Head and Shoulders – Rotator Cuff

Here’s the setting. Masters competition, clean and jerk with a  toe to bar ladder (sound familiar), 50 year old male lifts a barbell for a clean and jerk and feels a searing rip in his arm and has to drop the bar. He cannot lift his arm away from his side and is in agony, maybe had a little “bursitis in past” but nothing bad enough to stop him. Second scenario is 40ish year old 930 class filled with bunch of overachievers and one of them keeps getting some pain in the side of her arm halfway down the arm everytime she reaches in front or to the side trying to lift kettlebells. She has been waking up at night with some pain and has noticed that her numbers have been dropping as she tries to protect her arm and shoulder pain from getting worse. Both people may have rotator cuff tears. Both people may have torn one of his rotator cuff muscles. Rotator Cuff tears are probably one of the the most mispronounced things that we deal with in Orthopedic Surgery. Not Rotor Cuff, Not Rotor Cup, but rotator cuff. We call it a cuff because it forms a cuff of tissue that surrounds the humerus and lifts or rotates the shoulder joint. Made up of 4 separate muscles , the cuff is responsible for most activities of daily living with regards to shoulder function. Some things that you cannot do with a decent sized tear of the rotator cuff….brush teeth, reach into a cabinet, lift a gallon of water, reach behind back, throw a ball, carry a heavy object in front of you or to the side, sleep well.
Now there are differing severities of tears and different sizes. A lot of people can live with small tears of their cuff and may not exhibit any weakness or may not have any pain. The most common muscle that is injured is called the supraspinatus which lifts your arm off to the side and helps lift it overhead. If the tear becomes big it can then tear into the next muscle or the infraspinatus tendon. The infraspinatus helps to externally rotate your arm, that is to rotate your hand away from your body vs. towards your abdomen. Here is a side view of a tear of the supraspinatus the biceps tendon is seen towards the front of the shoulder.
This is a real life picture of a full thickness rotator cuff tear. Small tear.
Here is a bigger full thickness tear. Note how retracted the tendon can get which can make it difficult to stretch the tissue back to where it belongs.
If the tendons have been torn for a long time like over 1 year, they pull away from the bone, becoming atrophied and scarred. The tissue also can lose its strretchiness (real medical word) and make it impossible to reattach if it is an chronic tear that happened in the past. This is what a repair looks like for a medium sized tear. Note the sutures passing through the tendon and then being tied down the to bone like a boat at a pier.
This is what it looks like before the tear is tied down. Anchors go into the bone and then the sutures are passed through the tendon.
There are different sizes of the tear. The inital tearing can be what is called a partial tear where the attachment site of the tendon to the bone is partially disrupted. Decision for treatment is made based on how symptomatic the patient is and how big the partial tear is. We call the attachment site the footprint of the rotator cuff. If I know the footprint is typically 16mm of tendon attached to bone and at the time of surgery I see 8 mm of bone exposed then I know it is a 50% tear of the tissue as seen here.
If something is torn greater than 50% we usually repair it. If it less than that we can shave it or smooth it edges.  An MRI is good at saying full thickness tear or not, but it is not great at showing how big a partial tear is sometimes and so it can take looking inside the shoulder and measuring the tear making an intraoperative decision whether to repair it or trim it.
Full thickness tear MRI
Partial thickness tear MRI
The rehab from the repair can be substantial. You can check it out at www.orthopedicsne.com.  6 weeks of intermittent sling use, no reaching or lifting or actively elevating arm. PT will start passive range of motion of stretching your arm without actively moving it. Typing and writing are OK. After 6 weeks you can move actively your arm by yourself. Strengthening begins and getting moderate strength by 4 months  followed by another 3 -4 months to get stronger. For heavy duty lifting, people will say 9 months to 1 year to get back full strength. I would put Crossfitting at high levels in the last category. For cross fitters I can make up modified workouts for people at different stages of their rehab.
The cuff is extremely important for shoulder function. It allows full pain free range of motion when it is working, when it is not people don’t realize how important it is in life. Prevention means taking it easy when lifting at a level that you are comfortable with. If starting CrossFit, it means not loading up the barbell like a roll of lifesavers and seeing how many different colors you can put in there. It means you have to gradually build up your weights to a level that you are comfortable with and then proceed from there. Once again, being over 40 means that you have to be smarter than your youthful counterparts. When snatching and jerking, your strongest body part has to be your head, not your shoulders.


