Rotator Cuff Tear Treatment

Are you suffering from shoulder pain? Does it hurt to lift your arm and reach for things? Did you have an injury, or maybe your shoulder just started hurting one day for no apparent reason? Well, you may have a rotator cuff tear. This is a prevalent shoulder condition that many people suffer from. The good news is that you don’t have to live with it. Fortunately, there are effective treatments.

The rotator cuff comprises four muscles and tendons that stabilize the shoulder joint and power shoulder movements.

When the rotator cuff becomes torn, the damaged area is usually located where the tendon connects with the humerus bone, the tendon insertion site. Rotator cuff tears can occur acutely with traumatic injury or from chronic impingement or age-related degenerative processes that weaken the tendon over time.

Patients with rotator cuff tears will often present with pain and sometimes restricted range of motion or weakness. Activities requiring raising the upper extremity overhead or reaching can become difficult.

Partial-Thickness Rotator Cuff Tears

A “partial-thickness” rotator cuff tear exists when some but not all the fibers in the tendon are disrupted. A partial tear is considered “low-grade” when less than 50% of the tendon thickness is torn. It is regarded as a “high-grade” partial tear when a tear involves more than 50% of the tendon thickness. Another subset of partial-thickness tears is intra-tendinous tears. These tears involve fibers inside the tendon rupturing while the fibers on the outside (at the top and bottom) remain intact.

Treating partial-thickness rotator cuff tears that have recently become symptomatic may begin with a short course of anti-inflammatory medication and physical therapy to address any biomechanical deficits. While these simple treatments will not heal the tear, they can sometimes diminish symptoms, particularly in low-grade tears. High-grade tears often require more advanced treatment.

For more persistently symptomatic partial tears, injection therapy can be beneficial. Corticosteroid injections have been used traditionally, but there are concerns about adverse effects and the fact that corticosteroids do not promote healing; in fact, they inhibit it. More recently, orthobiologic injection therapy has been showing considerable promise in treating partial-thickness tears. Dr. Meier sometimes utilizes Platelet-Rich Plasma (PRP) and Cell Therapy with Bone Marrow Aspirate Concentrate (BMAC) to treat partial-thickness rotator cuff tears, with patients reporting a high level of good-to-excellent results in terms of symptomatic relief and improved function. Tendon healing has also been noted in many cases with follow-up diagnostic ultrasound. Many patients prefer to try these orthobiologic injection therapies before resorting to surgery in the hopes of avoiding surgical treatment altogether. PRP and BMAC provide a reasonable and safe alternative to try without burning bridges.

When patients fail to experience the desired diminution of their symptoms with conservative treatments, Arthroscopic Shoulder Surgery provides a minimally invasive surgical means for effectively addressing partial-thickness tears. At the time of arthroscopy, the magnitude and pattern of the tear can be directly assessed visually and measured to determine the best course of surgical treatment. Generally, partial tears of less than 50% of tendon thickness are debrided or “cleaned up” with a suction shaver to remove unstable torn tendon fibers, so they no longer cause irritation and inflammation in the joint. Higher-grade partial tears over 50% of the tendon thickness are usually repaired with suture anchors to re-establish the tendon insertion site on the humerus bone, like fixing a full-thickness tear.

Full-Thickness Rotator Cuff Tears

When all the fibers throughout the depth of the rotator cuff tendon are entirely torn, this constitutes a “full-thickness” tear, creating a through-and-through hole in the rotator cuff. Once a rotator cuff tear has occurred, it will never heal because of tendon retraction. Tendon retraction refers to the gap within the tendon hole due to the pull of the rotator cuff muscles. Surgical repair is the only way to heal a full-thickness rotator cuff tear. Rotator cuff repair involves reattaching the torn tendon to its bony insertion site on the humerus. Traditionally, this has been done through an open incision that requires cutting or detaching the overlying deltoid muscle to access the underlying rotator cuff. More recent technology has allowed the development of less invasive arthroscopic surgical techniques that enable surgery to be conducted through multiple, half-inch-sized “portals” instead of a formal incision using fiber-optic camera technology. Dr. Meier prefers to perform all rotator cuff repairs arthroscopically due to the better visualization and access to the joint that it provides, as well as decreased surgical trauma and postoperative discomfort.

