Rotator Cuff Tear Repair Surgery
The rotator cuff is a group of four tendons — the supraspinatus, infraspinatus, teres minor, and subscapularis — that surround the shoulder joint, working together to stabilize the humeral head within the socket and power the rotational and lifting movements of the arm. When one or more of these tendons tears — whether from a sudden injury such as a fall or a lifting accident, or from gradual degeneration and fraying that accumulates over years of repetitive overhead use — the result is pain, weakness, loss of range of motion, and a crackling sensation during certain shoulder movements that can significantly impact daily activities, sleep, and athletic performance. Rotator cuff tears are one of the most common causes of shoulder pain and disability in adults, particularly those over 40, and they range in severity from partial-thickness tears that involve only a portion of the tendon to full-thickness tears where the tendon is completely detached from the bone.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with a traveling shoulder fellowship under Dr. Charles Rockwood and Dr. Richard Hawkins and fellowship training in arthroscopic surgery at the Southern California Orthopedic Institute/UCLA. Rotator cuff repair is one of the most frequently performed procedures in Dr. Glashow’s practice and one of the most common reasons professional athletes seek his care — as Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers, he manages rotator cuff injuries in hockey and basketball players where overhead function, throwing strength, and rapid recovery are non-negotiable performance demands. A member of the Arthroscopy Association of North America, with more than 15,000 procedures performed and recognition as a Castle Connolly Top Doctor every year since 2000, he performs rotator cuff repair at Midtown Surgery Center and at his Upper East Side practice in New York City.
Causes of Rotator Cuff Tears
Rotator cuff tears develop through two primary mechanisms — and many tears involve a combination of both.
Degenerative Tears: The most common cause. Years of repetitive overhead use, age-related reduction in blood supply to the tendon, and chronic shoulder impingement — where the rotator cuff is pinched beneath the acromion during overhead movements — gradually weaken and fray the tendon until a partial or full-thickness tear develops. Degenerative tears are most common in the supraspinatus tendon and typically affect patients over 40.
Acute Tears: A sudden forceful event — such as falling on an outstretched arm, lifting a heavy object with a jerking motion, or sustaining a direct blow to the shoulder — can tear a rotator cuff tendon acutely. Acute tears can occur in otherwise healthy tendons but are more common in tendons that already have underlying degenerative weakening.
Symptoms of a Rotator Cuff Tear
- Pain at rest and at night, particularly when lying on the affected shoulder
- Pain when lifting or lowering the arm, especially overhead
- Weakness when lifting or rotating the arm
- A crackling or crepitus sensation when moving the shoulder in certain positions
- Difficulty reaching behind the back
- Progressive loss of shoulder range of motion and strength
When Is Rotator Cuff Surgery Recommended?
Not all rotator cuff tears require surgery. Many partial-thickness tears and even some full-thickness tears — particularly in older, less active patients — can be managed successfully with conservative treatment including rest, anti-inflammatory medications, corticosteroid injections, and physical therapy focused on strengthening the remaining intact rotator cuff muscles.
Surgery is typically recommended when pain persists despite several months of conservative treatment, the tear is large (greater than 3 cm), there is significant weakness and functional limitation, the tear was caused by a recent acute injury in an active patient, or the patient requires reliable overhead strength for work or sport. Dr. Glashow evaluates each patient with clinical examination and MRI to determine whether non-operative management or surgical repair is the most appropriate approach.
Surgical Techniques for Rotator Cuff Repair
All-Arthroscopic Repair: Dr. Glashow performs the majority of rotator cuff repairs using an all-arthroscopic technique — inserting a small camera and miniature instruments through two to four keyhole-sized incisions to reattach the torn tendon to its anatomic footprint on the humerus using suture anchors. This approach produces less tissue disruption, less post-operative pain, smaller scars, and a faster recovery than open techniques. All-arthroscopic repair is performed on an outpatient basis at Midtown Surgery Center.
Mini-Open Repair: For certain tear patterns — particularly larger or retracted tears that benefit from direct visualization — Dr. Glashow may use a mini-open approach, which combines arthroscopic evaluation and treatment of associated pathology (such as bone spur removal) with a small 3 to 5 cm incision to perform the tendon repair under direct visualization. This technique avoids detaching the deltoid muscle and produces excellent results for tears that are difficult to manage entirely through the arthroscope.
