Rotator Cuff Tears

Rotator cuff tears produce a recognizable pattern of symptoms, though presentation varies by tear type, size, and acuity. Common findings include:

• Shoulder pain that is deep, aching, and located over the outer arm or deltoid — often worse at night and with overhead activity
• Weakness with lifting the arm, reaching overhead, or rotating the shoulder outward
• A painful arc of motion — pain that is worst between approximately 60° and 120° of shoulder elevation
• Difficulty with specific tasks such as reaching behind the back, brushing hair, or putting on a coat
• A sudden, sharp pain with an audible pop in the case of an acute traumatic tear
• Sleep disturbance — inability to lie on the affected shoulder is an extremely common complaint
• Clicking or catching sensations with shoulder movement

Symptoms that persist beyond 4–6 weeks despite rest and anti-inflammatory medications warrant orthopedic evaluation. Call us at (301) 515-0900. Same-day appointments are available for acute shoulder injuries.

Diagnosis begins with a detailed history of your symptoms, mechanism of injury, and functional limitations, followed by a focused physical examination. Your physician will assess range of motion, strength, and tenderness, and perform several validated clinical tests:

• Jobe test (empty can test): The most sensitive test for supraspinatus tears, with sensitivity of approximately 88% and specificity of 62%
• External rotation lag sign and Hornblower sign: Highly specific for infraspinatus and teres minor tears; the Hornblower sign is particularly reliable for posterior cuff deficiency
• Lift-off and belly-press tests: Assess subscapularis integrity
• Impingement signs: Evaluate for concomitant subacromial impingement

In-office X-rays are obtained at your first visit to evaluate for acromial morphology, calcific deposits, glenohumeral arthritis, and superior humeral head migration. The latter is a hallmark of chronic massive cuff deficiency. MRI is the definitive imaging modality: it provides 93% sensitivity and 99% specificity for full-thickness tears and allows detailed assessment of tear size, tendon retraction, and the degree of muscle atrophy and fatty infiltration. These factors directly influence surgical planning and prognosis. Ultrasound is a useful dynamic, lower-cost alternative for diagnosis of full-thickness tears and is increasingly used in the office setting.

Most patients leave their first appointment with a clear diagnosis and a tailored treatment plan.

Rotator cuff repair recovery follows a predictable progression, though the timeline varies significantly based on tear size and tissue quality. Patience during the healing phase is essential. The repaired tendon undergoes a biological incorporation process that takes 3–6 months to achieve structural integrity.

General milestones:

• 0–4 weeks: Sling immobilization to protect the repair; pendulum exercises and passive range of motion only. For large and massive tears, strict immobilization for 6 weeks is sometimes required.
• 6–8 weeks: Progressive passive and active-assisted range of motion; isometric strengthening
• 2–4 months: Progressive strengthening; most patients achieve functional range of motion by 3-4 minths
• 4–6 months: return to light overhead and recreational activity
• 6–12 months: Full return to sport and demanding overhead activity; overhead athletes (pitchers, swimmers, tennis players) typically require 9–12 months

Return to sport after arthroscopic rotator cuff repair has been reported in approximately 75% of athletes within an average of 6–7 months, with competitive overhead athletes requiring longer timelines. Outcomes are most favorable when repair is performed before significant muscle atrophy or fatty infiltration has developed. This is a strong argument for timely surgical evaluation when non-operative management is failing.

Our in-house physical therapy team at all three MOS locations manages your rehabilitation from the first post-operative visit through your return to full activity.