Initially, surgeons performed rotator cuff repairs by stitching sutures into the edge of the torn tendon and then passing the sutures through drill holes placed into the humerus bone through an open incision. In the 1980s, suture anchors emerged, eliminating the need for passing sutures through drill holes in the bone. The use of suture anchors allowed all-arthroscopic surgical techniques to flourish since the compact size of these implants permitted their placement into the joint through narrow cannulas.

In the late 1990’s Dr. Meier helped pioneer the surgical technique of double-row rotator cuff repair. Until then, rotator cuff repairs were performed by lining up suture anchors on the humerus in a single file (single-row technique). After several years, once clinical follow-up studies revealed an alarmingly high rate of these tendons failing to heal, surgeons became interested in developing ways to improve rotator cuff repair results. Dr. Meier performed and published several biomechanical studies in the laboratory showing that the standard single-row rotator cuff repair technique produced a repair that did not fully restore the native tendon insertion site’s anatomy, was relatively weak, and allowed excessive tendon-bone motion. These factors were suspected to have played a role in the healing failures. Dr. Meier then helped to describe a new double-row rotator cuff fixation technique wherein the implants were placed geometrically instead of in a single file. Dr. Meier’s laboratory work demonstrated that double-row fixation was biomechanically superior to single-row fixation. It also increased the tendon-bone contact area by fully re-establishing the native tendon insertion anatomy. Additionally, it exponentially increased the repair’s strength and durability and minimized tendon-bone motion.

At first, this new double-row fixation technique received mixed responses from other surgeons. Criticisms included the perception that double-row repairs were much more complex and thus, excessively difficult to perform. The increased cost of using more implants per surgery also became a sticking point, at least initially. However, other surgeons recognized the logic in this new approach and that it had the potential to improve patients’ functional outcomes. Over time, numerous clinical follow-up studies have demonstrated that, as Dr. Meier theorized, healing rates in rotator cuff repairs are significantly better with double-row versus single-row fixation.

Nowadays, more orthopedic surgeons are making an effort to learn the double-row technique, realizing that it is in the best interest of their patients. Dr. Meier has devoted his time and energy to traveling the world to teach other surgeons how to perform this procedure.

After optimizing surgical technique and tendon fixation, the last frontier in rotator cuff healing is the body’s healing response. Rotator cuff tears tend to occur in degenerative tissue with poor blood supply. The longer a patient lives with a torn rotator cuff, the larger the tear becomes, and the less of a biological healing response the patient can mount to heal the repair. Studies of bone marrow biopsies have shown that the bone of the humerus loses marrow cells over time with greater chronicity of tendon tears. Since the tendon lacks a sufficient blood supply for healing, the bone is where rotator cuff mending must come. Not even the most perfectly performed surgical repair will endure if the body does not bond the tendon back to the bone in the first twelve weeks after surgery. In his ongoing quest to optimize the healing of rotator cuff repairs, Dr. Meier pioneered the BMAC Bio-CUFFshotTM Rotator Cuff Repair technique. This method involves infusing the bone at the tendon repair site with concentrated, healthy marrow cells from the pelvic bone to restore an improved healing response. While the healing rate of conventional rotator cuff repairs is only 60-70%, Dr. Meier has achieved a much higher healing rate with the BMAC Bio-CUFFshotTM Rotator Cuff Repair.

Massive & Irreparable Rotator Cuff Tears

Massive and irreparable rotator cuff tears are full-thickness tears that have been allowed to increase in size and severity over time. Studies show that untreated tears tend to enlarge progressively due to ongoing muscle contraction pulling on the weakened tendon. Tears that become irreparable are usually very large, involving more than one rotator cuff tendon, and feature severe tissue retraction and contracture. The rotator cuff muscle tissue will atrophy due to long periods of relative inactivity and become replaced by fat through a degenerative process called fatty infiltration. As a result, the rotator cuff tissue shrinks and becomes stiff, so it is no longer possible to pull the torn edge of the tendon back to its attachment point on the bone. These processes are typically irreversible once significant muscle atrophy and fatty infiltration set in.

Because of this, one can make an excellent argument to repair tears proactively. And to do so while the tears are still small and manageable, with repair surgery to avoid the problems associated with massive and irreparable rotator cuff tears. Once a tear has progressed to the point where it is irreparable, a primary repair is no longer an option, and only reconstructive procedures remain.  It is interesting to note that there can be a tendency for less experienced surgeons to incorrectly label a complicated rotator cuff tear as “irreparable” when it is a failure to recognize and restore the proper tear pattern. Dr. Meier has encountered numerous revision cases where the first surgeon told the patient their tear was irreparable. Only after appropriate scar tissue release and restoration of the tear pattern was a complete primary repair ultimately possible.

