Rotator Cuff Tears

What is a rotator cuff tear?

Your rotator cuff is a group of four muscles whose tendons wrap around the ball of the shoulder. Together they keep the ball centered in its shallow socket and let you lift and turn your arm. A tear means one or more of those tendons has frayed or pulled away from where it attaches to the bone.

Doctors describe tears by depth. A partial-thickness tear goes only part of the way through the tendon. A full-thickness tear goes all the way through. Some tears happen all at once, from a fall or a heavy lift. Many others develop slowly as the tendon wears with age and use.

What does a rotator cuff tear feel like?

Most people notice an ache over the outside of the shoulder that can spread down the upper arm. It is often worst at night, especially when lying on that side, and when reaching overhead or behind the back. The arm may feel weak or tire quickly when you lift it.

If you suddenly can’t raise your arm after a fall or injury, get it checked soon rather than waiting to see if it settles down.

Do I need surgery for a rotator cuff tear?

Often, no. For tears that came on gradually, a structured physical therapy program is a sensible first step. In a multicenter study of 452 patients with full-thickness tears that were not caused by an injury, patients reported meaningful improvement after 6 and 12 weeks of therapy, and fewer than one in four chose surgery over the next two years. Those who did go on to surgery usually decided early.²

A Cochrane review that pooled the randomized trials came to a similar conclusion: compared with exercise-based care, repair may make little or no meaningful difference in pain or function at one year, although the authors noted the evidence is uncertain.¹ Keep in mind that those trials mainly studied small, age-related tears of a single tendon. They tell us less about tears caused by an injury, large tears, or younger and very active patients.

Non-surgical care usually combines targeted strengthening, adjusting the activities that aggravate the shoulder, pain control, and sometimes an injection.

When does surgery make sense?

Dr. Stepanyan is more likely to recommend a repair when:

• The tear followed a clear injury, especially if your arm became weak right afterward.
• You are younger or very active and the tear goes all the way through the tendon.
• Pain and weakness remain after a genuine course of physical therapy.
• The tear is large or involves more than one tendon.
• Your job or sport depends on a strong, reliable shoulder.

The longest randomized study on this question followed 103 patients with small and medium tears for 15 years. Patients whose tendons were repaired early had better shoulder function scores and less pain than those who began with physical therapy. Fifteen of the 51 patients in the therapy group eventually had surgery anyway. In patients treated with therapy alone, the average tear roughly doubled in size, from about 16 mm to about 32 mm. Measures of general health were similar between the two groups, and the study was relatively small.³

If you choose not to have surgery, the tear should be watched over time, and the decision can always be revisited. Your age, the size of the tear, and what you want to get back to all shape the recommendation, and you make it together with Dr. Stepanyan.

What happens in surgery?

Most repairs are done arthroscopically, through a few small incisions with a camera. Dr. Stepanyan reattaches the torn tendon to the bone using small anchors and strong sutures. Some tears are too old or too large to be repaired fully. In those cases, other options, including reverse shoulder replacement, may restore function. Possible risks include infection, stiffness, ongoing pain, nerve injury, and the tendon not healing to the bone.

Can a repaired tendon tear again?

Yes. A repair only succeeds if the tendon heals back onto the bone, and sometimes it doesn’t. A review of 31 high-quality studies found that, on imaging, roughly 15% to 21% of repairs had torn again, depending on how long after surgery patients were checked.⁴

Healing depends on your age, the size of the tear, how much the muscle has turned to fat, how the repair is done, and how rehabilitation goes. Protecting the repair in the first weeks and progressing on schedule give it the best chance, though no one can promise a result.

Should I get a second opinion?

It’s reasonable to get one if you have been told you need surgery and aren’t sure, or if your shoulder still hurts after a previous repair. Dr. Stepanyan regularly sees patients for a second look. Request a visit and mention that you’d like a second opinion.

Where can I see Dr. Stepanyan?

Dr. Stepanyan sees shoulder patients in Glendale, East LA and Santa Fe Springs. If you have X-rays, an MRI or an ultrasound, bring the images and the reports to your visit.

What does recovery look like?

These are typical stages after a rotator cuff repair, following Dr. Stepanyan’s physical therapy protocol. Your own plan may differ.

1. Weeks 0–6

   Protect the repair

   You wear a sling at all times, including while you sleep, and take it off only to wash and do your exercises. Gentle pendulum swings and elbow, wrist and hand motion keep the arm from stiffening.

2. Weeks 6–12

   Restore motion

   The sling comes off at six weeks. Your therapist moves the shoulder through a widening range, then you begin raising the arm yourself and using it for light everyday tasks below shoulder height.

3. Weeks 12–20

   Build strength

   Range-of-motion limits are lifted, and strengthening begins for the rotator cuff and the muscles around the shoulder blade. Running and cycling are usually fine at this stage.

4. Week 20 and beyond

   Return to sport

   Endurance and sport-specific work build toward full activity. A throwing or racquet program typically starts around five months, and contact sports around six months, once Dr. Stepanyan clears you.

Strength can keep improving for up to a year after surgery. Dr. Stepanyan’s therapists follow his written rotator cuff repair protocol; if anything here differs from what you were told, follow your own plan.

Sources

1. Karjalainen TV, Jain NB, Heikkinen J, et al. Surgery for rotator cuff tears. Cochrane Database Syst Rev. 2019;12(12):CD013502. PubMed
2. Kuhn JE, Dunn WR, Sanders R, 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(10):1371-1379. PubMed
3. Moosmayer S, Lund G, Seljom US, 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(19):1785-1796. Journal article
4. Longo UG, Carnevale A, Piergentili I, et al. Retear rates after rotator cuff surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2021;22(1):749. Journal article