Rotator Cuff Tear

A rotator cuff tear primarily affects the middle and older age group, and can be injured in an acute event like fall or accident.

The rotator cuff tear is more commonly a chronic phenomenon in which the tear happens over the span of many years gradually progressing from a partial tear to a complete tear. These tears are usually caused due to bone spurs or osteophytes present on the undersurface of Acromion or the Acromioclavicular joint.

These bone spurs are formed because to aging as well as due to overuse of the shoulder due to daily activities or recreational activities like racquet sports, swimming, volleyball, painting etc. There may be periods of exacerbation or acute on chronic injury which may accelerate or cause completion of the tear leading to acute type of presentation.

MRI of the shoulder joint

MRI of the shoulder joint

The tear may involve one or more of the tendons of the rotator cuff.  Most common tendon to be involved in a rotator cuff tear is a supraspinatus tendon and infraspinatus tendon. Deficiency of rotator cuff can cause compromise in elevation as well as rotation movements and may present in the form of weakness.


Patients with rotator cuff tear most commonly present with chronic pain in the side and front of the shoulder which is exacerbated with movement, especially overhead elevation as well as rotation.  These patients may also complain of nighttime pain, discomfort and awakenings.  The patient may also complain of weakness and loss of function in the arm, in the shoulder joint.  Occasionally, the patient may complain of numbness and tingling associated with pain.

In patients who present with chronic rotator cuff tear, may complain of off and on gradually worsening shoulder pain from many months to years and patients with acute presentation, patient may inform of an accidental injury with sudden onset of pain and weakness.  Occasionally, the patient may present with sudden onset of complete loss of function in the arm when it is also named as pseudoparalysis.  Acute rotator cuff tears are essentially found in younger population.  Patients with chronic rotator cuff tear may occasional present without any pain, though will complain of weakness and loss of function.

The diagnosis of rotator cuff tear is usually suggested by certain tests that are done by the physician in the office.  The tear can be confirmed with the help of advanced imaging and x-rays usually performed to rule out any bony injury as well as to look for bone spurs or osteophytes which are common under the acromion and over the acromioclavicular joint.

Confirmation of diagnosis can be done with MRI.  The tear in chronic setting is usually caused due to bone spurs or osteophytes which are present on the undersurface of the acromion and over the acromioclavicular joint.  These osteophytes cause reduction in space for the rotator cuff to move as well as cause impingement on digging in to the tendon leading to inflammation and partial tear and subsequently complete tear of the tendon.  An MRI can help find the tear and the muscle involved as well as help in grading the tear to be partial, high grade partial or complete or only inflammation of the tendon cause tendinitis.


A rotator cuff tear may occasionally be confused with certain other conditions like acromioclavicular arthritis, impingement syndrome, cervical radiculopathy, fibromyalgia, shoulder dyskinesis, elbow pathologies like lateral or medial epicondylitis, and many more.



Once the diagnosis is suggested or confirmed by physical examination and MRI, there are multiple options for the treatment of a rotator cuff tear.
Rotator cuff tendinitis without a tear can be usually treated with rest and anti-inflammatory medications, heat or cold compresses and with the possible use of cortisone injection in the subacromial area to decrease the inflammation.  The patient can also be sent for physical therapy rehabilitation.  It takes around 2 to 4 weeks to recover from rotator cuff tendinitis.

Occasionally, there can be a recurring problem and patient may need to have cortisone injections after 3 months.  It is relatively safe to get 3 to 4 cortisone injections for a year at a difference of 3 or more months between the two shots.  In patients with partial rotator cuff tear, patients are initially treated conservatively with anti-inflammatory medications, avoidance of activity which aggravate the pain, cortisone injection and physical therapy.

Patients with rotator cuff tear are surgical candidate though conservative treatment can be tried before going for surgery. Patients who do not improve or who have recurrence with deterioration of symptoms are suggestive of surgical option.  Patients who are smokers are asked to quit smoking and avoid nicotine in any form for good healing of the cuff.


Surgical treatment of a rotator cuff tear involves arthroscopic examination of the shoulder joint through small incisions.  This surgery is usually performed on an outpatient basis. Patient is usually given a shoulder nerve block prior to the surgery. This block helps in pain relief during the surgery and for the next day after the surgery.