  1. Hi Sean

    Great work on your dedication on replying to all the comments, I’m sure everyone really appreciates it.

    My case;

    I have the following MRI results. It’s been 9 months of physio but the pain just is getting worse. I have full rom but painful. Steroid injection did nothing

    Would you recommend surgery?

    Thickened subacromial bursa particularly anteriorly and superiorly.
    Small insertional tear of the posterior supraspinatus with intact bursal and articular surface fibres. The defect measures approximately 5.5mm in longitudinal medial to lateral extent as well as anterior to posterior extent.
    Infraspinatus tendinosis with some fissuring at the posterior margin.


    • Hi, as usual, I can’t comment on your shoulder directly. In general partial tears of rotator cuff can respond to debridement vs repair if conservative measures have been exhausted. Good luck with it. Sean

  2. Again I cannot comment on you individually but chronic tears are difficult to reattach given the atrophy that can occur and retraction. That is why the numbers of success are so low.

  3. I was injured at work 10/2016. Tendinitis, ac joint arthrosis. I had 7 injections in my shoulder in 2017. In 2018 I had another MRI that stated I had a partial thickness rotator cuff tear greater than 50%. An orthopedic surgeon Read the MRI and said I was hanging on by strings and almost have a complete tear and need two anchors and clean up. Jan 8, 2019 I had surgery but only had a cleanup not rotator cuff repair surgeon said it looked fine in the 10 seconds he spend with me. I am so confused. Could the MRI been wrong?

    • Sometimes MRIs are read differently than what it looks like at time of surgery

  4. Dr Sean
    I had an MRI on my left shoulder that I injury at work. The conclusion
    Moderate to severely Tendinopathiv
    And hypertrophic Supraspinatus tendon. Interstitial mircotearing from its critical zone to its insertion. Partial thickness 9mm I’ll defined interstitial tear within the tendon medial to the footplate. The tendon at risk for macrotear/avulsion. Mild peritendinobursitis. What should I do?

    • I would see an orthopedic surgeon. Happy to see you for that.

  5. I had a full thickness rotator cuff tear last year and had surgery to repair it May 2017. They used 4 anchors to repair it and I did 7 months of therapy.. Although I had notable decreased strength in my arm, I eventually returned to my factory job, where I was put on the same job as when I tore it. Only 13 months later, I have re-torn it. It is once again a full thickness tear. My ortho doctor says I need surgery once again. Is this really my only option? Also, how likely is it that it can even be repaired once again?

    • A recurrent tear can happen and should have a revision repair if feasible. The chances of 100% success after a revision are lower than the original surgery unfortunately.

  6. Hello Dr. Sean I am a 21 year old male with a torn rotator cuff (supraspinatus). Acute injury after falling off a trampoline. This injury happened in July 2017.
    – Supraspinatus tendinosis with articular sided high-grade partial thickness impending full thickness tear (1.4 cm)
    -subdeltoid bursitis
    -insertional infraspinatus tendinosis
    -tear anterior labrum

    Before my injury I was lifting fairly heavy and would like to return to my old work out routines. The pain has limited me and cant do certain workouts without sharp sudden pain. I have good range of motion and can do things that don’t affect my daily activities, but working out with high intensity as before will cause pain.
    My orthopedic surgeon advised me that I was very young and there’s a possibility platelet rich plasma can fix the torn issue. Compared to a middle aged adult my tissue quality is better which would cause a better healing response. He said that surgery should always be a last resort especially in my case since im still young. I got the PRP about 6 weeks ago and there’s definitely a difference in my shoulder in terms of how loose it felt before and feels a bit tighter now. Still not 100% pain free. My questions to you is, have you heard of PRP and does your office use this? Also do you think I need surgery?

    • I did 3 weeks of physical therapy and had no pain with any exercises and have a pretty good amount of strength in my shoulder. Pain only occurs when I do abnormal movements and certain workouts. But for the most part i can get a good work out, just have to modify some workouts to not irritate shoulder.

