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What Is a Rotator Cuff Tear?
A rotator cuff tear is a split or break in one or more of the tendons that connect the shoulder muscles to the upper arm bone. The rotator cuff muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. A tear may be partial, affecting only some tendon fibers, or complete, separating the tendon more fully from its attachment. Rotator cuff tears can affect adults after an injury or develop gradually as the tendons become worn with age and repeated use.
Symptoms
Rotator Cuff Tear Symptoms
- Shoulder pain, especially with movement or overhead activity
- Night pain that may make it difficult to sleep on the affected shoulder
- Shoulder weakness
- Reduced range of motion
- Clicking or crackling (crepitus) when moving the shoulder
- Difficulty lifting the arm
- Difficulty reaching overhead or behind the back
Causes
What Causes a Rotator Cuff Tear?
Sudden injury
A fall onto the arm, forceful lift, or sports injury can suddenly overload the rotator cuff. This force may pull the tendon away from its attachment or split it, sometimes causing a tear in an otherwise healthy tendon.
Gradual tendon wear
Tendon aging, repeated overhead use, and reduced blood supply can weaken the rotator cuff over time. Chronic tendinopathy, inflammation, and narrowing around the tendon can add stress, making a tear more likely and allowing partial damage to become more extensive.
Risk Factors
Rotator Cuff Tear Risk Factors
| Risk category | Examples |
|---|---|
| Non-modifiable | Older age, prior rotator cuff tear, and inherited tendon vulnerability |
| Potentially modifiable or exposure-related | Repetitive overhead work, throwing sports, poor lifting technique, smoking, and untreated shoulder tendon problems |
Having a risk factor does not mean that a rotator cuff tear will occur, and tears can also happen without an obvious risk factor. Repetitive strain may contribute to rotator cuff tendinopathy, while an accident can cause a rotator cuff injury in many different types of shoulders.
Complications
Rotator Cuff Tear Complications
- Chronic shoulder pain can persist, particularly with lifting or overhead movement.
- Shoulder stiffness can limit daily activities and make rehabilitation more difficult.
- Loss of strength may interfere with lifting, reaching, work, or sports.
- Tendon retraction can cause the torn tendon to pull farther from its normal attachment.
- Muscle wasting (atrophy) can develop when the tendon remains torn and the muscle is not used normally.
- Shoulder arthritis, including cuff tear arthropathy, can develop with longstanding extensive tendon damage.
WHY FOLLOW-UP MATTERS
Persistent symptoms need assessment
Worsening weakness or loss of shoulder function should prompt clinical review. Chronic tendon retraction and muscle wasting can sometimes make later rotator cuff repair more difficult.
Diagnosis
How a Rotator Cuff Tear Is Diagnosed
A clinician reviews how the injury happened, when symptoms began, and which activities worsen them. The examination may assess shoulder range of motion, strength, tenderness, and pain during specific movements.
- X-rays do not directly show a tendon tear, but they can identify bone changes, arthritis, or other causes of shoulder pain.
- Ultrasound can show the rotator cuff while the shoulder moves and may identify a partial or complete tear.
- MRI provides detailed images that can help show the tear’s location and size, tendon retraction, and muscle wasting.
Treatment & Management
Rotator Cuff Tear Treatment and Management
ACTIVITY MODIFICATION
Avoid or adjust movements that worsen pain while maintaining safe shoulder motion. A clinician or therapist can help identify activities that protect the tendon without causing unnecessary stiffness.
MEDICATION AND PAIN RELIEF
Clinician-approved pain relievers or anti-inflammatory medicines may help control symptoms. Use them according to medical advice, especially if you have kidney disease, stomach problems, heart disease, take blood thinners, or have other health conditions.
PHYSICAL THERAPY
Physical therapy may use progressive exercises to restore motion, improve shoulder blade control, and strengthen the rotator cuff and surrounding muscles.
INJECTIONS
An injection may temporarily reduce pain when clinically appropriate, but it does not repair a torn tendon. A clinician can discuss potential benefits and risks based on the tear and treatment plan.
When surgery may be considered
Surgery may be considered for a recent traumatic tear, persistent pain or weakness, a larger or more complex tear, poor tendon quality, or activity goals that are not being met with nonsurgical care. Other factors include age, overall health, and how the shoulder responds to treatment. Arthroscopic rotator cuff repair uses small instruments and a camera, while some tears may require an open or mini-open approach. After repair, postoperative rehabilitation is essential, and the result cannot be guaranteed for every person.
Prevention
How to Help Prevent a Rotator Cuff Tear
- Build shoulder and upper-body conditioning gradually rather than suddenly increasing exercise intensity.
- Warm up before throwing, lifting, or other activities that place demand on the shoulder.
- Use balanced strengthening for the shoulder, rotator cuff muscles, and upper back.
- Use safe lifting technique and ask for help with heavy or awkward loads.
- Take regular breaks from repetitive overhead work and vary tasks when possible.
- Have persistent shoulder pain assessed early rather than continuing activities that worsen it.
Recovery Timeline
Rotator Cuff Tear Recovery Timeline
| Stage | Typical focus |
|---|---|
| Early phase | Protect the shoulder, control pain, and maintain safe motion |
| Rehabilitation phase | Restore range of motion and gradually rebuild shoulder strength |
| Return-to-activity phase | Resume work, sport, and overhead activity gradually when strength and movement have improved |
Improvement with nonsurgical care may take several weeks to months. After rotator cuff repair, tendon healing and strengthening commonly take several months and require consistent rehabilitation. The timeline varies with tear size, tendon retraction, muscle wasting, treatment type, general health, and adherence to the rehabilitation plan.
DURING RECOVERY
Know when recovery is not on track
Contact the treating clinician for increasing pain, new weakness, fever, wound drainage, or loss of expected movement during recovery.
