Rotator Cuff Tears and Repair: 43 Questions Patients Ask

A group of four muscles and their tendons that wrap around the ball of the shoulder. They hold the ball in the socket and help you lift and rotate your arm.

A tear in one or more of these tendons, most often the supraspinatus at the top of the shoulder. A partial-thickness tear goes partway through the tendon; a full-thickness tear goes all the way through, leaving a hole or pulling the tendon off the bone. See rotator cuff tears and partial-thickness tears.

Some tears happen suddenly, from a fall, lifting something heavy or a shoulder dislocation. Most develop gradually from wear over time. Smoking, repetitive overhead work and age increase the risk.

Very common, and more so with age. Rotator cuff problems rise from about 10% of people aged 20 or younger to about 62% of people over 80.¹ In one community screening study, about two-thirds of tears caused no symptoms.²

Pain on the outside of the shoulder and upper arm, pain at night (especially lying on that side), and weakness or pain lifting the arm, reaching overhead or behind your back. A sudden injury may cause immediate weakness.

A full-thickness tear does not heal back to the bone on its own. Many people still get good pain relief with therapy, but tears can enlarge over time, especially when they become painful.^3,4

Some tears stay stable for years, while others grow. In a 15-year study, tears treated without surgery roughly doubled in size on average.⁵ Large, long-standing tears can lead to muscle wasting and, in some patients, a type of shoulder arthritis called rotator cuff arthropathy.

Dr. Dold examines your shoulder’s strength and motion using a combination of specific tests, which the AAOS guideline notes is more accurate than any single test.⁴ X-rays are taken in our office to look at the bones.

Either can confirm a tear. A Cochrane review found MRI and ultrasound equally accurate for full-thickness tears, with about 92% to 94% sensitivity.⁶ An MRI also shows tear size, retraction and muscle quality, which help plan surgery.

Yes, especially partial tears and small degenerative tears in older or less active patients. Treatment includes physical therapy, activity changes, anti-inflammatory medication and, sometimes, a steroid injection. In a trial of patients older than 55 with small, non-traumatic tears, therapy and surgery gave similar results at 6 years.⁷

A single injection can relieve pain in the short term, and the AAOS guideline says it can be considered.⁴ Multiple injections may weaken the tendon: more than one injection before surgery has been linked to a higher revision rate,⁸ and injections within a few weeks of surgery increase infection risk.⁹

For small and medium full-thickness tears, long-term trials favor repair. In a randomized trial, 71% of repaired shoulders had good or excellent results at 10 years vs 42% after physiotherapy, and repair remained better at 15 years.^10,5

For full-thickness tears in active patients, acute tears after an injury, high-grade partial tears, and tears that remain painful or weak despite non-surgical treatment.

Often, yes. In one study, traumatic tears repaired within about 3 weeks had the best results.¹¹ A randomized trial of small traumatic tears found similar 1-year results with therapy, but nearly a third of unrepaired tears grew.¹² Dr. Dold will advise on timing for your tear.

Age alone does not rule out repair. Healing rates are somewhat lower in older patients and in large tears, but many older adults do very well. The decision depends on your symptoms, activity level, tear size and tendon quality.

Dr. Dold repairs the tendon arthroscopically, through small incisions with a camera. For most full-thickness tears he uses a double-row (transosseous-equivalent, or suture-bridge) repair, which presses the tendon flat against a broad area of bone to support healing. Meta-analyses of randomized trials show better tendon healing with double-row repair, especially for larger tears.^13,14,4

Small suture anchors are placed in the bone to hold the tendon down. Dr. Dold uses all-suture anchors or PEEK or bioabsorbable anchors depending on the repair. A randomized trial found all-suture anchors performed as well as solid anchors.¹⁵ The anchors stay in place permanently or are gradually absorbed and do not need to be removed.

The REGENETEN® bioinductive implant (Smith+Nephew) is a thin collagen patch that can be placed over the rotator cuff tendon during arthroscopic surgery. It is designed to support the body’s own healing response and is gradually absorbed as new tissue forms. REGENETEN® is one of the options Dr. Dold may use, for example to reinforce a full-thickness repair or to treat some high-grade partial-thickness tears. He will discuss whether it is right for your tear. Learn more about the REGENETEN implant.

