The shoulder rotator cuff is a group of four tendons that connect shoulder muscles to the upper arm bone. These tendons work together to:

• Lift the arm
• Stabilize the shoulder joint
• Keep the ball of the shoulder centered in the socket during movement

The four rotator cuff tendons are:

• Supraspinatus
• Infraspinatus
• Subscapularis
• Teres minor

When one of these tendons tears, the shoulder can lose strength and stability, which may affect everyday activities and sports performance.

Common symptoms include:

• Shoulder pain when lifting the arm above shoulder level
• Weakness when lifting or rotating the arm
• Difficulty reaching overhead or behind the back
• Pain at night, particularly when lying on the affected shoulder
• Reduced endurance when lifting objects, exercising, or performing repetitive shoulder movements

Some tears develop gradually, causing progressive pain and weakness over time. Others occur suddenly after an injury and may lead to noticeable loss of strength.

Rotator cuff tears are typically diagnosed by an orthopedic surgeon who specializes in shoulder conditions.

Imaging studies used to confirm the diagnosis:

• MRI — the most common test used to visualize the rotator cuff tendons and determine the size and depth of a tear.
• Ultrasound — may be used to evaluate tendon integrity and movement in real time.
• X-rays — help assess the joint and rule out arthritis or bone-related problems.

The final diagnosis is based on a combination of physical examination, imaging, and how the shoulder is functioning.

Rotator cuff tears are treated by orthopedic surgeons who specialize in shoulder and sports medicine conditions.

For the highest level of specialization, look for a fellowship-trained shoulder surgeon. Fellowship training is an additional year of advanced surgical training that typically includes:

• Diagnosis and treatment of complex shoulder injuries
• Advanced arthroscopic procedures such as rotator cuff repair
• Management of complex tear patterns and revision cases
• Surgical planning focused on restoring shoulder strength and mechanics

Patients do not feel pain during rotator cuff surgery. The procedure is performed under regional anesthesia with sedation or general anesthesia.

After surgery, some discomfort is expected — particularly during the first 48–72 hours. Pain is managed with medication, ice, sling support, and activity modification.

Many patients also receive a regional nerve block, which can keep the shoulder numb for several hours after surgery.

As healing progresses, pain typically improves steadily over the following weeks. Structured rehabilitation then helps restore motion and strength while protecting the repair.

Arthroscopic rotator cuff repair is a reliable procedure for appropriately selected patients. The AAOS 2025 Clinical Practice Guideline states that healed rotator cuff repairs show better patient-reported and functional outcomes than physical therapy alone or repairs that do not heal.

Outcomes vary with: tear size and retraction, tendon and muscle quality, patient age and health, timing of repair, adherence to rehabilitation, and the surgeon's experience.

In general, smaller and medium-sized tears heal more reliably, while large or massive tears carry higher re-tear risk. Recent literature reports re-tear rates of roughly 5–10.3% for small/medium tears and around 37–50% for large/massive tears.

A 2024 review reported that about 75% of patients returned to sport after arthroscopic rotator cuff repair, at an average of 6.4 months.

At The Joint Preservation Center, our surgeons track outcomes for 5 years because true success is whether the shoulder remains strong, functional, and durable over time.

Recovery occurs in phases because the tendon must heal back to the bone.

Most patients wear a sling for several weeks to protect the repair while early healing takes place. During this time, gentle guided motion is introduced to keep the shoulder mobile.

Many patients regain meaningful day-to-day function within 3–4 months. Full recovery of shoulder strength and endurance can continue improving for 6 months or longer.

A structured rehabilitation program and adherence to recovery guidelines play an important role in achieving the best possible outcome.

Unlike rotator cuff repair (which preserves native tissue), shoulder replacement involves implanting metal and polyethylene components.

Shoulder replacement can be effective for advanced arthritis or irreparable rotator cuff tears. However, potential risks include:

• Implant loosening over time
• Wear of plastic components
• Mechanical failure
• Instability or dislocation
• Need for revision surgery

Younger and more active patients place greater stress on implants, which may affect long-term durability.

Yes, many people can still move their shoulder even when a rotator cuff tear is present. Other muscles around the shoulder can temporarily compensate.

However, this compensation often comes with reduced strength, fatigue, or pain during certain movements. Over time, continued strain may lead to worsening weakness or progression of the tear.

Traumatic tears often happen after a fall, lifting injury, or shoulder dislocation. Patients typically notice immediate pain and weakness.

Degenerative tears develop gradually as the tendon weakens with age, repetitive use, or reduced blood supply. These tears may cause slowly increasing pain and weakness over months or years.

Both types can affect shoulder strength and stability.

Pseudoparalysis refers to the inability to actively lift your arm despite having intact nerve function. It occurs when a massive rotator cuff tear is so extensive that the remaining muscles cannot generate enough force to elevate the arm against gravity.

Pseudoparalysis typically indicates a massive or multi-tendon tear that may require advanced surgical intervention such as superior capsule reconstruction, tendon transfer, or reverse shoulder arthroplasty.

Yes. It is common for MRI to reveal concurrent pathology alongside a rotator cuff tear, including bone spurs (subacromial impingement), biceps tendon tears or instability, SLAP tears (superior labral tears), and AC joint arthritis or osteolysis.

We routinely address combined shoulder pathology during a single arthroscopic procedure. For example, rotator cuff repair can be combined with biceps tenodesis, SLAP repair, subacromial decompression, or distal clavicle excision depending on what your imaging and intraoperative findings indicate. Addressing all contributing structures in one operation avoids the need for a second surgery and typically produces better overall outcomes.

The Joint Preservation Center accepts most PPO insurance plans that have out-of-network benefits:

If you have a PPO insurance plan with out-of-network benefits:

• There is no charge for office visits.
• If you need surgery, there is no charge for the surgeon’s professional fee. You are only responsible for your in-network copay or deductible related to the surgery center or hospital. These facilities are in-network with most insurance plans and bill separately for their services.

We exclusively work with surgery centers that are in-network with the following insurances:

• Aetna PPO
• Anthem PPO
• Blue Cross PPO
• Blue Shield PPO
• Cigna PPO
• United Healthcare PPO
• HealthNet PPO
• Others (Contact Us)

Note: If you have Medicare, Medicaid, TRICARE, or VA programs, or if your PPO does not have out-of-network benefits, you can still see our specialists and the surgery center will still be in-network. In this case, our specialists charge $250 for the initial office visit (all follow ups are included). Surgery is typically in the range of $6K – $8K depending on what you need done.

If you are unsure whether your plan is accepted, our team can verify your coverage before your appointment.