Introduction
The shoulder is the joint I have spent more than twenty years operating on. It is complex, demanding, and the joint that most consistently rewards precise diagnosis and careful decision making. Get the diagnosis right, select the right intervention, execute it well and the outcomes are excellent. If any of those steps are missed or done incorrectly and the patient undergoes treatment that isn’t appropriate, then their shoulder will be no better than where they started.
At New York Bone & Joint Specialists, shoulder care begins with evaluation. Not every shoulder that hurts needs surgery. Not every shoulder with a positive finding on MRI needs to be operated on. The rotator cuff tear that is incidental, asymptomatic, and small in an older, lower-demand patient is a different clinical problem than the acute full-thickness tear in a fifty-year-old or twenty-nine-year-old contractor who uses their shoulder for work. The management philosophy has to be specific to the patient in front of you, and the recommendation has to be honest about what surgery will and will not accomplish.
This page describes what we treat, how we make decisions, what our outcomes look like, and why the clinical model at New York Bone & Joint produces results that differ from what most patients experience elsewhere.
Shoulder Conditions We Treat
| Condition | What It Is | The New York Bone & Joint Approach |
| Rotator Cuff Tear | Partial or full-thickness tear of one or more rotator cuff tendons, most commonly the supraspinatus. May be acute (traumatic) or chronic (degenerative). | Non-surgical for appropriate candidates. Surgical repair (arthroscopic double-row technique) for full-thickness tears in active patients before significant fatty infiltration develops. Re-tear rate 2–4% vs. published 10–20%. [2] [3] |
| SLAP Tear | Superior labrum anterior-to-posterior tear at the biceps anchor. Common in overhead athletes and throwing sports. | Physical therapy and activity modification first. Surgery (SLAP repair or biceps tenodesis depending on age and tissue quality) when conservative management fails. 90% return-to-overhead-sport after repair. [4] |
| Shoulder Instability / Bankart Lesion | Anterior labral tear following traumatic shoulder dislocation. Recurrence rate >70% in patients under 25 without surgery. [5] | Pre-operative bone loss assessment as standard. Bankart repair for appropriate candidates. Latarjet procedure for significant bone loss (>20–25%). Re-dislocation rate <4% vs. published 5–15%. [5] [6] [7] |
| Biceps Tendon Injuries | Partial or complete proximal biceps tendon tear; biceps tendinopathy in the bicipital groove. | Non-surgical for older, lower-demand patients. Biceps tenodesis (reattachment to humerus) for younger active patients who require functional strength and cosmesis. Tenotomy for older patients who prefer simplest procedure. |
| Shoulder Impingement / Bursitis | Subacromial impingement of rotator cuff tendons against the acromion. Associated with bursitis and rotator cuff tendinopathy. [1] | Physical therapy-first approach targeting rotator cuff strengthening and periscapular stabilization. Cortisone injection when appropriate. Subacromial decompression reserved for documented structural impingement that has failed genuine conservative management. |
| Frozen Shoulder (Adhesive Capsulitis) | Progressive capsular contraction causing pain and restricted range of motion in all planes. Three stages: freezing, frozen, thawing. | Stage-appropriate treatment: physical therapy in freezing stage, corticosteroid injection into glenohumeral joint, manipulation under anesthesia, or arthroscopic capsular release for refractory frozen shoulder. |
| Shoulder Arthritis | Glenohumeral osteoarthritis or inflammatory arthritis (rheumatoid, psoriatic) affecting the shoulder joint. | Non-surgical management for early and moderate arthritis: cortisone injections, viscosupplementation, physical therapy. Total shoulder replacement (anatomic TSR and reverse TSR) is performed at New York Bone & Joint for appropriate candidates with advanced glenohumeral arthritis. Our sports medicine team manages non-surgical care; surgical consultation with Dr. Popovitz determines when replacement is indicated. |
| AC Joint Injuries | Acromioclavicular joint separation following direct trauma to the shoulder. Grades I–VI. | Non-surgical management for Grade I–III injuries. Surgical stabilization for Grade IV–VI injuries or chronic symptomatic Grade III. |
Surgical vs. Non-Surgical: How We Decide
Ninety percent of New York Bone & Joint shoulder patients are treated successfully without surgery. This reflects a clinical reality: most shoulder conditions respond to the right non-surgical program when that program is genuinely structured and genuinely followed.