The patient also given general anesthesia during the surgery. Patients are placed in lateral position with supports. The shoulder joint and the rotator cuff is examined using arthroscope through small incisions. If a tear is found in the rotator cuff, it is repaired using sutures and anchors through small incisions.

The bone spurs from the acromion as well as the acromioclavicular joint if present are excised and the bone smoothened to prevent recurrence. Occasionally patient may have fraying or tearing of the biceps tendon which may need to be fixed too. Patients are given antibiotics to cover for the risk of infection in the perioperative duration.


Patients are treated in a specialized elbow sling postoperatively. Immediately after the surgery, the patients are instructed not the use the operated extremity and keep it in sling except for shower and exercises as instructed.  The patients are provided with medications in the hospital as well as for home to take care of pain.  Patient may observe bruising of their arm up to the elbow or even up to the wrist after the surgery.

This is due to trickling of the blood from the surgical site along the gravity. Incisions need to be kept clean and dry.  The patients are instructed to avoid bath and hot tubs, swimming, heavy lifting, driving and smoking.  The patients can take shower and remove the dressings after 72 hours from surgery and replace it with dry dressing.  The patients are advised to eat healthy and nutritious diet with lot of fibers.

The patients are also instructed to use over-the-counter laxatives for constipation that may develop due to pain medications.  Patients are usually seen in office in 7-10 days after the surgery. They are sent for Physical Therapy at an appropriate time after the surgery for quicker recovery after the surgery to regain full range of motion and strength. Time of start of Physical Therapy is dependent on the size of the tear, surgery performed as well as many other factors.

Rotator cuff repair usually takes about 12 weeks to heal completely, but it could take more time to regain full range of motion and strength and may vary from patient to patient. Patient may have difficulty sleeping in bed immediately after the surgery and are suggested to use recliners or multiple pillows to make themselves comfortable.  It may take one to three months for the patient to get comfortable in bed after the rotator cuff repair surgery.


Patients with rotator cuff tendinitis and partial tear as well as patient with full tear, but who do not prefer to undergo surgery are sent for physical therapy to strengthen their muscles as well as regain range of motion.  Specific exercises to strengthen the rotator cuff muscles is performed under supervision as well as with home-based exercise program.  The patients who undergo surgical management and repair of rotator cuff are also enrolled in physical therapy starting from 1 to 4 weeks after the surgery. Time of start of Physical Therapy is dependent on the size of the tear, surgery performed as well as many other factors.

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Larger rotator cuff tears are usually kept in sling for a month before the physical therapy is started.  Patients who are smokers are asked to quit smoking and avoid nicotine in any form for good healing of the cuff.  If the patient continue to smoke after the surgery, then the chances of failure are high.

Patients who have smaller tear are put into rehabilitation program early and have quicker recovery.  It may take 3 to 6 months for complete recovery of rotator cuff repair.  Once fully recovered, the patient will regain full range of motion and strength so as to return back to normal activities of daily living as well as recreation.


Complications are not common but can occur. It is pertinent that patients understand prior to making the decision of have this operation so you can make an informed decision on the advantages and disadvantages of surgery. These can be:

Medical (Anesthetic) complications:

Medical complications include those due to your general wellbeing and due to Anaesthesia given before and during the surgery. These include but not limited to:

Allergic reactions to medications, excessive blood loss requiring transfusion with its low risk of disease transmission, heart attack, stroke, kidney failure, pneumonia, bladder infections. Complications from nerve blocks such as infection or nerve damage. Serious medical problems can lead to ongoing health concerns, prolonged hospitalization.

 Surgical Complications:

Risks of Rotator cuff repair surgery may include though not limited to:

  • Infection – Patient may need to be administered prolonged antibiotics or even undergo cleaning surgery. Results are usually suboptimal in this population group.
  • Deltoid detachment –This is a complication after an open repair and unusual to happen after an arthroscopic repair
  • Stiffness – Despite physical therapy and patient motivation, stiffness may occur. It is treated with Physical therapy. Recalcitrant shoulder stiffness may require capsular release to regain range of motion.
  • Tendon re-tear.There is a chance for re-tear following all types of repairs. The larger the tear, the higher the risk of re-tear. Smokers and patient with systemic diseases are at a higher risk for re-tear. Repeat surgery is needed only if there is severe pain or loss of function.
  • Tingling and numbness
  • Damage to nerves or vessels
  • Hardware problems
  • Residual pain
  • Reflex Sympathetic Dystrophy