  7. I am a 62 year old female, and was recently diagnosed with a full thickness, insertional tear involving the supraspinatus tendon measuring 11 mm in the AP dimention with a transverse gap of 9 mm. The acromion is literally down sloping and there is a subacromial spur.

    To fix this, do I have to have surgery?

    • The only way to fix a full thickness rotator cuff tear is with surgery.

  8. I am in the UK and its decision day today as I’m going for my third appointment with my consultant.

    I have been diagnosed with a full tear to my supraspinatus tendon but am considering whether to have surgery to repair it. I had some pain and some limited movement and was diagnosed with a partial tear after an ultrasound.

    However, by the time I had my MRI, the pain wasn’t as bad and the movement is still a bit limited, but not so painful – the MRI showed a full tear. I believe the pain was occurring when it was partially torn and now that it has torn completely, the pain isn’t as bad.

    I have been weight training for over 20 years so have strong shoulders which my surgeon thinks is compensating for the tear and this is why I am still able to continue with training, albeit adapting one or two exercises which are uncomfortable. I am not in pain at night, nor do I feel it affects my everyday life.

    In my last appointment with my surgeon, I explained I am concerned about the recovery time after the op as I would not be able to weight train and I see the gym as a very important mental release after a stressful day at work. My surgeon then said he is now wondering how much more he can give me if he operates and he wants to think about it for another month or so.

    I am seriously considering saying no to any surgery – would you agree?

    • obviously I can’t comment on your case individually and that decision is ultimately between you and the doctor you choose. Full thickness rotator cuff tears are usually surgical cases.

  9. Last winter I started playing squash and developed chronic shoulder pain. After a tournament the pain got to the point of being very painful and limiting my movement. At this point (March 2017) I stopped playing squash and saw a orthopedic doctor. I was diagnosed with an impingement and received an injection in the shoulder and started physical therapy. (It was also found that I had some scapular diskinesis). Initially these steps had positive results and by June I was pain free.

    However in July the pain returned and has been chronic since. Last week I got an MRI and the results from my physician were that I have a high grade partial rotator cuff tear. The doctor recommended surgery to complete the tear and then repair it.

    I’m mulling over the decision to break and reattach the cuff. I am 45 years old, very active, love to white water and sea kayak, play racquet sports, etc… and would like to continue to have these activities in my life. I think no matter what I need the decompression surgery on the acromion to alleviate the impingement. What considerations should I have in mind in deciding on repairing the rotator cuff? The doctor presented it as a question of when, not if, the cuff will completely tear thus requiring surgery, and that doing it sooner is better for a more successful outcome. I recognize surgery is a serious undertaking and just want to make sure I am looking at things properly, with the best long-term results for a full functioning shoulder my primary goal.

    Thanks so much, Steve

    • Biggest issues for partial cuff tears are how big is the partial tear, is it small medium or large which sometimes cannot be determined by MRI. Also has PT been tried enough to warrant having a surgery.

  10. I am 63 years old. I had rotator cuff surgery on my rt shoulder 9 years ago. On 4/6/17 i fell and re-tore the same shoulder plus the mri showed some older small tears. When I first fell i couldn’t move my arm at all but as time went on , it did move more and more. Actually able to raise my arm over my head after 4 months. Of course I had reduced strength. I waited this long because I was awaiting workers comp approval. I had the second surgery done on 9/25/17 but the tendons were too retracted to reattach. My doctor removed scar tissue and now recommends PT. What do you think?

    • Hi Howard, I would have to see you as a patient to give you specific personal advice for your shoulder as you have a complicated case. Sean

  11. Hello Dr. Sean. I am a 38 Y Old male and i had left shoulder pain for 2 to 3 months and i started PT and was doing PT for 4 to 5 weeks and my pain under my deltoid on the back of the bicep would not go away. I finally got an MRI done and here is the findings from MRI. 1. High Grade Partial Thickness tear of the superior one third of subscapularis tendon fibers. (Approximately 60% of the overall tendon thickness). Mild underlying tendinosis.
    2. Contigous detached tearing of the anterosuperior, superior, posterosuperior and posterior labrum extending from 2:00 to 8:00 with small posteroinferior paralabral cyst at 7:00 position.

