About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles – all geared to improve your quality of life.

32 comments on “Do I Need Rotator Cuff Tear Surgery? – Expert Series

  • Aloha, thank you for this information. I am right-handed with right rotator cuff tear, determined “old” in MRI, no bicep tendon tear. Constant sting in right bicep muscle. My preferred Ortho.DR. immediately recommended surgery (arthroscopic surgery). Knowing that I have left bicep tendon tear (>10 years), which resolved w/o surgery. (??) maybe I said something? Going to seek 2nd opinion for non surgical. Thank you again.

  • I am a Dentist outside of Phila. and just had an MRI of my right shoulder, large tear found due to playing squash and racketball for 35 years. Initial injury 1-1/2 to 2 years ago, which I let heal for 4-6 months. It felt better went back to playing squash and must have made it worse 4 months ago. I am afraid to have surgery not because it is surgery but because it will take me away from my work for 6 weeks or so, with a high chance that I may not play again anyway? I was advised to have surgery by one Ortho. surgeon, going for second opinion monday. Is this so called large tear healable with steroids and physical therapy at this point???
    Tx Russ

    • Once a tear reaches a certain size it will usually continue getting larger. Your pain might improve with injections and PT, but the tear will not heal.

  • Hi I am Bill, I have a large rotar cuff tear from the point of my shoulder back as seen on MRI. I work a very physical job and have worked everyday since I fell. I have the ability to lift 70 lbs containers all day long without much pain. It aches at night and once and a while a shooting pain. I saw the Dr yesterday and he told me if I wait a year to have surgery and my arm and shoulder really start hurting he could not repair it. The problem for me is if I get the surgery I will lose my job, one that I really love. Also I do not want in a year my right arm to be useless. I would want to know does it always get worse in time, what are the odds. I know a tear is a tear, but if it did not get worse I could deal with pain. Trying to figure out what to do, thx Bill

    • Hi Bill … I deal with these issues everyday .. it doesn’t get easier. Some tears will become larger some will not… we can not predict it. Some tears become harder to repair as time passes, yet many do not. Again, can not predict which will change. This is not an easy decision.

      • I m suffering from acute full thikness tear of rotator cuff in right shoulder due to an accident few weeks ago.. the gap is of 2cm. Do i need surgery..my age is 56 years.please reply its urgent. I cannot move my arm backwards nor can i lift it upwards

      • I can’t say … a 2 cm gap doesn’t tell me enough about your tear. Some of these may go on to require surgery, some may not. Physio might help alleviate the pain too.

  • Dear Dr Luks, thank you for your response, yes I really do not know what to do. I almost wish it would hurt much more then I know I could not work. I am out trimming hedges with no problems at all. Does my shoulder and arm hurt, yes but no real pain just aching. How can I do stuff like this with a tear like that. I would love to get the surgery and keep my job but that’s not going to happen so it’s going to have to be either or. Thanks again, take care of yourself. Bill

  • Hi Dr Luks: I am a fifty seven year old female with a demanding job of grinding concrete. Am extremely fit and do tons of extra activities. Fell four months ago and tore my rotator cuff. Had X-ray, ultrasound and MRI. Result is full thickness tear of the suprsaspinatus extending as a high grade partial tearing of the infraspinatus with substantial tendon retraction but only mild muscle atrophy. I have been doing physio excercises since March with no improvement. I cannot touch the back of my neck, nor raise my arm past my waist. I have had several incidents with my shoulder popping out and in since the tear I was asked if it affected my daily living and yes it most certainly does. Today my doctor received a letter from the specialist saying I should go to moonshoulder.com and excercise more and maybe he would check again in a few months. I am not one to sit on my butt and am a very quick healer so yes I do my exercises and more. I have adjusted my work so I can handle the pain and using other methods to cope with chores at home. I am just a simple lady but if something is broken it needs to be fixed before it can heal or am I wrong. I live in Alberta Canada but if you have any ideas about what to do I would appreciate it very much. I would love to have my life back. Thank you so much for your time.

    • Your tear seems to be fairly large. It also sounds like you fit into the acute rotator cuff tear category… waiting further could jeopardize your ultimate result.

