Rotator Cuff Repair

Understanding Your Injury

The rotator cuff and why tears matter

The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, providing stability and powering rotation and elevation of the arm. Rotator cuff tears are among the most common shoulder injuries in adults, becoming increasingly prevalent with age.

Tears range from small partial-thickness injuries to massive full-thickness tears involving multiple tendons. Symptoms typically include pain with overhead activity, weakness, and difficulty sleeping on the affected shoulder. Some tears are acute (from a fall or lifting injury); many develop gradually from repetitive use and degenerative change.

Dr. Strassman evaluates every rotator cuff tear individually — not every tear requires surgery. He discusses conservative options first and recommends repair when the tear is symptomatic, the tissue is repairable, and surgery is likely to improve function and reduce pain.

Common Symptoms

Pain on the outside of the shoulder, often radiating to the upper arm

Weakness with overhead reaching or lifting

Night pain that disrupts sleep

Crackling or clicking sensation with shoulder movement

Difficulty with activities such as throwing, reaching behind the back, or combing hair

Tear Classification

Not all tears are treated the same

Partial Thickness

Partial Tear

The tendon is damaged but not completely severed. Many partial tears respond well to physical therapy and injections. Surgical repair is considered when conservative treatment fails or the tear involves more than 50% of tendon thickness.

Small to Medium (<3cm)

Full-Thickness Tear

The tendon has torn completely through. Repair is typically recommended for active patients with full-thickness tears causing symptoms. Arthroscopic repair restores the tendon to its footprint on the humeral head using suture anchors.

Large to Massive (3cm+)

Large / Massive Tear

Tears involving multiple tendons or significant retraction require more complex decision-making. When repair is possible, Dr. Strassman augments the repair with a dermal patch to reinforce healing and improve outcomes in large tears. When the cuff cannot be adequately repaired, options include lower trapezius tendon transfer to restore rotational strength, tuberoplasty for pain relief in select patients, or reverse shoulder replacement when arthritis is also present.

Surgical Technique

Arthroscopic Repair: Minimally Invasive Precision

Dr. Strassman performs rotator cuff repair arthroscopically through small incisions using a camera and specialized instruments. This approach offers less soft tissue disruption, faster early recovery, and lower infection risk compared to open surgery — without compromising the quality or durability of the repair.

The torn tendon is reattached to the bone using suture anchors placed at the tendon's anatomic footprint on the humeral head. For larger tears, a double-row repair technique is used to maximize the contact area between tendon and bone — improving healing rates and biomechanical strength.

Any concurrent pathology found at the time of surgery — such as biceps tendon disease, AC joint arthritis, or labral damage — is addressed simultaneously.

What happens during surgery

1

Small portals (5–10mm) created around the shoulder

2

Camera inserted to visualize tear and assess tissue quality

3

Bone surface prepared to stimulate healing response

4

Suture anchors placed, tendon secured to footprint

5

Any additional pathology treated (biceps, AC joint, labrum)

Rehabilitation

Recovery Timeline

Rotator cuff healing is biologically driven and cannot be rushed. Protocol timing varies based on tear size and tissue quality — Dr. Strassman tailors the protocol accordingly.

Wk 0–6

Protection Phase

Arm in sling. Pendulum exercises and gentle passive range of motion only. The repair must be protected to allow tendon-to-bone healing. No active shoulder use.

Wk 6–12

Active Motion Phase

Sling discontinued. Active range of motion begins under PT guidance. Progressive stretching to restore full elevation and rotation.

Mo 3–4

Strengthening Phase

Rotator cuff and periscapular strengthening begins. Resistance band and light weight exercises. Continued functional improvement.

Mo 4–6

Return to Activity

Most patients return to daily activities and light work. Overhead athletes and heavy laborers may require longer recovery — up to 9–12 months for full return.

Small Tear PT Protocol (PDF) Large Tear PT Protocol (PDF) Partial Tear PT Protocol (PDF)

Common Questions

Frequently Asked Questions

Does every rotator cuff tear need surgery?

No. Many partial tears and even some full-thickness tears in older, less active patients can be managed successfully with physical therapy and injections. Surgery is recommended when symptoms persist despite conservative treatment, when the tear is acute and large, or when function is significantly compromised.

Will my rotator cuff tear get bigger if I wait?

Research shows that untreated full-thickness tears do tend to enlarge over time. The rate varies by patient and tear type. Early evaluation helps establish a baseline so the tear can be monitored appropriately. If surgery becomes necessary, operating on a smaller tear with better tissue quality generally yields superior outcomes.

How long until I can use my arm normally?

Most patients regain functional use of the arm for daily activities by 3–4 months. Full recovery, including return to sport or heavy labor, typically takes 6–12 months depending on tear size and individual healing.

What if my tear is too large to repair?

Massive or irreparable tears have several treatment options depending on patient age, activity level, tear characteristics, and tissue quality. Dr. Strassman tailors the approach to each individual — options include partial repair with dermal patch augmentation to reinforce the repair and improve healing biology, lower trapezius tendon transfer to restore rotational strength when the cuff cannot be repaired, tuberoplasty to smooth the humeral head and reduce pain in select patients, or reverse total shoulder replacement for patients who also have significant arthritis. Dr. Strassman discusses all applicable options at consultation based on your imaging, functional goals, and tear pattern.