    • And your question is

  12. I have been diagnosed with 8mm full thickness rotator cuff injury. My doctor has recommen6 surgery ANF my second opinion doctor recommended 6 weeks of PT. I just completed the 6 weeks of PT and my shoulder feels better with little pain and I can move it more. I have lupus and afraid to undergo the danger of anesthesia. Please advise me.

    • Janet, I am happy to see you in the office, I cannot comment on you specifically. I recommend surgery for full thickness tears for my patients.

  13. July will be 2 years since I fell and tried to catch myself by grabbing the doorknob. After about 4 days of pain, I went to the Express Care and was referred to an orthopedic surgeon. I was sent for an MRI and my options were discussed. We started PT and it did wonders. I decided not hold out for surgery. A year later, I started having pain again and went back to my ortho. We discussed that surgery would probably be the best option. He said that this will more than likely keep happening. Since I am still “young” it would be beneficial. He also gave me a slip for another round of PT because I couldn’t decide on the surgery yet. Before I made the PT appointment, things improved. Now I am beginning to have the pain again. I’m trying to decide if I should do the surgery. This is what my MRI stated:
    1. High-grade partial full thickness tear involving the supraspinatus tendon, some articular fibers are torn and retracted by approximately 1.4cm
    2. Small to moderate amount of fluid within the subacromial subdeltoid bursa
    3. Small to moderate glenohumeral effusion
    4. Moderate amount of fluid surrounding the biceps tendon compatible with tenosynovitis and may also be secondary to recent fall.
    What do you think? And how is a tear partial full thickness? I thought it was one or the other?

    • For my patient if pain kept coming back, I would have to look at mri and if it was hanging on by a thread then most likely fix it. You are correct it is either high grade partial or full thickness tear. You can set up a virtual consult if you want and I can look at MRI, click upper left corner on menu for virtual consult

  14. Sean, Here is the results of my MRI. What do you think. They are recommending surgery. I believe this to have been torn for years. Finally going to get it fixed.

    Full-thickness disruption of supraspinatus is evident, with
    retraction of the torn proximal tendon. The tear lies within
    the mid substance of the tendon and measures 10 x 10 mm in
    size (series 5 image #14, and series 7 image #10). The
    remainder of the tendon appears atrophic. The infraspinatus
    tendon reveals a small partial-thickness articular surface
    tear at its anterior distal margin series 5 image #11, and
    series 7 image #8. No full-thickness defect is evident.
    Marked spurring and hypertrophy of the acromion and clavicle
    is evident. There appears to be remodeling of the
    undersurface of the acromion which is suspicious for chronic
    contact with the humeral head. No edema within either the
    clavicle or acromion is evident.

    There is no evidence of glenohumeral joint effusion. The
    biceps is medially subluxed, and appears perched upon the
    medial margin of the intertubercular groove. There is a
    discoid isointense appearance of the biceps anchor,
    consistent with interstitial tendinopathy/tearing. A
    discrete linear defect within the tendon is not identified.

    The fibrocartilaginous labrum appears grossly intact. The
    subscapularis tendon is distally abnormal, with disruption
    of the articular sided fibers. The superficial bursal fibers
    of the tendon are intact.

    There is no significant muscular atrophy about the shoulder
    on the current examination. A small quantity of fluid within
    the subacromial/subdeltoid bursa is evident.

    • I usually recommend surgery for full thickness tears. If tears are old they may be tough to reattach due to retraction.

  15. Evaluated by two orthopedic surgeons currently 03/07/17 giving me completely different recommendations … please help me sort?? Seen for shoulder weakness, stiffness, pain … started in July few days, pulled “light” ride bike off of rack holder in garage and heard “crunch”.. hurt several weeks, would wake me up at night. In September 2016, shoulder “specialist” decided to start with ultrasound guided cortisone injections front and back of shoulder … helped reduce pain, especially at night. For months, still experienced weakness, pain in lifting out to side, afraid to do plank, other excercises.. I’m 51, marathon runner, like to cross train … 2/2017 an MRI showed a 12mm full thickness tear of the Supraspinatus tendon. One upper extremity ortho recommended surgery for repair of tear, long recovery. Received a second opinion today by a shoulder specialist who noted the tear, but said it was small, common in my age as a 51yr old female and does NOT require surgery. Furthermore, he felt my symptoms were from adhesive capsulitis (frozen shoulder) and recommended a cortisone injection directly in joint, I had that done today. Due to such completely different recommendations, uncertain as how to proceed? Is the tear significant? Should it be repaired … waiting can make it worse?? How can the doctors tell the difference as to if it’s frozen shoulder or the tear? Would be grateful for your perspective! Thanks!!! Margie