Some of these conditions may require hospitalization, aspiration, injections or even surgery

Factors leading to likelihood of suboptimal recovery after a rotator cuff repair:

  • Poor tendon/tissue quality
  • Previous failed surgeries
  • Large or massive tears
  • Poor patient compliance with rehabilitation and Physical Therapy
  • Older than 65 years group
  • Smoking and use of other nicotine products
  • Workers’ compensation claims
  • Postoperative infection

Certain patient population is at a higher risk for complication which include but are not limited to:

  • Smoking
  • Seizures
  • Obstructive sleep apnea
  • Obesity
  • High blood pressure
  • Diabetes
  • Other medical conditions involving your heart, lungs or kidneys
  • Medications, such as aspirin, that can increase bleeding
  • History of heavy alcohol use
  • Drug allergies
  • History of adverse reactions to anesthesia


  • Suspected cardiac problem: severe chest pain or pressure, shortness of breath, tightness in chest, pain in left arm, jaw pain, dizziness or fainting, unexplained weakness or fatigue, rapid or irregular pulse, sweating, cool, clammy skin, and/or paleness
  • Suspected Stroke: trouble speaking, changes in vision, confusion or other change in mental status
  • Suspected venous thrombosis: swelling of the legs, ankles, or feet, discomfort, heaviness, pain, aching, throbbing, itching, or warmth in the legs, sudden shortness of breath, chest pain, coughing up blood, rapid or irregular heart rate
  • Suspected Sepsis: high grade fever, with shivers associated with fatigue, dizziness, racing heart, pale or discolored skin, sleepy, difficult to rouse, confused, short of breath
  • Heavy bleeding from the surgical site
  • Severe allergic reaction with trouble breathing, swelling, hives


  • temperature more than 101 degrees Fahrenheit
  • increased pain or tenderness near the incision
  • poor pain relief
  • signs of infection: increased swelling, redness, increased drainage, increased warmth, pus, foul smell, bleeding at the incision, incision coming apart
  • inability to feel or move fingers or toes
  • pale blue, white or abnormally cold fingers or toes
  • nausea (upset stomach) or vomiting (throwing up) that won’t stop
  • increased tiredness
  • a generally worse feeling than you had when you left the hospital
  • problems urinating, severe constipation or severe diarrhea
  • a concern about any other symptoms that seem unusual


Rotator cuff pathologies are common and usually present with pain and weakness in overhead activities as well as in rotation.  Physical examination as well as MRI can be helpful in diagnosis of pathology.  Impingement syndrome, rotator cuff tendinitis and partial tears are usually treated conservatively.

Patients who fail conservative treatment as well as in patients who have complete rotator cuff tear usually need surgical treatment in the form of arthroscopic surgery and repair. The results of arthroscopic surgeries are good and reliable.

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Based on 115 reviews
Dr. Karlkare and his staff were excellent. Dr. Karkare explained everything clearly and took his time getting to know my Dad.
Anna Acker
22:46 07 Sep 23
Dr Vedant Vaksha had done emergency surgery in 2020 after a traumatic injury.His office at Complete Orthopedics handled the continued care thereafter.Dr V and his staff had been Professional and friendly throughout the process, taking the time to explain all the questions on how to proceed and what to expect.Whenever I needed to speak with Dr V or the office they were a phone call away, without waiting or calling several numbers like in so many other medical offices.The office was accommodating to scheduling to my needs at all times. Dr Vedant Vaksha earned the following5 out of 5 stars, highly recommended.
John Kuey
20:58 05 Sep 23
Dr. Vaksha helped me recover from an injury. I am very thankful that he took the time to explain the best treatment for my injury. Also thankful for the wonderful office staff!
Joseph Castelli
22:30 02 Aug 23
The office is wonderful!… Dr Paresh was very helpful and attentive and made my sister in laws recovery so much better.. Thank you for everything
Jazz Lorenzo
17:48 14 Jul 23
The ladies are very welcoming, the service is great, the doctor is very professional and caring and the building is super clean. I really like to come here, the atmosphere is very friendly... Come and you will love it too.
Joan Carasco
14:41 30 Jun 23
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.