Treatment for a torn rotator cuff falls into four groups: physical therapy and exercise, injections for pain, surgery to repair the tendon, and, for large tears that cannot be repaired, other operations such as a reverse shoulder replacement. Which one suits you depends on how the tear happened, its size, your age, your strength and what your shoulder needs to do. Many people start with physical therapy. Some tears are better seen by a surgeon early.
This page sets the options side by side for a clearer conversation with your doctor or surgeon. It does not choose for you. That choice is made with someone who has examined your shoulder and seen your scan.
Key takeaways
- The main options: physical therapy, injections, surgical repair, and other operations for tears that cannot be repaired.
- How it happened matters: gradual, age-related tears are often treated first with physical therapy; sudden tears after an injury in active people are often assessed for repair early.
- Injections: cortisone can ease pain for weeks to a few months but does not heal the tendon.
- After a repair: a sling for about 4 to 6 weeks, and full recovery often takes 6 to 12 months.
Where are you right now?
- Just diagnosed: start with “Four words that change the options” and the comparison table.
- Weeks into physical therapy and not settling: go to “If it isn’t going to plan” and the questions for your surgeon.
- After surgery: rotator cuff surgery recovery sets out the stages. Your surgeon’s protocol comes first.
- Getting back to work or sport: the “When can I…” table compares ranges with and without surgery.
Four words that change the options
- Partial-thickness: the tendon is frayed part way through. Usually treated without surgery first.
- Full-thickness: a hole through the tendon. Many are still managed without surgery, but some grow, so size and strength are watched.
- Degenerative: wear over years with no single injury. Common after 50.
- Traumatic: one clear event, such as a fall or catching a heavy load, then sudden weakness.
Timing matters most for traumatic tears in active people. Over months, the torn end can pull back and the muscle can waste, which makes a later repair harder. That is why these tears are usually seen by a surgeon within weeks.
The options
Physical therapy and exercise
A torn tendon rarely grows back onto the bone by itself, so the aim is to strengthen the rest of the cuff, the deltoid and the shoulder blade muscles until they share the load. Torn rotator cuff without surgery covers this route week by week, and rotator cuff strengthening exercises sets out a staged program. In trials of people over about 55 with smaller, non-injury tears, physical therapy alone often gave results close to surgery over several years.
Injections
A cortisone injection above the tendon can calm pain enough to sleep and exercise. The number is usually limited, because repeated steroid may weaken tendon tissue. A cortisone shot in the shoulder explains how to use the window it gives. Platelet-rich plasma (PRP) is sometimes offered; the evidence for cuff tears is mixed.
Surgical repair
Keyhole surgery stitches the tendon back to the bone with small anchors, and the tendon then takes months to grow back on. Re-tears are more common with larger tears, older age and poorer tendon quality, so ask about your own chances. Preparing for rotator cuff surgery covers what to set up before.
When a tear cannot be repaired
Some long-standing tears have pulled back too far, or the muscle has wasted too much, to stitch back. Many people still keep useful movement by training the front of the deltoid. Surgical options include a partial repair or clean-up, aimed mainly at pain; a graft or tendon transfer, usually for younger people without arthritis; and a reverse shoulder replacement, where the ball and socket are swapped so the deltoid lifts the arm. Shoulder replacement recovery covers the months after.