    • Margie, Sometimes we see people with both frozen shoulder and rotator cuff tear. My recommendation for a full thickness tear is to usually fix it so it doesn’t become bigger. However if you have a frozen shoulder you have to deal with that first before repair because it can get very stiff after a repair. The way to tell if someone has a frozen shoulder is if they have limited range of motion of their arm all the way up in front of them off to the side and reaching behind them. So typically I would have somebody get a full range of motion first and then repair the rotator cuff after that.

  16. Hi there ,
    I am a 28 year old in my second year of nursing . I was kicked by a patient and have torn my rotator cuff. I have been doing physio since the injury 9 weeks ago. I had an MRI at 7.5 weeks which showed a 50% supraspinatus tear 8mm x 2mm . The pain has progressively been getting worse since the injury despite pain meds and physio. I was told to do steroid injections instead of surgery. However because of my active lifestyle and age and I’m worried if I don’t get surgery I will have problems for life . Especially if the conservative approach does not work and I end up needing surgery anyway in a year. I have read the full recovery is harder after surgical repair of an old tear. I’m also concerned the increase in pain suggests the tear is increasing . Any thoughts would help! Thanks

  17. Dear Dr. Rockett,
    So incredibly happy to have found your blog. I’m a nurse at a local teaching hospital on the west coast. How you have time for this blog is beyond me but I appreciate it.
    I’m 49 and have been crossfitting for over three years and absolutely love it. I have been dealing with my shoulder since early summer. An MRI six weeks ago showed a high grade partial undersurface tear of anterior fiber right supraspitatus and partial undersurface tear of anterior infraspinatus tendon.
    I’ve done it all…rest, PT, slowly working my way back. I still have pain though after certain work outs. I’m signed up for a masters comp at the end of January and am starting to give up on doing it.
    The surgeon I saw told me the likelihood of a full tear is low and the surgery and recovery is about the same for either so I was just going to forge ahead.
    Now I’m worried about the risk causing further damage to the surrounding areas by not surgically fixing it. Is that a risk? Also, I also want to get back to where I was an not be limited in my workouts.
    Do you know any surgeons in the central Ca area who have experience treating crossfit athletes? As someone stated above most medical professionals I have spoken to don’t understand or have a positive view of crossfit.
    Thank you for your time.

    • Hi courtney, sorry for the delay from the holidays, There is always a risk with a high grade partial tear becoming a complete tear. email kmee@orthopedicsne.com and tell me what cities you are looking at

  18. Good morning,
    I have question regarding my Labrum.
    I swam for 14 years, 4 of which was 2Xday 4Xwk and once on friday.
    2010 At the start of my shoulder pain (a 5 year journey) I did shoulder exercises for roughly a year. And taped my shoulders during practices to keep them from popping.
    2011 I was put on a month of no swimming because my shoulders.
    2012-2013 I was taking 15-17 Ibuprofen on practice & meet days from aug-may (4-5 day X wk) and about 10 Ibuprofen from may-aug….
    Keep pushing through the pain. 2014 dropped the ibuprofen if just wasn’t helping. Also, last year of swimming.
    2016-I decide to get it looked at and found: 16mm tear in Left labrum and 2mm tear in Right labrum. Along with some other things.

    My question is how wide is the labrum? Is the 16mm tear small or should I be worried about it?

    • That 16mm usually refers to the length of the tear from top to bottom along the glenoid. Read my shoulder instability post and you can see the labrum. I would have it assessed yes.

      • Thank you, when I had assessed they said PT should heal it

      • Thank you

  19. I had an MRI done on my right shoulder last week and here is what the report stated:


    There is no evidence of significant joint effusion. However, important fluid collection in the subacromiodeltoid bursa suggestive of bursitis.

