Should you get a second opinion before rotator cuff repair?

Short answer: Yes, if the surgery is planned rather than urgent. Not every rotator cuff tear needs repair, and the tears that do need it are not all the same operation. A second look at your MRI and exam can confirm the diagnosis, the type of repair, and whether the tendon is likely to heal.

When a second opinion changes the plan

• The MRI shows a tear, but the tear may not be the source of the pain. MRI finds rotator cuff tears in 34 percent of people with no shoulder symptoms, and in 54 percent of those over 60.
• The tear is large or the muscle shows fatty change, so healing odds matter. Retear rates after repair of large and massive tears reach as high as 94 percent in some published series, which is why we score healing risk before surgery.
• You have been told the tear is irreparable. Dr. Denard's published series of 101 massive tears repaired arthroscopically found 88 percent of patients satisfied at more than four years, and only 5 percent needed a replacement.

Questions to ask your surgeon

1. Is this tear the cause of my pain, or could it be something else?
2. How large is the tear, how far has it retracted, and what does the muscle look like?
3. What is my chance of the repair healing, and would a graft patch improve it?
4. What happens if I wait three to six months?
5. How many of these repairs do you do each year?

What your imaging should show

Tear size and retraction, which tendons are involved, fatty infiltration of the muscle (Goutallier grade), and whether arthritis is present. Those four facts decide between therapy, standard repair, augmented repair, and replacement.

What the research shows

For large tears, Dr. Denard uses the Rotator Cuff Healing Index, a 15-point score built from retraction, fatty infiltration, tear size, age, bone density and work demand. Patients scoring 4 or below heal about 86 percent of the time; at 7 the rate falls to 38 percent, the point where a graft patch is considered.

Get a second opinion without the trip

If you already have an MRI, Dr. Patrick Denard can review your images and report remotely and record a narrated video explaining what they show and what he would recommend, typically within 48 hours, for $250. Start a remote MRI review. To be seen in person in Medford or Grants Pass, request an appointment or call 541-608-2595.

Learn more about rotator cuff repair at Oregon Shoulder Institute.

Frequently asked questions

Can a rotator cuff tear heal without surgery?

A full-thickness tear does not heal back to bone on its own. Many people still do well with therapy, especially older patients with lower demands, so the right answer depends on tear size, symptoms and goals.

Is arthroscopic repair better than open repair?

Dr. Denard performs rotator cuff repairs arthroscopically. National data show open repair carries roughly double the complication risk and a higher infection rate.

Related reading

• Do Rotator Cuff Tears Heal on Their Own?
• Why Some Rotator Cuff Repairs Need Extra Support and Who Gets It
• Told You Have a Massive or "Irreparable" Rotator Cuff Tear?

This page is for education and is not a substitute for an exam. Our surgeons have performed more than 10,000 surgeries, and more than 95 percent of patients go home the same day.