The surgical conversation at New York Bone & Joint begins when one of three conditions is met: the clinical picture is one where surgery is clearly the most effective path forward (an acute full-thickness rotator cuff tear in a fifty-year-old active patient, for example); conservative management has been tried and has reached its limit; or the condition has a time-sensitive window after which the surgical option becomes significantly less effective (rotator cuff fatty infiltration, shoulder instability with progressive bone loss).
What we don’t do is recommend surgery as the default because it’s the faster path to a recommendation, because the patient expects it, or because the imaging shows a finding. A finding on an MRI is not automatically the source of the patient’s pain. The recommendation has to be based on the full clinical picture.
New York Bone & Joint Shoulder Outcomes
| Procedure | New York Bone & Joint Outcome | Published Benchmark | What Drives the Difference |
| Rotator Cuff Repair — Re-tear Rate | 2–4% | 10–20% [2] | Appropriate patient selection (before significant fatty infiltration), double-row technique, coordinated in-house physical therapy protocol. |
| Rotator Cuff Repair — Patient Satisfaction | 94% | 80–90% (varies by tear size) | Outcome data above, plus honest pre-operative candidacy assessment. |
| Bankart Repair — Re-dislocation Rate | <4% | 5–15% [5] | Rigorous pre-operative bone loss assessment (CT when indicated). Anatomic repair technique. No Bankart repair on patients who should be having Latarjet. |
| SLAP Repair — Return to Overhead Sport | 90% | 40–80% [4] | Appropriate patient selection (repair vs. tenodesis decision based on age and tissue quality). Precise anchor placement. Overhead athlete-specific physical therapy protocol. |
The Shoulder Surgical Procedures We Perform
Arthroscopic Rotator Cuff Repair
Rotator cuff repair is performed arthroscopically at Lenox Hill Hospital as an outpatient procedure. For full-thickness tears, we use a double-row repair technique that provides superior footprint coverage and healing geometry compared to single-row repair. [3] The graft of the rotator cuff footprint is recreated as closely as possible to the native anatomy.
The repair is followed by a protected rehabilitation protocol (four to six weeks in a sling with passive motion only) before active strengthening begins. Return to overhead sport is criteria-based at nine months.
For the full procedure overview, see our rotator cuff repair page.
SLAP Repair and Biceps Tenodesis
SLAP tears are among the most commonly missed diagnoses in shoulder medicine. Standard MRI has limited sensitivity for labral pathology: MRI arthrogram is the appropriate diagnostic study for overhead athletes with persistent shoulder pain and negative or equivocal standard MRI.
For patients under 35 with Type II SLAP tears and overhead athletic demands, SLAP repair is the appropriate procedure. For patients over 35–40, or those with degenerative tissue or significant biceps involvement, biceps tenodesis produces comparable functional outcomes with better reliability at that age.
For the full overview, see our SLAP repair page.
Bankart Repair and Shoulder Stabilization
Every shoulder instability patient at New York Bone & Joint is evaluated for glenoid bone loss before surgery. We don’t discover significant bone loss intraoperatively. CT imaging is obtained when the number of dislocations and clinical picture suggest bone loss is possible.
For patients with greater than 20–25% glenoid bone loss, the Latarjet procedure is performed rather than Bankart repair because a Bankart repair on a deficient glenoid will fail at a high rate regardless of surgical technique. For patients with adequate bone stock, arthroscopic Bankart repair with anatomic capsulolabral reconstruction produces a re-dislocation rate below 4%.
For the full overview, see our Bankart repair page.
Shoulder Arthroscopy
Shoulder arthroscopy is performed as an outpatient procedure at Lenox Hill Hospital through two or three small portals. The arthroscope provides a magnified, real-time view of the glenohumeral joint, subacromial space, and biceps anchor.
Concurrent findings identified at arthroscopy (like labral pathology, biceps involvement, and/or cartilage damage) are addressed in the same surgical session.
For the full overview, see our shoulder arthroscopy page.