    Signs of tendinosis of the subscapularis, supraspinatus and infraspinatus which tendons are in hypersignal on all sequences and mildly thickened. Thee subscapularis tendon presents a very mild mid and suprasubstance laminar tear at its upper third. The supraspinatus tendon presents an important infra, mid and suprasubstance tear at its anterior two-thirds. At its posterior third, there is a full tickness tear extending on 9 mm AP x 16 mm, lateral with myotendinous retraction measuring up to 2 cm. The infraspinatus tendon presents a mild infra, mid and suprasubstance laminar tear at its most upper third. The teres minor tendon and the long head of the biceps tendon are otherwise unremarkable. There is no atrophy nor significant fatty involution of the muscle.

    Type II acromion. No evidence of fracture, luxation nor aggressive bone lesion.


    Signs of tendinosis of the rotator cuff as described above.
    Full thickness tear of the posterior supraspinatus.
    Laminar tear of the subscapularis, supraspinatus and infraspinatus.
    Subacromiodeltoid bursitis.

    I have been doing CrossFit for four years and have had a Rotator Cuff issue for six years but didn’t know it was torn. I haven’t heard back from my doctor yet but I would like to get feedback from people who have similar issues and who do CrossFit. I have been limited on how much weight I can put over head and it’s affecting kipping anything and hand stands.

    Any feedback is appreciated.

    • Usually we recommend repair for a full thickness supraspinatus tear.

      • What is the recovery for this? Can I do any type of work out while I’m awaiting surgery and after surgery? I recall reading about you providing that information.

        • look up my post on 1 armed workouts after shoulder surgery. Strengthening before is usually a good idea.

          • Hi, I had my surgery on January 13 and it was successful and I am not in my 6th week of recovery and doing physio. The Dr tells me that I can only go back to the gym in four months but that I won’t be doing weights for a while.

            Can you provide me with your feedback on returning to the gym? Do you have a special program to follow? I am willing to pay if you do.

  20. Sustained an injury to my left shoulder and the ultrasound reads: “…tear of supraspinatus tendon with maximum dimensions of 9 x 2 x 6 mm seen 6 mm from the biceps…” Would this size of tear require surgery?

    • Sometimes the torn piece of rotator cuff flips into the joint like a hang nail and can cause pain, so the answer would be if it is painful yes.

  21. Dear Dr. Rockett,
    I’ve been doing CF for five years now. I went to the Games in 2013 in the master’s division (55-59). I’m currently a trainer at a box in central Vermont and just had surgery on my right shoulder for a rotator cuff repair. I bumped into your website while searching for workouts I could do post-surgery. It appears that you might be willing to provide post-surgery, workout suggestions? Is that correct? I understand that sort of advice is very case sensitive. Do you by any chance review cases and provide personalized advice for folks?

  22. Do you have any recommendation/referral for an Orthopedic Surgeon in the Philadelphia, PA area. I have a “moderate to severe partial thickness tear of the insertional fibers of the supraspinatus and infraspinatus tendons without tendon retraction.” My MRI report also states a “partial thickness tear of the subscapularis tendon”.

    I’ve been doing rehab on it for about 3 months and it feels somewhat better. However, at this point it seems surgery is probably my only option to get back to overhead lifting and playing golf.

    Any and all thoughts are greatly appreciated.

    • The docs at the Rothman institute are solid. I don’t know them personally

      • I have a question,what does 30mm segment of subscapularis tendon with 9mm thickness mean,is that small,medium,large or complete,supratinasious is also involved,8x14x22, can these heal on there own after a year of being diagnosed via mri with and without contrast?

        • Those tears sound like they are on the medium to large size, they do not reattach to the bone usually.

  23. Hello,
    I’m 40, M, been doing crossfit for almost 3 years. Have a rotator cuff tear in left shoulder. Ultrasound report says, “supraspinatus shows normal thickness and there is a hypoechoic zone on the articular face with a 9mm anteroposterior dia, long dia 5mm and 3mm thick involving 35% of the thickness in relation to a partial rupture. The rest of the tendon does not show echogenicity alteration.