Recovery After Rotator Cuff Repair
Patients wear a sling for four to six weeks after surgery to protect the repair while the tendon heals to the bone. Gentle passive range-of-motion exercises — performed by a physical therapist or with the opposite hand — begin within the first week to prevent stiffness. Active motion and progressive strengthening are introduced gradually over the following months. Most patients return to daily activities within two to three months and to full overhead sports or physically demanding work between four and six months, depending on the size of the tear repaired and the quality of the tendon tissue. Dr. Glashow coordinates rehabilitation closely with physical therapists and uses clinical milestones rather than a fixed calendar to advance each patient through the recovery program.
Rotator Cuff Repair Surgery in New York City
If you are experiencing persistent shoulder pain, weakness when lifting or rotating your arm, or have been diagnosed with a rotator cuff tear and want to discuss your treatment options, Dr. Glashow provides comprehensive evaluation with same-day imaging at his Upper East Side practice. Contact our office to schedule your consultation.
Frequently Asked Questions About Rotator Cuff Repair Surgery
How do I know if I have a rotator cuff tear?
The most common symptoms are pain in the shoulder — particularly with overhead movements, lifting, and lying on the affected side at night — along with progressive weakness in the arm and a gradual loss of range of motion. Some patients hear or feel a pop at the time of an acute tear, followed by immediate weakness. However, many degenerative tears develop gradually without a single identifiable event. Dr. Glashow diagnoses rotator cuff tears through clinical examination and MRI, which shows the exact location, size, and severity of the tear and guides treatment decisions.
Can a rotator cuff tear heal on its own?
Rotator cuff tendons have a limited blood supply, and once torn, they generally do not heal back to the bone without surgical intervention. However, not all tears require surgery — many patients with partial tears or small full-thickness tears can achieve excellent pain relief and functional improvement with physical therapy and non-operative management. The tear itself remains present, but the surrounding muscles can often compensate adequately for daily activities. Surgery is recommended when conservative treatment fails to provide adequate relief or when the tear is large enough to risk progression.
What is the difference between a partial and a full-thickness rotator cuff tear?
A partial-thickness tear involves damage to a portion of the tendon’s thickness — the tendon is frayed or partially torn but still attached to the bone. A full-thickness tear extends through the entire thickness of the tendon, creating a hole or completely detaching the tendon from its bony insertion. Partial tears may be managed with conservative treatment and monitored for progression. Full-thickness tears — particularly those that are symptomatic, large, or in active patients — are more likely to require surgical repair.
What happens if a rotator cuff tear is left untreated?
An untreated rotator cuff tear can enlarge over time as the torn edges retract and the remaining tendon fibers bear progressively more load. As the tear grows, the muscle connected to the torn tendon can undergo fatty infiltration — a process in which the muscle tissue is gradually replaced by fat, producing irreversible weakness that surgery cannot fully restore. Additionally, chronic, large rotator cuff tears can lead to shoulder arthritis — a condition called rotator cuff arthropathy — that may ultimately require shoulder replacement. This is why Dr. Glashow recommends evaluation for any persistent shoulder pain, even when the symptoms seem manageable — early diagnosis preserves the most treatment options.
How long does recovery take after rotator cuff surgery?
Recovery follows a structured rehabilitation program. The sling is worn for four to six weeks. Passive range-of-motion exercises begin within the first week. Active motion starts around six weeks. Strengthening begins at approximately three months. Most patients return to daily activities within two to three months and to full overhead sports or heavy work between four and six months. The timeline is guided by the size of the tear that was repaired, the quality of the tendon tissue, and the patient’s individual healing response.
Can a repaired rotator cuff tear again?
Re-tear rates after rotator cuff repair range from approximately 10 to 30 percent depending on the size and chronicity of the original tear, the quality of the tendon tissue, the patient’s age, and compliance with the rehabilitation protocol. Smaller tears in younger patients with good tissue quality have the lowest re-tear rates. Larger, chronic tears with significant tendon retraction and fatty infiltration of the muscle have higher re-tear rates. Even when a re-tear does occur, many patients still experience significant improvement in pain — the re-tear may be smaller and better positioned than the original tear, and the surrounding tissue heals in a more favorable configuration.