There are several options for rotator cuff tears that are truly irreparable. Sometimes, trying a rehabilitation program for strengthening and conditioning can be worthwhile. By building up the compensatory muscles, such as the pectoralis major, latissimus dorsi, and deltoid, these muscles can be recruited to compensate for the lack of stabilizing force usually provided by an intact rotator cuff. This may not return full strength to the arm, but may adequately restore basic function in lower-demand patients. This can be a preferable option, particularly in elderly, frail patients in whom surgery may pose undue risks. 

Irreparable rotator cuff tears that continue to cause pain or significant weakness despite conservative measures can be treated with reconstructive surgery. A procedure called Superior Capsular Reconstruction (SCR) involves sewing a collagen graft into the rotator cuff defect to restore the stabilizing effect of the superior capsule of the shoulder joint. This newer procedure can be desirable for a higher-demand patient with an irreparable rotator cuff tear. While long-term follow-up is still limited, initial clinical results show improvement in shoulder function in most selected patients.

Another technique that has shown promise in restoring function to shoulders with irreparable rotator cuff tears is Lower Trapezius Tendon Transfer (LTTT) surgery. In this procedure, a portion of the lower trapezius tendon is detached from the scapula, moved, and attached to the humeral head to replace the function of the rotator cuff. This tendon transfer is typically tolerated well since the trapezius is a very large muscle and only a small portion is needed to substitute for the rotator cuff.

Rotator cuff arthropathy (RCA) is the destruction of the shoulder joint due to longstanding instability resulting from a massive rotator cuff tear. RCA can cause worsening pain and loss of the ability to perform overhead activity. Patients with RCA can benefit from Reverse Shoulder Arthroplasty (RSA), a type of joint replacement surgery where a prosthetic ball and socket replace the ball and socket of the shoulder joint, but in a reversed position. In other words, an artificial “socket” replaces the natural “ball” of the patient’s shoulder, and a prosthetic “ball” replaces the patient’s “socket”.  By altering the biomechanics cleverly, the deltoid muscle is recruited to substitute for the absent rotator cuff, reducing pain and allowing the patient to elevate their arm again. Some downsides to RSA are that it is highly invasive and associated with a relatively high complication rate. RSA is considered an “end-of-the-line” procedure since, if it fails, there are not a lot of options or good backup plans. Dr. Meier does everything possible to help patients avoid resorting to RSA, especially his more physically active patients.

Failed Rotator Cuff Surgery

Generally, rotator cuff surgery has a high patient satisfaction rate, but patients may experience poor results or complications after surgery for several reasons. Dr. Meier is an expert in performing revision rotator cuff repair surgery. Many patients travel from around the world to be evaluated and treated by him after experiencing failed shoulder surgery elsewhere.

Dr. Meier believes that the first step in addressing a failed rotator cuff surgery is determining the cause of the failure. Once he identifies the reason, he can address the problem directly. Shoulder surgery may fail due to missed or incorrect diagnoses, technical errors in surgery, and deficiencies in the biologic healing response.

Corrective revision surgery may be beneficial if it addresses missed pathology, corrects technical issues, or augments an insufficient biological healing response. Dr. Meier believes planning what will be done differently during a second surgery is critical if one hopes for a different outcome than after the initial surgery.

To begin an evaluation of a failed shoulder surgery, obtaining current X-rays and an MRI is necessary. Diagnostic ultrasound can also provide helpful information. During the office evaluation, Dr. Meier may perform diagnostic injection tests with lidocaine under ultrasound guidance to determine what part of the anatomy is responsible for residual pathology and ongoing pain symptoms. Diagnostic injections may be performed sequentially in the subacromial space, acromioclavicular joint, biceps bursa, and glenohumeral joint, monitoring the pain response after each injection. After identifying the reason or reasons for the persistent symptoms, Dr. Meier can formulate and implement a strategic surgical plan. The following table provides a list of the most common problems encountered at the time of revision surgery and the appropriate procedures to address them:

