The short answer. A rotator cuff tear is a tear in one of the tendons that cover the head of the upper arm bone and help you lift and rotate your arm, and most people improve without surgery1,2. Surgery is more often considered after a recent injury, for a large tear, or when pain and weakness last despite therapy1. Platelet-rich plasma (PRP) and bone marrow concentrate are also used, and studies have found fewer re-tears when either is added to a surgical repair, and greater improvement in pain and function after bone marrow concentrate injections than with a home exercise program3,4,5.
The rotator cuff is a group of four muscles whose tendons form a covering around the head of the upper arm bone (humerus), attaching it to the shoulder blade1. In most tears the tendon is torn away from the bone, most often the supraspinatus tendon on top of the shoulder. The American Academy of Orthopaedic Surgeons (AAOS) estimates that almost 2 million people in the US see a doctor each year for rotator cuff tears1.
A fall on an outstretched arm or a jerking lift can tear the cuff, but most tears come from the tendon wearing down slowly over time1. When 664 residents of one Japanese village had shoulder ultrasounds, 22.1% had a full-thickness tear, rising from none in people in their 20s to 40s to 36.6% in their 80s, and about two-thirds of the tears caused no symptoms6. A pooled review of 30 studies and 6,112 shoulders called rotator cuff degeneration a common part of normal aging, common enough that it can be hard to tell whether a tear seen on a scan is causing a person's symptoms7.
AAOS describes the types this way1:
Tears generally start as wear inside the tendon and progress from partial to full thickness, though not every tear progresses or causes symptoms8. For partial tears, conservative treatment is often the first line for most patients; the decision to operate depends on factors such as age, arm dominance, cause, activity level, and the thickness and location of the tear9.
The most common symptoms, according to AAOS, are1:
A tear from a sudden injury usually causes intense pain, and there may be a snapping sensation and immediate weakness in the upper arm1. A tear that develops slowly may start as mild pain only when you reach overhead; some tears are not painful at all but still cause weakness1.
Symptoms often settle without an operation. AAOS reports that nonsurgical treatment (rest, activity changes, anti-inflammatory medication, physical therapy and, if needed, a cortisone injection) relieves pain and improves function in about 80 to 85% of patients1. On average, AAOS says, a cortisone injection relieves pain in about two-thirds of patients for at least three months, and repeated injections carry risks1.
A multicenter study from the MOON Shoulder Group followed 452 people with full-thickness tears that were not caused by an injury, all of whom started a structured physical therapy program. Fewer than 25% chose surgery over two years, and most who did decided between 6 and 12 weeks2. At 10 years, therapy had succeeded in more than 70% of patients, and scores in those who never had surgery did not decline over the decade10.
The trade-off is that an unrepaired tear can grow, and AAOS lists this among the disadvantages of nonsurgical care1. In a Norwegian study of 49 unrepaired tears rechecked after about 8.8 years, tears grew on average, often only moderately, but patients whose tears grew by 20 mm or more had worse shoulder function11.
Continued pain despite nonsurgical treatment is the main reason for surgery, and a doctor may also suggest it for people who are very active or use their arms overhead for work or sports1. Other signs that surgery may be a good option include1:
Timing may matter after an injury. In a study of 206 patients with injury-related full-thickness tears, those repaired within 4 months of the injury had better shoulder scores than those repaired later12. A 2025 study of 141 patients also linked longer time to surgery with lower scores13.
Repair usually means stitching the tendon back to the upper arm bone, most often arthroscopically and without an overnight stay14. A sling is usually worn for the first 4 to 6 weeks, strengthening exercises start at 8 to 12 weeks, and most patients have functional motion and adequate strength by 4 to 6 months14. A re-tear is possible after any repair and is more likely with larger tears, though AAOS notes that people who re-tear usually do not have greater pain or decreased function14.
| Study | Who was studied | What it found |
|---|---|---|
| Finnish trial, 2 years [15] | 180 shoulders with nontraumatic supraspinatus tears, randomized to physiotherapy alone, acromioplasty with physiotherapy, or repair | Shoulder scores improved in all three groups; repaired tears were smaller on follow-up imaging (4.2 mm vs 11.0 mm) |
| Finnish trial, about 6 years [16] | 150 shoulders, patients older than 55 | Shoulder scores in all three groups remained improved from baseline at an average of 6.2 years |
| Norwegian trial, 15 years [17] | 103 patients with full-thickness tears up to 3 cm | Primary repair gave better shoulder scores and less pain than physiotherapy; in tears treated by physiotherapy alone, average tear size grew from 16.2 to 31.6 mm |
The Finnish authors concluded that conservative care is a reasonable first treatment for isolated, nontraumatic supraspinatus tears in older patients15,16. The Norwegian trial, with the longest follow-up, supports repair as the first treatment for small-to-medium tears17.
Platelet-rich plasma (PRP) has been studied both as an injection on its own and as an add-on during surgical repair.
As an injection, compared with cortisone. A 2026 meta-analysis of 10 randomized trials with 591 adults who had rotator cuff tendinopathy or partial tears compared PRP injections with cortisone (corticosteroid) injections18. At six months, patients treated with PRP had better shoulder scores (10.8 points higher on the American Shoulder and Elbow Surgeons score and 10.7 points higher on the Constant-Murley score) and less pain, and PRP was associated with fewer adverse events18. The authors concluded that PRP may be a more durable treatment option for rotator cuff tendinopathy18.
Added during surgery. A 2022 review of 13 meta-analyses covering 1,800 patients, with follow-up of 12 to 36 months, found that using PRP during arthroscopic rotator cuff repair led to fewer re-tears, better short-term scores after surgery and better function compared with control groups, and pain scores showed short-term pain relief3. The authors concluded that PRP is effective in reducing re-tears after rotator cuff repair, improving function scores and reducing short-term pain3.
The rotator cuff studies of stem cells described here used cells taken from bone marrow4,5.
At our practice, physical therapy comes first. PRP, BMAC or the two combined may be considered when it has not worked. Not every patient is a candidate, and candidacy is decided at a consultation before any financial commitment. Orthobiologic procedures are performed at the Pueblo Surgery Center, a free-standing, AAAHC-accredited outpatient facility at the same address as the office. For BMAC, the marrow is drawn, processed and delivered in one visit, with light anesthesia so there is no discomfort during the harvest.
AAOS advises that chronic shoulder and arm pain are good reasons to see a doctor, and that continuing to use a torn shoulder despite increasing pain can cause further damage1.
Patients outside the area can have the first consultation and follow-ups by telemedicine, with imaging sent by email. If you are in the Santa Barbara area, Dr. Scheinberg can examine your shoulder, review any imaging and talk through the options. See shoulder care or call (805) 682-1394.
Short answers to the questions patients ask most.
Have a question about your own situation?
Call (805) 682-1394Expect several months. The arm is usually in a sling for 4 to 6 weeks, and most patients have functional motion and adequate strength by 4 to 6 months after surgery14.
Studies have found benefits. PRP injections gave better shoulder scores and less pain than cortisone at six months18, adding PRP or bone marrow concentrate to surgical repair was linked with fewer re-tears3,4, and bone marrow concentrate with platelet products improved pain and function more than a home exercise program5.
Reviewed by Dr. Richard Scheinberg, MD, a board-certified orthopedic surgeon in Santa Barbara with 40 years of surgical experience.
