A full-thickness rotator cuff tear extends through the entire depth of a rotator cuff tendon, creating a defect that reaches from one surface of the tendon to the other. The tear may involve only part of the tendon’s width or a larger portion of its attachment to the bone. Full-thickness rotator cuff tear treatment can involve non-surgical management or arthroscopic repair, depending on factors such as tear size and chronicity, tendon quality, symptoms, activity level, and functional goals. Michael J. Bercik Jr., MD, a full thickness rotator cuff tear surgeon, evaluates and treats these types of tears at his offices in Lancaster, Ephrata, and Mount Joy, Pennsylvania, using arthroscopic double-row repair techniques for patients who are appropriate surgical candidates.

What Makes a Tear Full-Thickness?

The rotator cuff is a group of four tendons that attach the shoulder blade to the upper arm bone (humeral head) and control shoulder movement and stability of the shoulder joint. A full-thickness tear, sometimes called a complete tear, occurs when one of these tendons, most often the supraspinatus tendon, is torn all the way through, creating a hole or split that fully separates the tendon from its attachment on the bone.

This is different from partial rotator cuff tears, where damaged tendon fibers remain connected to the bone by a bridge of intact tissue. Full-thickness rotator cuff tears generally do not restore their normal tendon-to-bone attachment on their own, although symptoms and shoulder function may improve with nonsurgical treatment such as a physical therapy program or oral pain medications in some patients. Tear size is described in centimeters, ranging from small tears under 1 centimeter to massive rotator cuff tears involving more than 5 centimeters or multiple tendons, which can lead to muscle atrophy and tendon retracts.

Acute Traumatic vs. Chronic Degenerative Tears

Full-thickness rotator cuff tears generally fall into two categories, and the distinction affects both symptoms and treatment planning.

  • Acute traumatic tears: Happen suddenly, often from a fall onto an outstretched arm, a forceful pull while lifting, or a shoulder dislocation, which is a common lifting injury. These tears tend to cause immediate, sharp shoulder pain and noticeable weakness, and they are more common in younger, active patients with otherwise healthy tendon tissue. Acute rotator cuff tears should ideally be repaired within one month to optimize tendon healing and reduce tear progression.
  • Chronic degenerative tears: Develop gradually as tendon tissue weakens with age, repetitive overhead use, or prolonged impingement between the tendon and the bone above it, often involving bone spurs and subacromial bursitis. Symptoms often build slowly over months or years, with night pain and pain relief difficulty, and by the time a chronic tear becomes full-thickness, the surrounding tendon and muscle may already show some degeneration.

The distinction matters for planning because acute tears in healthy tissue are often more straightforward to repair, while chronic tears with longstanding retraction or muscle changes can be more complex. For a broader look at how these injuries develop and progress, see rotator cuff tears.

Symptoms and Diagnosis of Full-Thickness Torn Rotator Cuff Tendons

Full-thickness tears can cause:

  • Significant weakness when lifting the arm, especially overhead or away from the body
  • Pain that may be sudden and severe after an injury, or a deep ache that has built gradually
  • Pain that disrupts sleep, particularly when lying on the affected shoulder
  • A sensation of the shoulder giving way or an inability to hold the arm up against light resistance
  • A cracking, popping, or catching feeling with certain movements

Because these symptoms can overlap with partial tears, shoulder impingement, and other conditions, a physical exam alone is not always enough to confirm a full-thickness tear. Dr. Bercik, a fellowship-trained shoulder surgeon, typically orders an MRI (magnetic resonance imaging) to evaluate tear size, retraction, and tendon quality, which helps determine whether a tear is likely to be repairable and what approach may apply. Patients noticing sudden arm weakness or an injury that will not improve are encouraged to see a full-thickness rotator cuff tear doctor for evaluation rather than wait to see if symptoms resolve on their own.

