Told You Need Rotator Cuff Surgery? Getting a Second Opinion in Dallas

If another doctor has told you that your rotator cuff is torn and needs surgery, the right next question is which kind of tear you have. There are two. A worn-in tear that has been there a while and recently became painful usually deserves a trial of physical therapy before anyone operates on it, and most of those shoulders never need surgery. A tear that happened with an injury and left the arm weak is a different problem, and it does better when it is repaired within the first few months. A second opinion with Dr. Brett Raynor sorts out which one you have, whether surgery is the right call, and if it is, exactly how he would do it. Bring your MRI.

Dr. Raynor is a fellowship-trained orthopaedic sports medicine surgeon at Texas Orthopaedic Associates in Dallas. Rotator cuff repair is one of the operations he performs most often, including large and revision repairs referred to him by other surgeons, and second opinions are a routine part of his practice.

Call (214) 265-3211, schedule online, or send an appointment request and note that you have an MRI showing a rotator cuff tear.

First question: which kind of tear is it?

The worn-in tear. Most rotator cuff tears happen slowly, from years of the tendon rubbing under the bone above it. They are common and often silent: in an MRI study of people with no shoulder pain, more than half of those over 60 had a cuff tear, about a quarter of them full-thickness (Sher et al., Journal of Bone and Joint Surgery, 1995). When one of these tears starts to hurt, the pain usually comes from the inflamed bursa and tendon around it, and that is something therapy, time and sometimes one injection can settle. In the MOON Shoulder Group study of 452 patients with full-thickness worn-in tears treated with a structured therapy program, fewer than one in four had chosen surgery two years later (Kuhn et al., Journal of Shoulder and Elbow Surgery, 2013). The patients who were improving by twelve weeks of therapy generally kept improving; the ones who were not went on to surgery and did just as well as if they had been repaired at the start. There is no penalty for trying.

The torn-off tear. The other kind happens to a shoulder that was working normally until a fall, a yank on the arm or a dislocation. The arm is weak afterward, sometimes too weak to lift, and the tear is often large. These tears do not do better with waiting. In a prospective series of traumatic tears with weakness, outcomes were not compromised when the repair was done within four months of the injury, and the large tears repaired after four months had the worst results (Petersen and Murphy, Journal of Shoulder and Elbow Surgery, 2011); a systematic review of fifteen studies found a trend toward better scores and motion when repair happened within three months (Mukovozov et al., Bone and Joint Research, 2013). Dr. Raynor treats these as a different problem from the worn-in tear, and the conversation about repair happens early rather than after months of therapy.

An MRI report says "full-thickness tear" for both kinds. As Dr. Raynor puts it in clinic, "a little pinhole in your jeans is a full-thickness tear, and a big gaping hole in your jeans is a full-thickness tear. Same word, two very different things." The history, the exam and the images together tell which one you have.

What the visit involves

Dr. Raynor starts with the story of how the shoulder started hurting, then examines it: motion, strength in each of the four cuff tendons, and the biceps. He reviews your X-rays and your MRI with you and draws the shoulder so the pictures make sense. Then the options, in order, in his words:

"Option one is just do nothing and live with it. Always an option. Option number two: physical therapy. It's never the wrong answer. Injections can calm it down, but one to two is enough; if we keep having to give them, it's time to ask what the plan is. Because we do have surgery for this. We have the ability to go fix this."

If you have already done the therapy and the shoulder has plateaued, or if the tear is the torn-off kind, you will hear exactly how he would repair it, what he expects to find, and what the recovery looks like. If the honest answer is that you have not yet given therapy a real chance, you will hear that instead, with a plan and a checkpoint.

When surgery is the right call

Surgery is the right call when a torn-off tear has left the arm weak; when a worn-in tear has had a real trial of therapy (two to three months, done properly) and the shoulder has plateaued; when injections are no longer lasting; or when a tear is getting bigger. That last point is why "do nothing" means monitoring, not ignoring: in a prospective study of tears that were not causing pain, 49% enlarged over a median of five years, 61% of the full-thickness tears did, and enlargement went along with new pain and with the muscle behind the tendon starting to waste (Keener et al., Journal of Bone and Joint Surgery, 2015). A tendon that has pulled back and a muscle that has wasted are harder to repair, so a tear that is being watched gets re-examined, and a tear that is changing gets fixed before that happens.