  • Husband has full thickness tear of the supraspinatus tendon with retraction of the tendon, dr said surgery, but he has no pain in shoulder, no lack of usage of arm, in fact does a lot of hard manuel labor and no pain , the only pain he has is every so many days he has bad neck pain that causes him not to be able to turn head. They did tey strong inflamation pills and they do help but not to tske for long period of time, really doesnt want surgery but has heard if you dont get it things can get worse and is 65 in age already! What would you recommend? Can he rake pills or get shot and wait on surgery or better done before getting older? He also has full range of his arm usage! Thank you for any adivce!

    • Without seeing him or his images i can not answer that. The right questions to ask your surgeon include what can happen over time? – Many, but not all tears become larger. What is the chance the surgery will be successful? Once retraction has started the success rate goes down… a lot.
      What is his recovery? It’s probably a lot longer than you think. The most likely time to re-tear your rotator cuff is 20-24 weeks after surgery… so no heavy repetitive lifting until after that… many people can not afford that much time off work. There is no easy answer here. Even the American Academy of Orthopedic Surgeons agrees with that.

  • Hello Dr. Luks, Thank you for sharing this informative series on RC injuries and treatment options. I have a RC problem, a small tear where the bicep attaches in the front. I’m 53. I’ve been in pain for over 1 year (woke up with it one AM after sleeping on that arm the night before,) but I have only recently sought medical help with the issue. I’ve done PT and am now swimming laps. Steroids, anti inflammatory meds, and surgery are all out because of pre existing conditions. My question is, why is the ROM for my arm so limited (and can it return to normal?) and why do small, insignificant jarring motions to the arm cause such extreme pain? It’s also interesting to me that my upper back is painful although the tear is in the front of my shoulder, particularly the muscles behind my armpit. Living with the pain and limited ROM may be easier if I have a better understanding of what is causing it. Again, thank you for all the good you do.

  • I am an 80 year old very active man- walk 45 minutes each day and played golf 3-4 times a week until recently
    6 weeks ago had a fall in the bathroom and after x-Ray and MRI I have a slight tear in rotator cuff with a small bone chip. I have been in PT 3 weeks and have regained a lot of motion— just want to get back to golf. Should I avoid surgery at all costs?

  • I am a 68 year old male going in for rotator cuff surgery in 2 days. I think I’m getting cold feet because of the time it takes to heal and the loss of my right arm for a significant time period. My pain is nominal during the day and I am able to do much to include golf but activities that require me raising the arm much causes some significant pain. Like Kayaking and casting a fly rod. At night, there is significant pain while lying down and it does keep me awake or wakes me early in the mornings. I had seen one doctor who gave me injections in the shoulder which didn’t help at all. My new doctor ordered an MRI and it told him I have a complete tear and he recommended surgery. I agreed to this and of course it is scheduled. My thoughts are should I have asked for alternatives or gotten a 2nd opinion? I guess I’m just unsure of the outcome and need reassurance that I’m doing the right thing.

    • Tough to say Robert.. so many variables. At 68 you likely have a degenerative tear and surgery is not the first option for treatment. Most people respond to physical therapy. But there may have been other issues other issues at play that I can not comment on since I did not examine you. This is certainly not an urgent procedure, so a second or third opinion won’t hurt.

  • Dr., first, thank you for taking questions.
    I’m a 47 yr old female railroad conductor, have been a conductor for 17 years.
    My job includes pulling/pushing on doors that can contain up to 200 lbs of pressure, dozens of times a day, climbing up and down on/off trains, throwing switches via switch handles, etc.
    All this I’m sure has helped bring about the shoulder pain I’ve had for the last four months. I’m still fully functional, but experience acute pain in the shoulder when reaching up or out (especially when done quickly), cannot lay on that shoulder, have pain when trying to tuck in my shirt in back, and lots of pain in the first few minutes upon waking.
    Ibuprofen helps, and while the pain was initially between the shoulder and clavicle, it’s now mostly in the outer upper arm, or below the surface of that area. Occasionally it feels like something’s “shifting” there (the strands of muscle or tendon, for instance).
    My question is, considering the shift in the focus of pain, does this sound like something that’s getting better? Considering that this has been going on for months, I’m getting used to it and learning to live with it. Should I be?

    • Sure sounds like your rotator cuff is bothering you. We each have a different threshold of pain which will lead us to seeing a doctor. Usually if the pain persists for a while I ask people to be examined by a shoulder doc to get a good handle on what’s going on.

  • Hi Dr. Luks:

    I’m a healthy 68 yr old female, working full time, exercising, and very active.