• Stiffness/restricted motion 🡪  capsular release/lysis of adhesions
• Residual impingement 🡪  revision acromioplasty
• Painful AC joint 🡪  distal clavicle resection
• Unstable biceps tendon 🡪  biceps tenodesis
• Neglected tendon delamination 🡪  double-layer RTC repair
• Unhealed rotator cuff tendon 🡪  revision RTC repair with Bio-Boost
• Unrepairable rotator cuff 🡪  superior capsular reconstruction
• Unrepairable RTC with arthritis 🡪  reverse total shoulder arthroplasty

Identifying the cause or causes of failure is key to effectively treating patients who have undergone failed rotator cuff repair surgery. If the source can be identified and addressed, then revision surgery has a good chance of being helpful. Because the biologic healing response is often compromised in these cases, Dr. Meier usually includes the BMAC Bio-CUFFshotTM Rotator Cuff Repair technique in revision cases.

Rotator Cuff Tear Treatment FAQs

Does a partial-thickness tear of the supraspinatus tendon require surgery?

Sometimes, yes, but not always. Partial tears can often be effectively treated with orthobiologic injection therapy such as Platelet-Rich Plasma (PRP) or Cell Therapy using Bone Marrow Aspirate Concentrate (BMAC). Orthobiologic injection treatment may stimulate enough of a healing response to help repair the damaged tissue or, at least, naturally reduce the chronic inflammation to the point where the shoulder symptoms decrease and function improves.

Does a full-thickness tear of the supraspinatus tendon need surgery?

Not always, but often surgical repair is necessary for full-thickness tears. A full-thickness tear means the tendon is completely torn, which is frequently associated with shoulder weakness, pain, and loss of motion. If the tendon is retracted, there is a gap between the edge of the tendon and the bone where it is supposed to be attached. The gap is usually too far for the body to bridge to mend the tendon naturally. So the surgical repair brings the tendon back into contact with the bone and holds it there for the body to heal it back in place.

How is rotator cuff surgery performed?

Rotator cuff surgery had traditionally been performed through open incisions but, nowadays, it is often performed arthroscopically by surgeons who have specialized training and experience. This means the surgeon makes small cuts and uses a tiny camera and tools to repair the tendon while visualizing the inside of the shoulder on a video monitor. The torn tendon is reattached to the bone using small anchors and stitches so it can then heal back into place.

What is supraspinatus tendon tear surgery?

This surgery repairs a torn supraspinatus tendon, one of the key tendons in the rotator cuff. The surgeon reattaches the tendon to the top of the upper arm bone (humerus) using anchors and sutures. It’s often done arthroscopically by surgeons with specialized training and experience for less pain and less scarring.

What is torn rotator cuff surgery?

Torn rotator cuff surgery repairs one or more damaged tendons in the shoulder. It’s often done arthroscopically by surgeons who have specialized training and experience. The goal is to restore shoulder movement and reduce pain by reattaching the torn tendons to the bone. Surgery may also involve cleaning out damaged tissue or shaving bone spurs.

What is the rotator cuff surgery recovery time?

Recovery usually takes 4 to 6 months, depending on the size of the tear and your overall health. The first few weeks are focused on healing, followed by physical therapy to regain motion and strength. Full return to normal activities can take several months.

How long will I have pain after rotator cuff surgery?

Some pain is expected in the first few weeks, especially right after surgery. This usually improves with time. Most patients notice a big drop in pain after the first 6 to 8 weeks, and ongoing improvement over the next few months as the shoulder heals and regains strength.

How long does rotator cuff surgery take?

The surgery itself can take 1 to  3 hours, depending on the size of the tear and if anything else needs to be done (like removing bone spurs). It is usually performed as an outpatient surgery.

What to expect after rotator cuff surgery?

Expect your arm to be in a sling for several weeks. You’ll start with gentle movements and begin physical therapy soon after. Full recovery takes time—usually several months—and most patients find that they continue to improve up to twelve months after surgery. You’ll have regular check-ins with your surgeon to monitor progress.

Ready to Take the Next Step in Shoulder Care?

Dr. Meier is a highly experienced orthopedic surgeon who has treated hundreds of patients with rotator cuff injuries—ranging from minor tears to full-thickness damage. He focuses on precision, evidence-based care, and helping patients get back to their everyday lives with less pain and more movement. Whether you’re an athlete, a weekend warrior, or just want to lift your arm without discomfort, Dr. Meier can guide you through your options and recommend the right treatment plan for your shoulder.

If you’re dealing with shoulder pain or have been told you might need rotator cuff treatment, we’re here to help. Reach out to Dr. Meier at MOSM.