    What would be the best course of action for this? Abandon crossfit and look for something else?

    • Obviously you need an examination and history to correlate these findings. If I had a patient with this I would have them do things that do not cause pain and be careful with explosive shoulder movements. So that may mean dropping weights down to a manageable number that does not stress the area.

  24. Hello Doc! Just received the MRI results for my right shoulder. “Partial Thickness high-grade articular surface tear at the insertion of the supraspinatus tendon (near fullthickness)… “Deep irregular cleft of fluid undercutting superior labrum, extended from anterior to posterior and also into the biceps anchor. Tear propagates further posteriorly extends to mid posterior labrum and there is tearing of the inferior labrum.” I am a 31 year old Firefighter/crossfitter/CF Coach, very actice, and have mild pain and near full ROM. It sounds like surgery is inevitable after reading the report. Advice/thoughts?

    • It sounds like there are some things that could be improved with surgery. It would take an exam to determine how many of those things are causing symptoms. Happy to see you if you are in the area.

  25. So, it seems my rotator surgery failed. I didn’t do anything that hurt and I have been beyond careful in building up strength. When the weather went cold in October, my shoulder just felt different and I have watched it lose all the external rotation strength I had regained to absolutely zero. I had a full tear and he wasn’t sure if he could fix it in the first place. It just is such a kick in the gut how things were going so well, and now just gone.
    I will know how large the tear is soon, but I have read that second surgeries on large tears usually aren’t successful. Is that true? I sure don’t want to go through all of that for nothing. If this is the best it’s going to be, I rather just get used to it.

    • Sorry Zina, That must be disappointing. So 2nd surgeries depend on a lot of things such as size of the tear, how long it has been torn, what kind of tissue quality there is, age of the patient, degree of retraction in the first place, atrophy of the muscle or tendon. So as you can see there are a lot of variables that can help figure out the relative chance of success or failure. Good luck, Sean

  26. I have full thickness tear of supraspinatus tendon tear measuring AP dimension -of 1.4 cm – ( MRI examination),gap on the coronal view measures width of 1 cm.
    May I please ask your advise – what are the likely best options?

    • Full thickness tears of the supraspinatus are most often treated surgically to prevent further retraction, prevent weakness, and prevent pain in the future.

    • Laura ,
      Hope you are doing well with your shoulder. Just saw your post from 2 years ago and I have the same condition a 1.4cm full thickness tear. Did you end up having surgery? Just wondering if that’s the road I am heading down.
      Thank you

  27. “The supraspinitus tendon shows a components of re-tear involving the inferior articulate surface. This involves the area of the critical zone. The area of involvement measures about 12mm in the long axis and 11mm in the short axis. This partial tear involves more then 50% of the tendon thickness. The superficial fibres however remain intact on the bursal surface”.

    What are the likely best options?

    • I would really have to examine you and see the MRI to comment. Radiologists oftentimes can over or under read MRIs and don’t have the benefit of examining the patient We do know that repairs sometimes don’t look on MRI like they have reattached as thick as a native tendon used to be.

  28. I just had an MRI and it’s impression stated that threr full-thickness tear at the far anterior distal supraspinatus tendon with small subcromial-subdeltoind bursal effusion. is this definate surgery or will PT help. Thank you in advance I am a 57 y/o female.

    • Sorry but a full tear does not reattach itself and we usually recommend surgery.

  29. No debridement is a much faster protocol and can get rid of sling in a few days with return to strength by 2 months. CrossFit heavier stuff could take 3 months

  30. Hi Dr. Rockett

    Thank you for all the information you provide through your blog. It is certainly invaluable. My question is in regards to shoulder debridement, specifically labral and rotator cuff . Do your shoulder debridement patients follow a protocol similar to a patient that has undergone a repair? Would the same apply to a “crossfit patient”?
    Thank you

  31. It would be very difficult at this late juncture unfortunately but I would not stop trying.

  32. Hi Dr. Rockett – 15 years ago, I had surgery to tighten a loose shoulder that was always dislocating…I’m 32 now and my range of motion is probably 140 degrees (in front of ear when arm is raised). Is it possible to regain mobility after such a long period of time?

