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The rotator cuff is a group of four muscles and tendons that hold the ball of the shoulder in its socket and help you lift and rotate your arm. A rotator cuff tear can happen suddenly, from a fall or lifting something heavy, or gradually with wear over time. It is one of the most common causes of shoulder pain and weakness in adults. Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, treats rotator cuff tears with physical therapy and injections when they are likely to work, and with arthroscopic repair when the tendon needs to be fixed.

On this page:What is a tear · Symptoms · Diagnosis · Non-surgical care · When surgery helps · The repair · Recovery · Results · Videos · FAQs · Research
At a glance

  • Pain on the outside of the shoulder, often worse at night, and weakness lifting the arm
  • Tears become very common with age, and many cause no symptoms1,2
  • Small, wear-related tears in older adults often do well with physical therapy3
  • Sudden (traumatic) tears in active people usually do well with repair, especially when it is done early4
  • After repair: a sling for about 4 to 6 weeks; most activities by about 6 months

What is a rotator cuff tear?

The four rotator cuff tendons (supraspinatus, infraspinatus, subscapularis and teres minor) attach to the top of the arm bone. A tear can be partial-thickness, fraying part of the tendon (see partial-thickness rotator cuff tears), or full-thickness, a hole through the tendon or a tendon pulled off the bone.

Tears are often part of normal aging. In a pooled review, rotator cuff abnormalities were found in about 10% of people aged 20 or younger and in 62% of people aged 80 or older.1 In a screening study of 664 villagers, about 22% had a full-thickness tear, and two-thirds of those tears caused no symptoms.2 So a tear on an MRI is not, by itself, the whole story: Dr. Dold matches the imaging to your symptoms and examination.

There are two broad types:

  • Traumatic (acute) tears happen with a fall, a dislocation or a sudden heavy lift, often with immediate weakness.
  • Degenerative tears develop gradually, usually after age 40 to 50, sometimes after years of rotator cuff tendinitis or impingement.

Symptoms

  • Aching on the outside of the shoulder and upper arm
  • Pain at night, especially lying on the affected side
  • Weakness or pain lifting the arm, reaching overhead or behind your back
  • Sudden weakness after a fall or injury, which can mean an acute tear
  • Clicking or catching with movement
When to be seen promptly: sudden weakness or inability to lift the arm after a fall or injury should be evaluated soon. Traumatic tears tend to do better when they are repaired early.4

Diagnosis

Dr. Dold examines your shoulder’s motion and the strength of each rotator cuff tendon, and checks for related problems such as biceps tendon problems, frozen shoulder or arthritis. X-rays show the bones and joint space. An MRI or ultrasound shows whether the tendon is inflamed, partially torn or fully torn, how large the tear is, and the health of the muscle, which helps predict how well a repair will heal.

Non-surgical treatment

Many patients, especially those with tendinitis, partial tears or small degenerative tears, improve without surgery:

  • Physical therapy to strengthen the remaining rotator cuff and shoulder-blade muscles and restore motion
  • Activity changes to avoid painful overhead and lifting positions for a time
  • Anti-inflammatory medicines
  • Injections, such as a corticosteroid injection, for pain that limits therapy

In a randomized trial of patients older than 55 with small, non-traumatic supraspinatus tears, physical therapy alone gave results similar to surgery after about 6 years.3 If you may need surgery, timing matters for injections: in a large database study, people who had shoulder injections before rotator cuff repair, especially several injections or injections close to surgery, were more likely to need a revision operation.5 Dr. Dold plans injections with this in mind.

When is surgery recommended?

