If you can't reach overhead without pain — or you can't sleep on that shoulder anymore — there's a good chance your rotator cuff is involved. We diagnose quickly, treat conservatively when we can, and repair when we should.
Surgical and non-surgical shoulder care at LAOSS.
Your rotator cuff is a team of four small muscles — the supraspinatus, infraspinatus, teres minor, and subscapularis — whose tendons wrap around the top of your upper arm bone (the humerus) like a cuff. Together they do two jobs at once: they hold the ball of the shoulder centered in its socket, and they lift and rotate the arm. When one of those tendons tears, you lose some of both.
Rotator cuff tears come in two flavors. Acute tears happen in a moment — a fall on an outstretched arm, a heavy lift gone wrong, a tackle, a yanked leash. Degenerative tears happen slowly, often without a single triggering event. The supraspinatus tendon, in particular, runs through a tight space under the shoulder blade and frays over decades of overhead work, sports, or just time. By age 60, a meaningful percentage of shoulders have some degree of rotator cuff wear, and many of those people have no symptoms at all.
The two most common stories we hear at LAOSS are the weekend warrior over 50 who lifted, fell, or threw something and now can't reach a top shelf — and the chronic overhead worker (painter, drywall installer, electrician, swimmer, baseball pitcher) whose shoulder has been getting steadily worse for a year or two. Both can be helped. The path just looks different depending on which story is yours.
The rotator cuff is a group of muscles and tendons in each shoulder. It holds your upper arm bone in your shoulder socket. It keeps your arm stable while allowing it to lift and rotate. Too much stress on the rotator cuff can cause a tear. This can be a painful injury.
Animations licensed from ViewMedica · Swarm Interactive
The supraspinatus runs across the top of the shoulder and starts the first 30° of lifting your arm — it's also the tendon that tears first in most degenerative cases. The infraspinatus and teres minor rotate the arm outward (think reaching for a seatbelt). The subscapularis tucks against the front of the shoulder blade and rotates the arm inward (think reaching into your back pocket). Which tendon is torn changes which motion hurts and which strength test is positive — and that, more than anything, drives our treatment plan.
A rotator cuff tear can look a lot like several other shoulder problems — impingement, biceps tendinitis, frozen shoulder, AC joint arthritis, even a cervical nerve issue. Getting the diagnosis right matters because the treatment paths are very different. At LAOSS, most patients leave their first visit with a working diagnosis and a plan in hand.
Your evaluation starts with a focused history: when it started, whether there was a specific injury, what activities or positions reproduce the pain, and how it's affecting your sleep and your work. From there we do a hands-on exam — measuring active and passive range of motion, testing each rotator cuff tendon in isolation (the empty-can test for supraspinatus, external rotation strength for infraspinatus, the lift-off and belly-press for subscapularis), and ruling out impingement, labral, and AC joint causes.
We typically order an X-ray at the first visit — not because X-rays show tendons, but because they show bone spurs, AC joint arthritis, calcific deposits, and the position of the humeral head, all of which inform the picture. When the exam suggests a tear, we move to MRI (occasionally ultrasound), which shows the tendon directly: whether the tear is partial- or full-thickness, how big it is, how far the tendon has retracted, and whether the muscle has begun to atrophy. Those four MRI findings, more than anything else, drive the surgical-vs-conservative decision.
Not every rotator cuff tear needs surgery. A surprising number of patients — especially those with partial-thickness or small full-thickness tears — get back to full function with a focused conservative plan. When repair is the right call, we do it through tiny arthroscopic incisions and stage your recovery carefully. Here's what each path looks like.
For partial tears, small full-thickness tears, and lower-demand shoulders, we start here. Most patients see meaningful improvement in 6–12 weeks.
When the tear is full-thickness, acute, large, or has failed conservative care — and especially in active patients — surgery restores the tendon and protects the joint long-term.
Rotator cuff repair is a technique-dependent operation. Tear pattern, tendon quality, and fixation choices all shift case to case — surgeon volume and judgment shape the outcome you feel at six months.
Our shoulder specialists move stepwise — least-invasive option that fits your tear and your life, surgery only when it earns its place.
If most of these match your situation, an evaluation with a shoulder specialist is the right next step.
These signs typically point toward an in-person evaluation for a possible rotator cuff tear.
Your first visit is designed to give you an answer the same day, not just another referral.
Cuff recovery is longer than most patients expect — the tendon needs time to heal back to bone before strength work begins. A clear plan with measurable milestones makes the path predictable.
After repair, the first six weeks are about protecting the fresh repair while it bonds to bone. After non-surgical treatment, the focus is calming inflammation and restoring motion.
Targeted physical therapy progresses from active motion into resistance work — rebuilding the cuff and the scapular stabilizers around it.
By 4–6 months most patients are back to full function. Throwers, swimmers, and overhead workers go through a sport- or job-specific return plan.
We talk through risks and benefits with every patient — informed consent is a conversation, not a form.
Every orthopedic intervention carries a small set of standard risks. We screen, prepare, and monitor for these on every patient.
Some risks are specific to cuff repair. We discuss these in detail at your visit so you can weigh them against the benefits.
At LAOSS, your shoulder is evaluated by board-certified orthopedic surgeons with fellowship training in shoulder and sports medicine — not by a generalist. That matters here. Rotator cuff care sits at the intersection of accurate imaging interpretation, refined arthroscopic technique, and the judgment to know which tears repair well and which ones are better served by a different plan.
From your first evaluation through your last PT visit, you'll work with a specialist who does this every day, supported by an in-house imaging and care-coordination team that keeps your treatment moving — not stuck waiting on referrals.
Dr. Bastian repaired my rotator cuff after I fell off a ladder painting my house. Six months in I'm back to lifting and sleeping on that side again. Highly recommend.
Book a visit with a shoulder specialist at any of our eight Los Angeles–area offices. Same-day appointments are often available.