Non-surgical vs. Surgical Treatment: How the Decision Is Made

Not every full-thickness tear requires immediate surgery. The decision between non-surgical management and repair depends on several factors that Dr. Bercik reviews individually with each patient:

  • Tear size and the amount of tendon retraction seen on imaging
  • The patient’s age, activity level, and functional goals
  • How long symptoms have been present and how they are affecting daily activities or work
  • The quality of the remaining tendon and muscle tissue
  • Overall health and factors that could affect surgical healing

Lower-demand patients with smaller full-thickness tears and tolerable symptoms may reasonably try physical therapy, activity modification, anti-inflammatory medication, or a corticosteroid injection before considering surgery. However, because full-thickness tears do not heal the tendon back to bone on their own, non-surgical care is generally aimed at managing symptoms rather than closing the tear. Active patients, larger tears, and tears causing significant weakness are more often directed toward arthroscopic repair, since delaying treatment can allow a tear to enlarge or the muscle to weaken further in some cases. Whether repair is appropriate for a specific tear is a decision made by your full-thickness rotator cuff tear doctor after a full evaluation, not from symptoms or imaging alone.

Arthroscopic Double-Row Repair

When surgery is indicated, Dr. Bercik, a board-certified full-thickness rotator cuff tear surgeon, performs arthroscopic rotator cuff repair using small incisions, a camera, and specialized instruments to reattach the torn tendon to bone. For many full-thickness tears, he uses a double-row repair technique, which places two rows of suture anchors, one closer to the joint surface and one farther out on the bone, to secure the tendon across a broader area of its natural attachment footprint rather than at a single line.

Research comparing repair constructs has found that double-row techniques tend to restore more of the tendon’s natural footprint and provide stronger initial fixation than single-anchor-row methods, which may support the healing environment at the tendon-bone interface during rotator cuff repair surgery. Whether a double-row, single-row, or a related transosseous-equivalent technique is used for a given tear depends on tear size, tendon retraction, tissue quality, including supraspinatus tendon condition, and the anatomy found once the joint is visualized during arthroscopic rotator cuff surgery by a skilled full thickness rotator cuff tear specialist.

Rehabilitation: From Sling Immobilization to Full Strength

full thickness rotator cuff tear surgeon

Recovery after arthroscopic rotator cuff repair generally moves through a series of phases, though the pace and specific milestones are set by Dr. Bercik and the physical therapy team based on the individual repair and how healing is progressing.

  • Protection phase: Most patients wear a sling for several weeks (typically for 4 to 6 weeks post-surgery) after surgery to protect the repair while the tendon begins to heal to bone. Only passive motion, movement guided by the therapist rather than the patient’s own muscles, is typically allowed during this early period.
  • Motion phase: As healing progresses, therapy shifts to active-assisted and then active range-of-motion exercises to gradually restore movement without placing excess load on the repair.
  • Strengthening phase: Once adequate motion is regained and the surgical team confirms the repair is healing appropriately, progressive strengthening exercises begin around 8 to 12 weeks post-surgery, to rebuild rotator cuff and surrounding shoulder muscle strength.
  • Return-to-activity phase: Patients work toward the specific demands of their work, sport, or daily activities, with clearance based on strength, motion, and symptom benchmarks rather than a fixed date. Patients should avoid heavy lifting for at least 3 months post-surgery.

This full process commonly spans several months, since tendon-to-bone healing takes time and progressing rehabilitation too quickly can put the repair at risk. Dr. Bercik provides a more specific timeline at follow-up visits based on tear size, repair technique, and each patient’s healing progress.

Long-Term Outcomes and Re-Tear Risk

Arthroscopic repair is intended to reattach the torn tendon and relieve pain and weakness, but as with any tendon repair, healing does not occur in every patient, and re-tear is a possible outcome.

Research on rotator cuff repair has identified several factors associated with a higher likelihood of re-tear, including larger tear size, greater tendon retraction, fatty infiltration of the muscle, and older age at the time of surgery. Repair technique, including the use of arthroscopic repair or open repair, adherence to the rehabilitation program, and overall tissue quality also play a role in how a repair holds up over time.

Surgeons with high surgical volume usually have lower complication rates, and it is essential to ask about a surgeon’s experience with rotator cuff repairs during consultation. Because re-tear risk depends on so many individual factors, Dr. Bercik discusses the likelihood that applies to a specific tear, rather than a general figure, as part of surgical planning. Even when imaging shows a re-tear, many patients still experience improved pain and function compared with before surgery, though outcomes vary from patient to patient.

Risks, Limits, and Treatment Alternatives

Like any orthopedic treatment, both non-surgical care and arthroscopic repair for a full-thickness tear carry limits worth understanding before starting a plan.