A torn tendon does not usually heal back to the bone on its own, and some tears get larger over time. Dr. Dold usually recommends repair for:

  • Traumatic tears in active people. In one study of 206 patients, those repaired within 4 months of injury had better function than those repaired later, and results were strongest in patients repaired within 3 weeks.4
  • Full-thickness tears in younger and active patients. In a randomized trial of small and medium tears, primary repair gave better pain and function than physical therapy at 10 years.6
  • Tears that remain painful or weak despite a good course of non-surgical care

Arthroscopic rotator cuff repair

Dr. Dold repairs the tendon arthroscopically, through small incisions with a camera, usually as outpatient surgery under general anesthesia with a nerve block for pain control. The torn tendon is reattached to the bone with suture anchors; Dr. Dold commonly uses a double-row (transosseous-equivalent) repair, which spreads the tendon over a larger area of bone. Other problems are treated at the same time when needed, such as a biceps tenodesis for a damaged biceps tendon.

  • Partial tears or tendon augmentation: for selected tears, the REGENETEN bioinductive implant, a collagen patch placed over the tendon, is an option Dr. Dold may discuss.
  • Massive tears that cannot be repaired: options include superior capsular reconstruction (SCR) and other procedures; for tears with arthritis, see rotator cuff arthropathy.

For more detail, see Rotator Cuff Tears and Repair: 43 Questions Patients Ask.

TENDON SEAM™: a newer way Dr. Dold repairs the rotator cuff

For selected tears, Dr. Dold now repairs the rotator cuff with the TENDON SEAM Repair System, FDA cleared in 2023. Rather than holding the tendon at a few points with larger anchors and separate sutures, it sews the tendon to the bone with one continuous suture and a row of small micro-anchors. Each stitch is tensioned and locked on its own, creating a “seam” of many fixation points, much like the stitching that holds a seatbelt together.

  • Load sharing: the pull of the muscle is spread across many points instead of a few, which is designed to lower the stress on the tendon where it is most likely to pull through.
  • Footprint compression: an inner seam runs across the direction of pull, and an outer zig-zag presses the tendon onto the bone where it needs to heal.
  • Knotless and arthroscopic: done through small incisions, usually through the standard arthroscopic portal.
  • Recovery: because the repair shares the load across many fixation points, patients may spend less time in the sling and start motion and strengthening sooner than after a standard repair, depending on the tear.
What the manufacturer reports: in laboratory testing against a standard double-row repair, Smith+Nephew reports 2x stronger repairs, 10x less gap formation and 45% fewer procedure steps. These are company data on file, not yet published in a peer-reviewed clinical journal, and long-term clinical comparisons are still to come. Individual results vary.

Dr. Dold chooses the repair method that fits each tear; not every tear is suited to TENDON SEAM. Read more about TENDON SEAM rotator cuff repair.

Dr. Dold is a consultant for Smith+Nephew. TENDON SEAM is a trademark of Smith+Nephew or its affiliates.

Recovery after rotator cuff repair

Time after surgery Typical focus
0–6 weeks Sling for about 4 to 6 weeks to protect the repair; gentle motion guided by therapy. Desk work is often possible after about 1 to 2 weeks.
About 6 weeks Sling off; driving is usually possible once out of the sling. Active motion progresses.
3–6 months Strengthening. Golf commonly resumes at about 4 to 6 months.
About 6 months Heavier lifting and overhead activity. Throwing and contact sports are commonly 6 months or longer, decided case by case.

Timelines vary from person to person, and Dr. Dold will give you a specific plan. In a review of 1,224 patients, about 62% returned to their previous level of work, at an average of about 8 months; return was harder in physically demanding jobs.7 About 70% of athletes returned to their previous level of sport, with lower rates in competitive and overhead athletes.8

Results and risks

Arthroscopic rotator cuff repair has good long-term results: in a review of studies with at least 10 years of follow-up, patient satisfaction ranged from about 86% to 100% and revision surgery rates were low.9 Not every repair heals completely. About 25% of repairs showed a re-tear on imaging in a large review, but the effect on pain and function was generally small, and most patients were still satisfied.10 Smoking roughly doubles the risk of a re-tear,11 so stopping before surgery helps. Other risks include stiffness, infection and nerve or blood clot problems, which Dr. Dold reviews before surgery.