  33. Dr. Rockett – I am a 48 year old Crossfitter in Atlanta dealing with a few shoulder, hip and achilles tendonitis issues. As my work schedule only gets me up to your neck of the woods a few times a year, I was wondering if you had any recommendations for Orthopedics in Atlanta that “get” crossfitting like you do? My message therapist thinks I could use an assessment to determine some of the recurring issues I see her for. Any help would be greatly appreciated.

    • Hi Stacey. I don’t know anyone there but it sounds like you need it fixed. There is only so much strengthening can do. If you want to try go to my website orthopedicsne.com and check out PT protocols for shoulder strengthening. Good luck. Sean

    • Hi Paul. I don’t know anyone in Atlanta who has drunk the Kool-aid as much as I have. You could try the local university hospitals Good luck , Sean

  34. Hey Doc! First of all, thank you for all the posts and free advice you provide to the Crossfit community! I reside in Florida, and unfortunately cannot come visit you for treatment or diagnosis. However, I am wondering if you have any recommendations for someone in the Gainesville/Ocala area that has experience treating Crossfit athletes and getting them back into shape for competition? I find that when I speak to any health professionals that I know (or am related to) they generally have a very negative view of olympic lifting and the practice of Crossfit, and typically do not understand the mentality. I’m 28, and would like to one day get to Regionals or even The Games. I have a nagging shoulder injury resulting from a shoulder dislocation during a wrestling match when I was 14 that just never went away. I wrestled for years with this issue and just iced and dealt with it. Today, I am having constant clicking and a general feeling of instability that freaks me out whenever I go overhead. Ice, rest, and the like helps, but the joint has not felt “stable” in several years and recently has grown uncomfortable enough for me to quit being stupid and seek advice. I’d prefer a nonsurgical solution but I fear it may be the only option going forward if I want to return to 100% without worry. Again, thank you for all you do.

  35. Hello,
    I have had right shoulder pain since last October, I am 41yrs old and have been doing crossfit for 3 yrs. I tried to rest it for 3 months followed by 2 months of PT. Still same pain so I broke down and got an MRI. The Dr. said it have a Type II Slap Tear. Given the time and attempt to rest I am leaning towards having surgery. I had set it up for the end of this month. Now I am starting to have second thoughts on the bicept tendonitis. The reason for my second thoughts is I want to be albe to do overhead work down the road. What is your take on a very active 41yr old?

    • It sounds like you have tried diligently to make it go away on its own and attempted conservative measures without it helping. So now your options are living with it and modifying what you do to avoid painful things or get it fixed. I am happy to see you also if you want me to go over your exam and studies.

  36. Sorry to hear about your surgery, as always you need to check with your individual surgeon regarding what he or she will allow as they are the ones operating on you. I have let people stationary bike, air squat, sit ups, one armed kettle bells, but again you need to check

  37. I found your podcast on shoulders very informative and was very happy to hear from an MD who Crossfits. I’m 45 yrs old and have been Crossfitting for 3 years and have right shoulder issues specifically bursitis, impingement and a full thickness, full width rotator cuff tear. Going for surgery this Friday to repair the tear and wanted to know if you had any advice on CF movements (lower body) that I could do post op. Thank you in advance for your thoughts.


  1. Tuesday 130528 | CrossFit NYC - [...] likes to follow the path of least resistance Men’s biceps predict their political ideologies Head and shoulders — rotator…

About Me

D Sean Rockett, M.D., is an orthopedic surgeon and senior partner of Orthopedics New England with offices in Natick, Newton and Hopkinton, MA. Dr. Rockett is a CrossFit Level 2 Trainer and co-owner of CrossFit Launchpad. He also enjoys being the head orthopedic surgeon of the CrossFit Games Medical team.

About 321GOMD Blog

This blog pro­vides gen­eral infor­ma­tion and dis­cus­sion about med­i­cine, health and related sub­jects. The words and other con­tent pro­vided in this blog, and in any linked mate­ri­als, are not intended and should not be con­strued as med­ical advice. If the reader or any other per­son has a med­ical con­cern, he or she should con­sult with an appropriately-licensed physi­cian or other health care worker.

Subscribe to Blog via Email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 80 other subscribers

Add our banner to your page.

Get the Code Here