The options compared
| Option | Who it usually suits | Typical timeline | What it involves |
|---|---|---|---|
| Physical therapy | Partial and degenerative tears; people who can still lift the arm | Change often in 6 to 12 weeks; gains for 3 to 6 months | Graded strengthening 2 to 4 times a week |
| Cortisone injection | Pain that blocks sleep or exercise | Relief, if it works, often lasts weeks to a few months | One injection above the tendon; number usually limited |
| Surgical repair | Traumatic tears in active people; tears not improving after about 3 months of physical therapy; growing tears | Sling about 4 to 6 weeks; full recovery often 6 to 12 months | Keyhole reattachment of the tendon, then staged rehabilitation |
| Partial repair, graft or tendon transfer | Large tears that cannot be fully repaired, usually without arthritis | Often 6 to 12 months | Closing part of the tear, covering it, or moving a working tendon |
| Reverse shoulder replacement | Usually older adults with a large tear plus arthritis, or an arm that cannot be lifted | Sling about 6 weeks; recovery often 6 to 12 months | A new joint that lets the deltoid lift the arm |
Month by month: how the decision usually unfolds
- Weeks 0 to 6: diagnosis and a start on physical therapy. Sudden weakness after an injury usually gets a surgical opinion now.
- Weeks 6 to 12: progress is reviewed. An injection is sometimes discussed if pain blocks the exercises.
- Months 3 to 6: if pain and weakness have not clearly improved, surgery is usually discussed.
The tear on the scan is one half of the decision. What your shoulder needs to do is the other.
Where else this could be coming from
- Subacromial pain: shoulder impingement gives a painful arc, but strength is usually close to normal.
- A stiff joint: with frozen shoulder, the arm stays stiff even when someone else moves it.
- The neck: pain past the elbow, tingling, or pain that changes with neck movement points toward the neck.
Is this normal?
- “I was told to try physical therapy first.” A standard first step for degenerative tears. It does not rule out surgery later.
- “I was offered surgery straight away.” Common for traumatic tears in active people, because repair is usually easier while the tendon is close to the bone.
- “Will the tear get bigger while I wait?” Some degenerative tears grow over years; many do not. Strength checks or a repeat scan show which.
If it isn’t going to plan
It is month three. You still reach across with your other hand to pull the seatbelt down, and the thought in your head is that you have done the physical therapy, so surgery must be all that is left.
Sometimes that is true. Often, though, the load never rose enough to build strength. An exercise that felt easy in week two needs to be heavier by week ten, and a program that stayed at the same light band has not really been tested. If you are 3 months in with little change, get assessed by a physical therapist or shoulder surgeon, and ask whether your program was progressed enough.
Questions to ask your surgeon
- The tear: is it partial or full-thickness, how large, and how far has it pulled back?
- Repair: can it be repaired, and how healthy is the muscle on the scan?
- Waiting: what would 3 more months of physical therapy risk or gain for me?
- Recovery: how long in a sling, off work and unable to drive?
- Re-tear: what is my chance of the repair not holding, and what then?
When can I…
| Activity | Without surgery | After a repair |
|---|---|---|
| Sleep on that side | Often 6 to 12 weeks | Often 3 months or more |
| Drive | Usually early, if you can steer safely | Often 6 to 8 weeks or later |
| Reach overhead | Gradually over 3 to 6 months | Unloaded often from about 3 months |
| Lift | Heavier lifting often 3 to 6 months | Heavier lifting often 4 to 6 months |
| Desk work | Usually throughout | Often 2 to 4 weeks, one-handed |
| Manual work or sport | Often 3 to 6 months | Often 6 to 12 months |
If you have had surgery, your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Chest symptoms: shoulder pain, especially on the left, comes with chest pain or pressure, breathlessness or sweating.
- After a fall: the shoulder looks out of shape, or the arm or hand turns cold, pale or numb.
See a doctor today if
- Sudden weakness: you could lift the arm before a fall, heavy lift or sharp pull, and now you cannot.
- Hot, swollen shoulder: the joint is red, hot or swollen, or you have a fever, especially after an injection or surgery.
Get it checked soon if
- Growing weakness: the arm gets weaker over weeks, or drops when held out to the side.
- No progress: no clear improvement after 6 to 8 weeks of physical therapy.
- A new pop: a painful pop with new weakness, months into recovery.
More on this area: shoulder conditions.
The right treatment for a torn rotator cuff fits your tear, your shoulder and your life, and it is chosen with someone who has examined you.
Written by Louise Yow, Neck & Shoulder Physio.