Watch Dr. Dold: rotator cuff repair

These videos show real surgery, so some viewers may prefer not to watch.

Arthroscopic repair of a full-thickness rotator cuff tear
Full-thickness supraspinatus (rotator cuff) repair
Repair of a massive, retracted rotator cuff tear
Full-thickness rotator cuff tear: can it heal without surgery?
Repair of a partial-thickness rotator cuff tear with the REGENETEN implant

More videos on Dr. Dold’s YouTube channel.

More answers:Rotator Cuff Tears and Repair: 43 Questions Patients Ask · Partial-thickness tears · REGENETEN implant

What the research shows

Rotator cuff tears are among the most studied shoulder problems. Here is what the research adds.

Repair or therapy?

For degenerative tears, short-term trials and Cochrane reviews show similar results with or without surgery, which is why therapy is often tried first. However, a Norwegian randomized trial of small and medium tears found that the advantage of repair grew over time, with better results at 10 and 15 years, and tears treated with therapy alone tended to enlarge. This supports earlier repair for active patients with repairable tears, especially after an injury.

Healing and repair technique

Older age and larger tears raise the chance that a repaired tendon does not fully heal. Double-row repairs heal more often than single-row repairs, especially in larger tears, although clinical scores are often similar.

Rehabilitation

Early, protected motion improves range of motion and appears safe for many small to large tears; the exact protocol is tailored to tear size and repair quality.

Irreparable tears

For tears that cannot be fully repaired, options include partial repair, superior capsular reconstruction, tendon transfer and reverse shoulder replacement. A UK randomized trial found that adding a subacromial balloon spacer to debridement gave worse results than debridement alone.

What patients say

“Doctor Dold is truly the best orthopedic around. Not only is he a master of his craft but he is also a genuine person. He connects with you on a down to earth level and is interested in getting to know you as a person. Doctor Dold has performed both knee and shoulder surgery on me. He is a honest individual as well as his staff. He will let you know what’s best for you as a individual to excel physically through life to enjoy it to the fullest and healthiest way. He’s directed me to great Physical Therapist that I’d still go to this day. If you’re looking for the Top Orthopedic in industry this is your go to. He has worked on the Top professional athletes in all leagues including college and has got them performing stronger and better before. I can vouch and will forever have a long term relationship with Doctor Dold outside of the office as well. I’ve never let anyone else operate on my body because I did not trust them. Doctor Dold is your guy!”

Tanner D. · Knee & shoulder surgery · Submitted to our website

Patient reviews in their own words. Individual results vary. Read more patient reviews.

Why see Dr. Dold

  • Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
  • Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
  • Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
  • Author of a SLAP repair book chapter (Springer, 2017) and research on shoulder suture anchors (KSSTA, 2013)
  • Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
  • D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google

Frequently asked questions

Can a rotator cuff tear heal without surgery?

A torn tendon does not usually heal back to the bone on its own, but many people, especially older adults with small, wear-related tears, get good pain relief and function with physical therapy.3

When does a rotator cuff tear need surgery?

Surgery is usually recommended for traumatic tears in active people, full-thickness tears in younger and active patients, and tears that stay painful or weak despite non-surgical care.4,6

Should I have surgery soon after a traumatic tear?

Often, yes. In one study, patients repaired within 4 months of injury had better function than those repaired later, and results were strongest within 3 weeks.4

How long will I wear a sling after rotator cuff repair?

Usually about 4 to 6 weeks.

When can I drive and go back to work?

Desk work is often possible after about 1 to 2 weeks. Driving is usually possible once you are out of the sling, around 6 weeks. Physically demanding jobs take longer.7

How long does it take to recover from rotator cuff surgery?

Most activities resume by about 6 months. Golf commonly resumes at about 4 to 6 months; throwing and contact sports take 6 months or longer.

