Many rotator cuff tears calm down with a focused therapy programme, but some are better served by early repair—especially after trauma, in larger tears, or when pain and weakness simply won’t let go.
What is a rotator cuff tear?
Your rotator cuff is a group of four muscles and tendons that help lift and rotate your arm and keep the ball of the shoulder securely centred in the socket:
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
A rotator cuff tear happens when part (partial-thickness) or all (full-thickness) of one of these tendons pulls away from the bone at the top of your arm (humerus). Most tears involve the supraspinatus, but several tendons can be involved at once.
Tears may be:
- Degenerative – from years of overhead work, sports, or simply “miles on the shoulder”
- Traumatic – after a fall, heavy lift, or sudden jerking injury
Some people notice sharp pain and weakness overnight. Others develop a slow, nagging ache that interferes with sleep and activities over months.
When physical therapy is the right first step
For many patients, especially with smaller or degenerative tears, a structured non-operative plan is the safest and most effective starting point.
What “good therapy” looks like
Non-operative care usually combines:
- Activity modification for a period (limiting heavy, overhead or repetitive activities)
- Anti-inflammatory strategies (ice, short-term medications if appropriate)
- A targeted physical therapy programme to:
- Strengthen the remaining rotator cuff and scapular (shoulder blade) muscles
- Improve posture and shoulder mechanics
- Restore comfortable range of motion
Studies suggest that around three-quarters of patients can achieve good pain relief and functional improvement with non-operative treatment, especially for smaller or degenerative tears.
Signs your tear may respond well to therapy
You are often a good candidate for a “therapy-first” plan if:
- Your pain is mainly with overhead use, not constant at rest
- You can still lift your arm overhead (even if it hurts)
- Your tear is partial-thickness or small to medium in size
- The tear developed gradually rather than from a single major injury
- Your daily demands are moderate (for example, desk work or light manual work)
In this setting, Dr Lawyer will usually recommend a dedicated trial of therapy, often in the range of 6–12 weeks, before you make decisions about surgery—unless there are clear red flags that push the decision toward earlier repair.
When rotator cuff repair is the better option
There are times when continuing to “wait and see” does not serve your shoulder well. Research shows that, for some full-thickness tears, non-operative care can fail and tears may progress in size over time, especially in older patients or in those with larger tears.
Situations where surgery often comes up early
Dr Lawyer is more likely to discuss early rotator cuff repair if you have:
- A traumatic tear with sudden loss of strength
- For example, a fall or heavy lift where you suddenly cannot raise the arm at all
- A large or full-thickness tear (commonly >3 cm) on imaging
- Marked weakness that interferes with everyday tasks (reaching a shelf, lifting a kettle, dressing)
- Ongoing night pain that repeatedly wakes you despite a proper therapy programme
- Failure of focused non-operative care over several months
- High-demand overhead or throwing sports where strength and endurance at the extremes of motion are essential
In these patients, surgery is not “the easy way out.” It is a structural solution aimed at re-attaching the tendon and protecting the joint for the long term.
Grey-zone cases: Therapy first, then re-evaluate
Many people fall in the middle:
- Middle-aged, active, with a degenerative tear
- Some pain, some weakness, but not a completely non-functional arm
In this group, Dr Lawyer typically:
- Starts with a well-designed therapy block, not just general “shoulder exercises.”
- Re-checks pain, strength, sleep, and function after a defined period.
- Reviews imaging again, looking for any change in tear size or tendon quality.
If you are clearly improving, you may stay the course with therapy and maintenance exercises. If you plateau or decline, surgery moves higher on the list of options.
What does rotator cuff repair involve?
Rotator cuff repair is usually performed arthroscopically—through a few small incisions with a camera and specialised instruments.
During surgery, Dr Lawyer will:
- Inspect the entire shoulder, including cartilage, biceps tendon, and labrum
- Clean out inflamed tissue and any bone spurs that are compressing the cuff
- Mobilise the torn tendon back toward its normal footprint on the bone
- Secure the tendon with anchors and sutures so it can heal down again
Partial tears may need only smoothing (debridement) or a smaller repair, while larger, retracted tears require more extensive work.
Recovery timelines: Therapy vs repair
Every shoulder heals on its own timeline, but you can think in ranges.
If you treat your tear with therapy alone
- First 6–12 weeks:
- Focus on pain control, mobility, and early strengthening
- Many people notice sleep improving and daily tasks feeling easier
- 3–6 months:
- Continued strength gains and better endurance
- Return toward normal work and recreational activities
- Beyond 6 months:
- Maintenance home exercise programme is key to keeping symptoms quiet and preventing flare-ups
Some patients do so well that surgery is never needed. Others reach a “ceiling” where pain or weakness remains limiting, and that’s when repair comes back into the conversation.