Two things to know before surgery, whoever does it:

Steroid injections and surgery do not mix well close together. One or two injections over the course of treatment are reasonable. In a systematic review, two or more injections in the year before a repair were associated with about two to three times the rate of revision surgery (Cimino et al., Arthroscopy, 2020). Tell Dr. Raynor about every injection you have had and when.

Not every repair heals, and most patients do well anyway. Large and long-standing tears heal less reliably than small fresh ones. A meta-analysis found that patients whose repairs did not fully heal still had good pain relief and function, though measurably less strength than those whose repairs healed (Russell et al., Journal of Bone and Joint Surgery, 2014). Dr. Raynor will tell you honestly where your tear falls, and what his plan is if the tendon will not reach the bone: the tear that is too big to close has options, from moving the biceps to patches and a balloon spacer, and he decides on those before surgery, not during it.

How Dr. Raynor performs rotator cuff repair

The repair is arthroscopic, through four small portals, as an outpatient surgery with a nerve block. He cleans the bone where the tendon belongs, sets anchors at the inner edge of the footprint, passes their sutures through the torn tendon, then crosses the sutures over the top and locks them into a second row of anchors so the whole width of the tendon lies flat against the bone. Most repairs include a biceps tenodesis, which takes a few extra minutes and removes a common source of pain after surgery. You are in a sling for six weeks, strengthening starts at three months, most patients are doing what they want by six months, and the shoulder keeps improving for a year.

Watch the whole operation, narrated by Dr. Raynor, in his step-by-step rotator cuff repair animation. For the full description, see how Dr. Raynor performs rotator cuff repair; for what a tear is and how it is diagnosed, rotator cuff tears; and for the week-by-week plan afterward, the rotator cuff repair recovery guide.

What to bring

  • Your MRI images, not just the report. A disc or a link to the images. If the scan is more than a few months old and surgery is on the table, Dr. Raynor will usually get a new one; he does not like surprises in the operating room.

  • X-rays, if you have them.

  • A list of every injection you have had in the shoulder, with approximate dates.

  • Your therapy history: how long, how often, and whether it was helping.

  • Operative notes from any previous shoulder surgery.

  • Your questions, written down.

Questions worth asking any shoulder surgeon

  1. Is my tear the worn-in kind or the torn-off kind, and how does that change the plan?

  2. Have I given physical therapy a fair trial, and how will we know if it is working?

  3. How many rotator cuff repairs do you perform a year?

  4. Do you expect my tear to be fully repairable, and what is your plan if it is not?

  5. Will you address my biceps tendon, and why or why not?

  6. What does the first six weeks look like, and when can I drive, work and sleep flat again?

If a previous repair has failed

Dr. Raynor takes referrals for failed and re-torn repairs. A second opinion after a failed repair starts with why it failed: the size and age of the original tear, the quality of the tendon and muscle on the current MRI, and whether the tendon can be brought back to the bone. Sometimes the right answer is a revision repair; sometimes it is one of the alternatives for a tear that cannot be closed. He will tell you which, and why.

Patients traveling to Dallas

Patients come to Dr. Raynor from outside Dallas-Fort Worth for rotator cuff repair. His team can coordinate the visit, imaging and surgery around your travel. Plan to stay in Dallas for at least two weeks after surgery, sometimes up to six depending on what is done, and the therapy afterward can be done close to home.

  • Not necessarily. Full-thickness only means the tear goes all the way through the tendon; it says nothing about how big it is or how it happened. Many full-thickness worn-in tears do well with therapy. A full-thickness tear from an injury that left the arm weak is the kind that gets repaired.

  • For a worn-in tear, usually yes, and there is no penalty for trying: the patients in the MOON study who did not improve with therapy and had surgery afterward did as well as those operated on from the start (Kuhn et al., 2013). Twelve weeks is the checkpoint. If the shoulder is better at twelve weeks, it usually keeps getting better; if it is the same, more therapy is unlikely to change that. For a tear from an injury with weakness, therapy first is the wrong order.