The New York Bone & Joint Approach: What Makes it Different
| The New York Bone & Joint Advantage | What it Means for You |
| Preservation-first by design | 90% of shoulder patients treated without surgery. The clinical incentive at New York Bone & Joint is to find the most precise non-surgical solution first. Our sports medicine physicians manage the full non-surgical shoulder program: structured physical therapy, ultrasound-guided injections, return-to-sport protocols. Surgery is the right answer when it is the right answer. Not before. |
| Fellowship-trained subspecialist | Dr. Popovitz completed fellowship training in sports medicine at NYU Langone Medical Center, one of the premier sports medicine programs in the country. His subspecialty depth in shoulder surgery is specific, not general. Supporting him is a full team of board-certified sports medicine physicians: Drs. Munyak, Bytici, Davis, Razani, and Martin. They manage non-surgical shoulder care within the same practice. |
| US Open Tennis experience | Serving as team physician at the US Open Tennis Championships provides direct clinical experience with overhead athletes at the highest competitive level. The decision-making required at that level informs every shoulder consultation. |
| Rotator cuff re-tear rate 2–4% | Against a published benchmark of 10–20%. [2] [3] Achieved through appropriate patient selection (timing before fatty infiltration), double-row technique, and coordinated in-house rehabilitation. |
| Bankart re-dislocation rate <4% | Against a published benchmark of 5–15%. [5] Achieved through rigorous pre-operative bone loss assessment and anatomic repair technique. Latarjet performed when bone loss exceeds the threshold for safe Bankart repair. |
| SLAP repair return-to-overhead-sport 90% | Against a published benchmark of 40–80%. [4] Achieved through appropriate repair vs. tenodesis selection and overhead athlete-specific rehabilitation protocol. |
| Pre-operative bone loss assessment as standard | Every shoulder instability patient is evaluated for glenoid bone loss before surgery. CT imaging when indicated. No surprises in the operating room. The right procedure is planned before the patient is on the table. |
| In-house physical therapy | Your surgeon, sports medicine physician, and physical therapist are in the same center. The physical therapist reads the operative report. The rehabilitation protocol is built around what was actually done in the operating room. If your shoulder is being managed non-surgically, your sports medicine physician and physical therapist coordinate directly. No referral chain. No communication gap. |
| Total shoulder replacement available | New York Bone & Joint performs both anatomic total shoulder replacement and reverse total shoulder arthroplasty for appropriate candidates with advanced glenohumeral arthritis or irreparable rotator cuff disease. Performed at Lenox Hill Hospital — Northwell Health, as an outpatient or short-stay procedure. Same-center physical therpay coordination throughout recovery. |
From Dr. Popovitz: The Shoulder Case that Stayed with Me
| A patient came to see me in his late forties. He was a professional musician, a violinist. He had been managing right shoulder pain for 14 months. He had received three cortisone injections in the subacromial space for what had been diagnosed as impingement. Each injection gave him four to six weeks of relief before the pain returned. He had done physical therapy twice. His MRI showed subacromial bursitis and what the radiology report described as mild rotator cuff tendinopathy.
When I examined him, his rotator cuff strength was intact. His impingement signs were equivocal. But when I tested his long head of biceps, I reproduced his pain exactly. His MRI had been read as showing normal biceps. When I looked at the images myself with the clinical picture in mind, I saw a subtle partial tear at the biceps anchor and early changes at the superior labrum. I ordered an MRI arthrogram. It showed a Type II SLAP tear with a small paralabral cyst that had been described as incidental on his prior imaging. The three subacromial cortisone injections had been treating the wrong structure. I performed an arthroscopic SLAP repair. He returned to playing professionally at seven months post-surgery. 14 months of the wrong diagnosis, corrected in one visit with the right clinical examination and the right imaging. The cortisone never reached the structure generating his pain. This is the case I use when I explain to colleagues why the clinical examination, not the imaging report, is where the diagnosis is made. — Dr. Leon Popovitz |
References
- AAOS. Rotator Cuff Tears. OrthoInfo. orthoinfo.aaos.org/en/diseases–conditions/rotator-cuff-tears
- Galatz LM et al. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004. pubmed.ncbi.nlm.nih.gov/14960664
- Kholinne E et al. Return to physical activities after arthroscopic rotator cuff repair: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2023. pubmed.ncbi.nlm.nih.gov/36792854
- Boileau P et al. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005. pubmed.ncbi.nlm.nih.gov/15930531
- Cole BJ et al. Arthroscopic versus open Bankart repair for traumatic anterior shoulder instability. Clin Sports Med. 2000. pubmed.ncbi.nlm.nih.gov/10652663
- Balg F, Boileau P. The instability severity index score. J Bone Joint Surg Br. 2007. pubmed.ncbi.nlm.nih.gov/17998184
- Deng Z et al. Surgical considerations for glenoid bone loss in anterior glenohumeral instability. Eur J Trauma Emerg Surg. 2024. pubmed.ncbi.nlm.nih.gov/37642655
- Foley A et al. Return to sport following ACL reconstruction. Curr Rev Musculoskelet Med. 2025. pubmed.ncbi.nlm.nih.gov/40676343
- AAOS. SLAP Tears. OrthoInfo. orthoinfo.aaos.org/en/diseases–conditions/slap-tears