Non-surgical management does not close a full-thickness tear, and in some patients, symptoms, tear size, or muscle weakness can progress over time despite therapy, medication, or injections. Corticosteroid injections carry some risk of tendon weakening if used too frequently, which is why Dr. Bercik limits how often they are used.

Arthroscopic repair, like any surgical procedure, carries risks that can include infection, stiffness, nerve injury or blood vessel injury, incomplete healing, re-tear, and the general risks associated with anesthesia. Some tears, particularly large or chronic tears with significant retraction and muscle degeneration, may be only partially repairable or, in select cases, not repairable at all. For patients with irreparable tears or significant additional joint damage, alternative procedures such as tendon transfer or reverse shoulder replacement may be discussed as options outside of standard repair.

Reviewing which of these paths fits a specific tear is best done directly with a full-thickness rotator cuff tear surgeon, which can be arranged through the practice’s contact page, rather than decided from general information alone.

Full-Thickness Rotator Cuff Tear Care in Lancaster, Ephrata, and Mount Joy

Michael J. Bercik Jr., MD, is a board-certified orthopedic surgeon with sub-specialty training in shoulder surgery and orthopedic trauma, including fellowship training focused specifically on shoulder conditions. More detail on his training and background is available on the About page.

As a full-thickness rotator cuff tear specialist whose practice is limited to shoulder conditions, Dr. Bercik’s caseload is built around this one joint rather than general orthopedics. He treats both non-surgical and surgical rotator cuff cases, including partial rotator cuff tears and rotator cuff pathology, so the recommendation for a given tear is not weighted toward one path before an evaluation is complete. Patients are offered detailed consultations with time to review imaging, ask questions, and understand the reasoning behind a recommended plan before deciding how to proceed, including discussion of surgical repair, nerve block options, and surgical technique considerations.

Frequently Asked Questions about Full-Thickness Rotator Cuff Injuries

Only imaging, typically an MRI, combined with a physical exam can confirm whether a tear is partial or full-thickness. Symptoms can overlap between the two, so a full-thickness rotator cuff tear surgeon reviews imaging directly rather than relying on symptoms alone.

The tendon itself does not reattach to bone without surgery once it is fully torn, though some patients manage symptoms adequately with physical therapy, activity changes, and injections. Whether non-surgical management is appropriate depends on tear size, symptoms, and activity demands, which a full-thickness rotator cuff tear specialist reviews individually.

Recovery generally includes several weeks in a sling followed by a structured physical therapy progression through motion and strengthening phases, commonly extending over several months in total. The exact timeline depends on tear size, repair technique, and the patient’s healing progress.

The practice accepts most insurance providers. Coverage for specific services can vary by plan, so patients with questions about their benefits are encouraged to contact the office directly.

Double-row repair uses two rows of suture anchors, placed closer to and farther from the joint, to secure a torn tendon across a wider area of its natural attachment site on the bone, rather than along a single line.

No. The repair technique used depends on tear size, location, tissue quality, and retraction, along with what the surgeon finds once the joint is visualized during the procedure. Some tears may also be only partially repairable, or may be treated with alternative procedures.

Some full-thickness tears remain relatively stable, while others can enlarge or lead to progressive weakness and muscle changes over time. Because this varies by patient, an evaluation helps clarify what watching versus treating a specific tear may mean.

Schedule an Evaluation with a Full-Thickness Rotator Cuff Tear Surgeon

Shoulder weakness or severe pain that has not improved on its own is worth having evaluated, particularly if it followed an injury or is affecting sleep, strength, or the activities that matter to you. Michael J. Bercik Jr., MD, sees patients for full-thickness rotator cuff tear treatment at his offices in Lancaster, Ephrata, and Mount Joy, Pennsylvania. Call 717-560-4200 or request an appointment to schedule an evaluation and review your imaging, symptoms, and treatment options with Dr. Bercik directly.

Michael J Bercik

Medically Reviewed By Michael J. Bercik Jr., MD

Michael J. Bercik Jr., MD, is a board-certified orthopedic surgeon with sub-specialty training in shoulder surgery and orthopedic trauma. He completed his orthopedic surgery residency at the Rothman Institute in Philadelphia and two international fellowships focused specifically on shoulder conditions. He has treated shoulder patients throughout Lancaster County for more than a decade, with offices in Lancaster, Ephrata, and Mount Joy, Pennsylvania.