Can a repaired rotator cuff tear again?

Yes. Some repairs do not heal completely, but most patients still have good pain relief and function.10 Not smoking lowers the risk.11

Does Dr. Dold accept insurance?

Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.

Related pages

Research cited on this page

  1. Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014;23(12):1913-1921. PubMed
  2. Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: from mass-screening in one village. J Orthop. 2013;10(1):8-12. PubMed
  3. Kukkonen J, Ryösä A, Joukainen A, et al. Operative versus conservative treatment of small, nontraumatic supraspinatus tears in patients older than 55 years: over 5-year follow-up of a randomized controlled trial. J Shoulder Elbow Surg. 2021;30(11):2455-2464. PubMed
  4. Gutman MJ, Joyce CD, Patel MS, et al. Early repair of traumatic rotator cuff tears improves functional outcomes. J Shoulder Elbow Surg. 2021;30(11):2475-2483. PubMed
  5. Weber AE, Trasolini NA, Mayer EN, et al. Injections prior to rotator cuff repair are associated with increased rotator cuff revision rates. Arthroscopy. 2019;35(3):717-724. PubMed
  6. Moosmayer S, Lund G, Seljom US, et al. At a 10-year follow-up, tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears. J Bone Joint Surg Am. 2019;101(12):1050-1060. PubMed
  7. Haunschild ED, Gilat R, Lavoie-Gagne O, et al. Return to work after primary rotator cuff repair: a systematic review and meta-analysis. Am J Sports Med. 2021;49(8):2238-2247. PubMed
  8. Altintas B, Anderson N, Dornan GJ, et al. Return to sport after arthroscopic rotator cuff repair: is there a difference between the recreational and the competitive athlete? Am J Sports Med. 2020;48(1):252-261. PubMed
  9. Davey MS, Hurley ET, Carroll PJ, et al. Arthroscopic rotator cuff repair results in improved clinical outcomes and low revision rates at 10-year follow-up: a systematic review. Arthroscopy. 2023;39(2):452-458. PubMed
  10. Holtedahl R, Bøe B, Brox JI. The clinical impact of retears after repair of posterosuperior rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2023;32(6):1333-1346. PubMed
  11. Fan N, Yuan S, Du P, et al. The effects of smoking on clinical and structural outcomes after rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2022;31(3):656-667. PubMed
  12. 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. PubMed
    At 15 years, a randomized trial of small and medium tears found better pain-free motion after primary repair than after physiotherapy, and tears treated with therapy alone tended to enlarge.
  13. Karjalainen TV, Jain NB, Heikkinen J, et al. Surgery for rotator cuff tears. Cochrane Database Syst Rev. 2019;12(12):CD013502. PubMed
    A Cochrane review was uncertain whether repair gives clinically meaningful benefits over non-surgical care for symptomatic tears, especially degenerative ones.
  14. Longo UG, Risi Ambrogioni L, Candela V, et al. Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis. BMC Musculoskelet Disord. 2021;22(1):50. PubMed
    A meta-analysis found no significant difference in shoulder function at 2 years between surgical and non-surgical treatment.
  15. Kwong CA, Ono Y, Carroll MJ, et al. Full-Thickness Rotator Cuff Tears: What Is the Rate of Tear Progression? A Systematic Review. Arthroscopy. 2019;35(1):228-234. PubMed
    Asymptomatic and symptomatic full-thickness tears progressed at similar rates, and most did not progress significantly over short- to medium-term follow-up.
  16. Müller AM, Flury M, Alsayed HN, et al. Influence of patient and diagnostic parameters on reported retear rates after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2017;25(7):2089-2099. PubMed
    A meta-analysis identified patient and tear factors, such as age and tear size, that raise the risk of a re-tear after arthroscopic repair.
  17. 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. PubMed
    Healing after rotator cuff repair depended on both patient-related and surgical factors.