Platelet-rich plasma (PRP) or bone marrow aspirate concentrate (BMAC), taken from your own body, are options Dr. Dold may add during repair to support healing. Research on these treatments is ongoing, they are not FDA-approved for this use, and Dr. Dold will discuss whether they are right for you. See PRP therapy.

If the long head of the biceps is frayed or unstable, Dr. Dold usually performs a biceps tenodesis, reattaching it lower on the arm bone. Compared with simply releasing the tendon (tenotomy), tenodesis lowers the chance of a "Popeye" bulge.¹⁶ See biceps tenodesis.

It depends on your anatomy. Large randomized trials found that shaving the acromion does not improve results on its own,^17,18 and the AAOS guideline does not suggest doing it routinely with rotator cuff repair.^19,4 Dr. Dold decides based on what he sees at surgery.

For massive tears that cannot be repaired, options include superior capsular reconstruction (SCR), in which a graft is placed to restore the shoulder’s stability, as well as partial repair, tendon transfer and, in some patients, reverse shoulder replacement.⁴ Studies of SCR show substantial improvements in function.²⁰

General anesthesia with an interscalene nerve block. The block numbs the shoulder and arm for several hours after surgery and reduces the need for opioid pain medication early on.²¹

Yes. Rotator cuff repair is outpatient surgery, and most patients go home the same day.

The repair is placed under tension on sensitive bone. The nerve block typically lasts several hours, and pain often increases when it wears off, usually the night of surgery.²¹ Start your pain medication before the block fully wears off, and use ice.

Usually about 4 to 6 weeks, depending on the size of the tear and the repair. The sling protects the repair while the tendon starts to heal to the bone.

Many patients sleep more comfortably in a recliner or propped up on pillows for the first few weeks, wearing the sling.

Gentle motion begins early, guided by your therapist, followed by active motion and then strengthening. Research shows that early and delayed motion programs give similar long-term results.^22,4

After the sling is off, usually at about 6 weeks, and once you are off narcotic pain medication and can control the car safely.

Patients with desk jobs often return in about 1 to 2 weeks, working one-handed. Jobs that involve lifting or overhead work take longer, often several months. In a review, return to the previous job was more likely after light work (94%) than heavy work (63%).²³

Most patients return to lifting and overhead activity at about 6 months, after strength has been rebuilt.

Usually at about 4 to 6 months, often starting with putting and chipping. In one study, about three-quarters of golfers returned to the game after repair.²⁴

Throwing, overhead and contact sports usually take 6 months or longer and are decided case by case. In a large study, 85.5% of athletes returned to sport and 70% returned at the same level.²⁵

About 6 months, and strength can continue to improve for up to a year.

High. Studies with 10 years of follow-up report patient satisfaction of about 86% to 100% after arthroscopic repair.²⁶

Yes. In a large review, about 1 in 4 repairs had re-torn on imaging within about 18 months, but most patients still did well, and the difference in function between healed and re-torn repairs was small.²⁷ Larger tears, older age, smoking and diabetes raise the risk;^28,29 double-row repair is used to help lower it.¹³

Yes. Smokers have about twice the risk of re-tear,²⁸ and patients with diabetes have a higher re-tear rate as well.²⁹ Stopping smoking and controlling blood sugar before surgery help.

Some stiffness is common early on. Persistent stiffness occurred in about 6% of patients after arthroscopic repair in a systematic review.³⁰ Physical therapy helps restore motion.

Serious complications are uncommon. Risks include re-tear, stiffness, infection, nerve injury, blood clots and anesthesia-related risks. Dr. Dold will review your individual risks at your consultation.

Call for fever, increasing redness or drainage from the incisions, pain not controlled by your medication, or new numbness or weakness in the hand once the block has worn off. Go to the emergency room for chest pain or shortness of breath.

Rotator cuff repair is covered by most insurance plans when it is medically necessary. Dr. Dold accepts most major insurance plans, including Medicare and Tricare; please call 469-850-0680 to confirm your coverage. See insurance.

Practice dressing with button-front shirts, set up a recliner or pillows for sleeping, arrange help at home for the first week, stop smoking and avoid steroid injections in the weeks before surgery.

Request an appointment online or call 469-850-0680. Walk-in visits are welcome Monday, Wednesday and Friday, 8:30 to 10:30 am.