If you choose rotator cuff repair
Broadly:
- 0–6 weeks:
- Arm in a sling most of the time
- Passive motion only (your therapist or the other hand moves the arm; the repaired tendon rests)
- 6–12 weeks:
- Active motion begins (you start lifting your own arm)
- Gradual return to light activities at waist level and chest height
- 3–6 months:
- Progressive strengthening and endurance work
- Many people can return to desk work within weeks and to lighter sports or hobbies around 4–6 months, depending on the tear size and job demands
- 6–12+ months:
- Continued strength gains, especially for larger tears
- Return to heavy lifting or overhead sport can take most of this period
Most patients can expect meaningful improvement in pain and function, especially for small and medium tears, but it is important to understand that this is a long recovery and the shoulder continues to mature well beyond the 3-month mark.
Benefits and risks: Therapy vs surgery
Benefits of a therapy-first approach
- No surgical risk or anaesthesia
- Faster early recovery and fewer short-term activity restrictions
- You can always choose surgery later if symptoms persist
Risks / trade-offs:
- Tear size and muscle quality may worsen over time in some patients
- Persistent pain or weakness despite a full trial of rehab
- Higher likelihood of needing to modify certain sports or jobs long-term
Benefits of rotator cuff repair
- Addresses the structural problem by re-attaching the tendon
- Better average pain and function scores than non-operative care at 1–2 years in many studies (although the difference is often modest)
- May protect the joint in the long term for selected patients, especially after acute traumatic tears
Risks / trade-offs:
- Surgical and anaesthetic risks (bleeding, infection, stiffness, nerve injury—fortunately uncommon)
- Long recovery period with strict sling use and activity limits
- Re-tear is possible, particularly in larger or degenerative tears
Dr Lawyer will walk through these options in the context of your age, tendon quality, health, job, and sport, rather than assuming the same plan fits everyone.
How Dr Tracye Lawyer helps you decide
As a fellowship-trained orthopaedic sports medicine surgeon and former elite multi-sport athlete, Dr Lawyer has sat on both sides of the exam table. On your first visit, you can expect her to:
- Listen carefully to what matters most—sleep, work, lifting grandkids, or getting back to sport
- Examine how your shoulder moves, not just what the MRI report says
- Explain imaging in clear terms, including which tendons are torn and how severely
- Outline both non-operative and surgical paths, with realistic timelines for each
- Help you decide whether it makes sense to start with an intensive therapy block, move more quickly to surgery, or re-evaluate after a set period
You are not “signing up” for surgery just by booking a consultation; you are signing up for a clear plan.
When to schedule a shoulder evaluation
Consider seeing Dr Lawyer if you have:
- Shoulder pain lasting more than 4–6 weeks despite rest and simple measures
- Night pain that repeatedly wakes you
- Trouble lifting your arm overhead or out to the side
- Weakness that interferes with your job or sport
- A fall or injury with sudden loss of shoulder function
Early evaluation does not force you toward surgery—but it does give you more options.
Trusted external resource
Many patients appreciate the American Academy of Orthopaedic Surgeons’ patient guide on Rotator Cuff Tears (OrthoInfo) for additional background.
Also see Catalyst Orthopaedic & Sports Medicine
Rotator Cuff Tear FAQs
How do I know if I’ve torn my rotator cuff or just “pulled a muscle”?
A muscle strain usually settles over days to a couple of weeks. Rotator cuff tears often cause ongoing pain, weakness when lifting the arm, and difficulty sleeping on that side. Imaging (ultrasound or MRI) is helpful to confirm the diagnosis and size of the tear.
Can a rotator cuff tear heal on its own without surgery?
The tendon itself typically does not “grow back” to the bone once fully detached, but many people feel and function much better when the surrounding muscles are strengthened and inflammation is controlled. The goal of therapy is to help the shoulder work well in spite of the tear.
Am I too old for rotator cuff surgery?
Age alone does not decide the plan. Some active patients in their 60s and 70s do very well after repair; others do best with focused non-operative care. Tendon quality, bone quality, overall health, and goals matter more than the number on your birthday cake.
If I try therapy first, will I ruin my chances of a good surgical result later?
A well-designed therapy trial over a few months is very reasonable for many tears. In some cases, particularly large or acute tears, delaying surgery for too long may make repair more difficult, which is why Dr Lawyer looks closely at your imaging and monitors your progress.
How long until I can get back to sport after rotator cuff repair?
It depends on your sport and the size of your tear, but many patients return to recreational sport around 4–6 months, with heavier overhead sports sometimes taking closer to 6–12 months. The goal is a safe return, not a rushed one.
Important note
This article is for general education only and is not a substitute for personalised medical advice. Diagnosis and treatment decisions should always be made in direct consultation with a qualified orthopaedic surgeon who knows your full history and has examined your shoulder.