    I have a full tear of my superspinatus ( tossed a trash bag ) and 2 ortho doc opinions both say I need the surgery, or it could be non reparable, later on.

    I’ve talked to so many others , including PT experts, who say I should have opted for PT and injections first, prior to scheduling the surgery.

    What say ye?


    • Most shoulder docs agree that the management of degenerative small supraspinatus tears usually starts in the non-operative realm and progresses to a surgical approach if the patient does not respond to non-surgical measures.

  • Dr. Lucas. I am a 69 year old male with a near full thickness tear involving >50% of the supraspinatus. My Primary care doc started me off with x-rays and a round of PT, limited to 6 visits by my wonderful insurance. The results of the PT initially were not good, which led to an MRI. My PCD said the 50%+ tear was not repairable without surgery. I prepared myself mentally for the long recovery period, and went to see the surgeon. I was blown away when he said he didn’t want to do surgery, and instead, gave me cortisone and a script for 18 PT visits. I’m torn, no pun intended. I stopped performing because I couldn’t carry my equipment up the stairs without significant pain. I was looking forward to getting back to that after recovery. Additionally, my father is 94, and very healthy. I plan to follow him and his success. Just not sure how much fun it would be with a broken wing. Is there reason to believe that the PT visits can restore full function to my shoulder?

  • I am 62 years old. My right should rotator cuff is completely detached. It happened two Years ago. I go to the gym and lift weights 5x a week. It’s sore but not really painful. I have full range of motion. Should I have surgery? No injury, just wear and tear!

    • HI Sammy…
      Without examining you and looking at you and your studies it is impossible to offer you a treatment plan. Sorry, and I wish you success with your shoulder !

  • Hi Dr Luks,
    I’ve been lucky enough to dislocate my shoulder 5 times over the years and have developed a large Hill-Sachs lesion and torn Labrum. I am scheduled for a Remplissage procedure in a few weeks and have cold feet. I was told rehab is long and may take 6-8 months before I can return to surfing or go back to work as an RN. My last dislocation was 6 weeks ago and I am already back surfing, working, and in the gym. I know without surgery I will surely dislocate it again, but I am currently pain free and able live normally. I am 31 years old and am very active in outdoor sports. Should I get surgery now or keep risking future dislocations? Mahalo.

    • That’s a tough choice…. each time your shoulder dislocates you decrease the chances that surgery will be a success in the future.
      A labral repair and remplissage works well as long as there is no bone loss on the glenoid (socket). If there is bone loss of a certain severity then a bone block procedure such as a Latarjet (Bristow) might needed.

      As Orthopedists we prefer strong stable joints– if that is achievable. What happens if your shoulder dislocates in a strong surf and you can’t get back to shore easily? There are many situations where if your shoulder dislocates it can put you in harms way.

      While surgery is not absolutely indicated— there is a strong argument to be made for considering the proper procedure performed by the proper surgeon.
      Good Luck

  • Hello Dr. Luks,
    I have had 1 previous rotator cuff surgery now with (per MRI) a “recurrent with a 9×7 mm tear disrupting apx 75% overall tendon thickness. Worsening moderate tendinosis of intra-articular segment of long head of biceps, and mild synovitis at the biceps tendon sheath. Minimal subacromial-subdeltoid bursitis. Mild inferior humeral head cartilage thinning.” My ortho surgeon says no further surgery is indicated. He offered cortisone shots and PT. The bigger picture is that I have been recently diagnosed with breast cancer on that same side to which I am pre-op for that. I am afraid of lymphedema should I have to have ortho surgery post op breast surgery. Wouldn’t it be prudent to have the ortho surgery prior to breast surgery?
    Thank you in advance for your response.

    • I would think it would be prudent to deal with the breast issue first.
      Your shoulder shows degeneration of the cartilage (mild arthritis) and some degeneration of the cuff. That is why these tears recur. They recur because we are repairing degenerative tissue most of the time. Lymphedema is rare… and usually follows complete node dissections which are not commonly performed these days.

  • Lymphedema is a common problem among those with more advanced breast cancer. I am concerned that what could be managed pre-op breast CA surgery is not being addressed. Should the rotator cuff degenerate further, I will have to live with it indefinitely. Breast cancer patients avoid any invasive procedures on the operative side. This includes anything that might otherwise seem mild, such as needle sticks. I do appreciate you taking the time to answer. Thank you.

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