  • Often not, but it depends on what the tendon and muscle look like now, which is one of the main things Dr. Raynor assesses on the MRI. Long-standing tears can retract and the muscle can waste, which is why a tear that is being watched should be re-examined rather than forgotten.

  • Yes, to make the diagnosis. If you decide on surgery and the scan is more than a few months old, he will usually order a new one so he knows exactly what he is repairing.

  • Use the online appointment request and mention that you have an MRI showing a rotator cuff tear; those requests come directly to Dr. Raynor. You can also call the office at (214) 265-3211 or schedule online.

  • Yes. For a worn-in tear, the time it takes to get another opinion changes nothing. For a fresh traumatic tear, the window is the first few months, so get the second opinion sooner rather than later.

    1. Sher JS, et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77(1):10-15. https://doi.org/10.2106/00004623-199501000-00002 (over 60: 54% any tear, 28% full-thickness)

    2. Kuhn JE, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013;22(10):1371-1379. https://doi.org/10.1016/j.jse.2013.01.026 (fewer than 25% chose surgery by 2 years; 12-week checkpoint)

    3. Petersen SA, Murphy TP. The timing of rotator cuff repair for the restoration of function. J Shoulder Elbow Surg. 2011;20(1):62-68. https://doi.org/10.1016/j.jse.2010.04.045 (traumatic tears with weakness: outcome not compromised up to 4 months; massive tears after 4 months worst)

    4. Mukovozov I, et al. Time to surgery in acute rotator cuff tear: a systematic review. Bone Joint Res. 2013;2(7):122-128. https://doi.org/10.1302/2046-3758.27.2000164 (trend to better Constant score and motion with repair under 3 months; case-series evidence)

    5. Keener JD, et al. A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears. J Bone Joint Surg Am. 2015;97(2):89-98. https://doi.org/10.2106/JBJS.N.00099 (49% enlarged over median 5.1 years; 61% of full-thickness tears; enlargement linked to new pain and muscle degeneration)

    6. Cimino AM, et al. Corticosteroid injections may increase retear and revision rates of rotator cuff repair: a systematic review. Arthroscopy. 2020;36(8):2334-2341. https://doi.org/10.1016/j.arthro.2020.04.044 (two or more injections in the year before repair: about 2 to 3 times the revision rate; already cited on the live /rotator-cuff-repair page)

    7. Russell RD, et al. Structural integrity after rotator cuff repair does not correlate with patient function and pain: a meta-analysis. J Bone Joint Surg Am. 2014;96(4):265-271. https://doi.org/10.2106/JBJS.M.00265 (good pain and function even when the repair did not heal; strength measurably lower)

Why patients choose Dr. Raynor for rotator cuff repair

Dr. Raynor completed his orthopaedic surgery residency at Vanderbilt and his sports medicine fellowship at the Steadman Philippon Research Institute in Vail, Colorado. He is board-certified in orthopaedic surgery, a D Magazine Best Doctor every year since 2019, a team physician for the U.S. Ski and Snowboard Team, and the team physician for Highland Park High School, St. Mark's School of Texas, Ursuline Academy and The Hockaday School. He has published on shoulder instability and shoulder pain, teaches arthroscopy at AANA Masters Courses, and has reviewed for the American Journal of Sports Medicine since 2016. Rotator cuff repair is one of the operations he performs most often, and other surgeons refer large and revision repairs to him.

How to get a second opinion from Dr. Raynor

  • Call (214) 265-3211.

  • Schedule online through self-scheduling.

  • Send an appointment request and note that you have been diagnosed with a rotator cuff tear. These requests come directly to Dr. Raynor.

Office: Texas Orthopaedic Associates, a Division of OrthoLoneStar, 7115 Greenville Avenue, Suite 310, Dallas, TX 75231.

Medically reviewed by M. Brett Raynor, M.D., board-certified orthopaedic sports medicine surgeon. Updated October 2026.

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