  18. Millett PJ, Warth RJ, Dornan GJ, et al. Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. J Shoulder Elbow Surg. 2014;23(4):586-97. PubMed
    Single-row repairs had higher re-tear rates than double-row repairs, without detectable differences in clinical scores.
  19. Chen M, Xu W, Dong Q, et al. Outcomes of single-row versus double-row arthroscopic rotator cuff repair: a systematic review and meta-analysis of current evidence. Arthroscopy. 2013;29(8):1437-49. PubMed
    Double-row repair gave higher healing rates, mainly in large and massive tears, without a clear clinical advantage.
  20. Lapner P, Henry P, Athwal GS, et al. Treatment of rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2022;31(3):e120-e129. PubMed
    A network meta-analysis found double-row fixation had a higher healing rate than single-row with similar function.
  21. Bedeir YH, Schumaier AP, Abu-Sheasha G, et al. Type 2 retear after arthroscopic single-row, double-row and suture bridge rotator cuff repair: a systematic review. Eur J Orthop Surg Traumatol. 2019;29(2):373-382. PubMed
    Double-row and suture-bridge techniques were linked to more failures at the inner (medial) part of the cuff.
  22. Hu CW, Tsai SHL, Chen CH, et al. Early versus delayed mobilization for arthroscopic rotator cuff repair (small to large sized tear): a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2023;24(1):938. PubMed
    Early active or passive motion after repair improved range of motion and was safe for small to large tears.
  23. Houck DA, Kraeutler MJ, Schuette HB, et al. Early Versus Delayed Motion After Rotator Cuff Repair: A Systematic Review of Overlapping Meta-analyses. Am J Sports Med. 2017;45(12):2911-2915. PubMed
    An earlier meta-analysis found early motion improved range of motion but may raise re-tear risk, suggesting tear size should guide the protocol.
  24. Mazuquin B, Moffatt M, Gill P, et al. Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses. PLoS One. 2021;16(5):e0252137. PubMed
    Early rehabilitation gave better early motion without a clear difference in most other outcomes or in re-tear rates.
  25. Kovacevic D, Suriani RJ, Grawe BM, et al. Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response. J Shoulder Elbow Surg. 2020;29(12):2459-2475. PubMed
    For irreparable tears, surgery gave better perceived function than physical therapy alone, though high-quality comparisons were lacking.
  26. Werthel JD, Vigan M, Schoch B, et al. Superior capsular reconstruction – A systematic review and meta-analysis. Orthop Traumatol Surg Res. 2021;107(8S):103072. PubMed
    Superior capsular reconstruction gave satisfactory clinical and imaging results at 2 years, though high-quality comparative data were limited.
  27. Haque A, Parsons H, Parsons N, et al. Two-Year Follow-up of a Group-Sequential, Multicenter Randomized Controlled Trial of a Subacromial Balloon Spacer for Irreparable Rotator Cuff Tears of the Shoulder (START:REACTS). Am J Sports Med. 2025;53(6):1291-1298. PubMed
    The UK START:REACTS randomized trial found patients did better at 2 years with debridement alone than with debridement plus a subacromial balloon spacer.
  28. McElvany MD, McGoldrick E, Gee AO, et al. Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. Am J Sports Med. 2015;43(2):491-500. PubMed
    Despite a large increase in publications, there was little evidence that the results of rotator cuff repair improved over time.
Ready to get your shoulder checked? Request an appointment online or call 469-850-0680. Our staff will contact you by phone and text within an hour of your request (during business hours, Monday–Friday, 8 am–5 pm). Same-day appointments available, and walk-in visits are welcome Monday, Wednesday and Friday, 8:30–10:30 am at 6700 Dallas Parkway, Suite 100, Frisco, TX 75034.

Request an AppointmentCall 469-850-0680

REGENETEN and TENDON SEAM are trademarks of Smith+Nephew or its affiliates. Dr. Dold is a consultant for Smith+Nephew.

Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Individual results vary.