from person to person.
Should I get a second opinion?
It can help if you are unsure whether you need surgery, or if your pain continues after a past repair. Here’s how a second opinion works.
Where can I see Dr. Pareek?
Dr. Pareek sees shoulder patients at HSS in New York and at HSS in New Jersey. Bring any X-rays, MRI or ultrasound images, and reports you already have.
What does recovery look like?
These are typical ranges. Your surgeon’s plan comes first, and recovery varies from person to person.
- Weeks 0-6: Protect the repairYou usually wear a sling for much of this time. A therapist may move the arm for you, but you avoid lifting it with your own muscles. The length of time in a sling varies with the tear.
- Weeks 6-12: Restore motionYou begin moving the arm on your own in steps. Reaching overhead gets easier, and light daily tasks return.
- Months 3-6: Build strengthStrength work starts and grows slowly. Many people return to most daily activities and lighter work in this stretch.
- Months 6-12: Finish the recoveryHeavier lifting and sport come back gradually. Strength can keep improving for up to a year. These are typical ranges, and your surgeon's plan governs.
Sources
- Karjalainen TV, et al. Surgery for rotator cuff tears. Cochrane Database Syst Rev 2019;12:CD013502.
- Kuhn JE, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg 2013;22:1371-1379.
- Moosmayer S, et al. Fifteen-year results of a comparative analysis of tendon repair versus physiotherapy for small-to-medium-sized rotator cuff tears: a concise follow-up of previous reports. J Bone Joint Surg Am 2024;106:1785-1796.
- Longo UG, et al. Retear rates after rotator cuff surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord 2021;22:749.