Rotator Cuff Tear

A rotator cuff tear is a common shoulder injury that can cause pain, weakness, and limited movement—especially when lifting your arm. The majority of rotator cuff tears occur gradually over time; a small percentage may occur after trauma or injury. Rotator cuff tears can be partial (the tendon is damaged but not completely torn) or complete (the tendon is fully detached from its bony insertion; also known as a full-thickness rotator cuff tear).

Whether your tear is partial or complete, getting the right diagnosis and treatment can help you return to the activities you enjoy.

What Causes a Rotator Cuff Tear?

The rotator cuff is a group of four muscles and tendons that allow you to lift and rotate your arm. A tear happens when one or more of these tendons become damaged or tear free from the bone. A rotator cuff tear can be caused by:

• Repetitive overhead motions (often seen in sports like baseball, swimming, and tennis)
• Age-related wear and tear
• Bone spurs that rub against the tendon (impingement)
• Acute injury (e.g., falling on your arm or lifting something heavy)

Adults over age 40 and people with physically demanding jobs or active lifestyles are more likely to develop this condition.

What Are the Symptoms of a Rotator Cuff Tear?

Symptoms can vary depending on the size and type of tear, but commonly include:

• Pain that gets worse when lifting/lowering your arm
  • In most situations, the pain is related to “bursitis” (inflammation in the bursal sac that sits on top of the rotator cuff tendon)
• Weakness
• Limited range of motion, especially difficulty reaching behind your back
• Clicking or popping sounds with movement
• Pain at night or when lying on the affected shoulder

Some people experience a sudden, sharp pain from an injury, while others notice symptoms worsening over time. Symptoms can vary depending on the size and type of tear.

When Should I See a Shoulder Specialist?

You should visit an orthopedic surgeon or sports medicine specialist if you have:

• Persistent shoulder pain that won’t go away
• Trouble lifting or rotating your arm
• Weakness in your shoulder
• Pain that interferes with sleep or work

It is rare for patients to have a full-thickness rotator cuff tear and a frozen shoulder, but both can occur if the patient does not continually move the shoulder due to pain.

Early diagnosis and treatment help avoid long-term problems.

How Is a Rotator Cuff Tear Diagnosed?

To diagnose a rotator cuff tear, your specialist will:

• Ask about your symptoms, activity level, and injury history
• Examine your shoulder for tenderness, strength, and range of motion
• Order imaging tests like X-rays, MRI, or ultrasound to confirm the tear and see how severe it is

How Is a Rotator Cuff Tear Treated?

Treatment depends on:

• Size of the tear
• Retraction of the tear (how far has the tendon pulled away from the bone insertion
• Muscle atrophy (shrinkage) – for chronic tears, the muscle will shrink (atrophy) since its tendon is not attached to bone (it’s like the muscle is unplugged from the electricity it normally receives when the tendon is attached)
• Your age
• Activity level
• Overall health
• Severity of symptoms

Small or partial tears often improve with nonoperative treatment, while larger or complete tears may require surgery.

Nonsurgical Treatments

Most cases respond well to nonoperative care, including:

• Rest
• Activity modification
• Ice and anti-inflammatory medications (NSAIDs)
• Physical therapy
• Shoulder strengthening and stretching exercises
• Corticosteroid injections to reduce pain and swelling

Treatment usually begins with nonoperative options before considering surgery.

Surgical Treatments

Surgery may be necessary if:

• The tear is large or complete
• Pain and weakness persist after nonoperative treatment
• The patient is young or highly active
• The tear was caused by an injury

Surgical procedures include:

• Arthroscopic repair: Minimally invasive, using small incisions and a camera
• Tendon transfer or shoulder replacement: Options used for severe or irreparable tears

What Are the Risks of Rotator Cuff Surgery?

Rotator cuff surgery is generally safe and effective, but like any surgical procedure, it comes with potential risks, including:

• Recurrent tearing (failure to heal or recurrent tear)
  • This is the most common complication
• Stiffness or loss of range of motion
• Infection
• Nerve damage
• Blood clots

Recovery after rotator cuff surgery requires a strong commitment to rehabilitation. Following your surgeon’s and physical therapist’s instructions closely is the best way to avoid complications and achieve a full recovery.

What Does Recovery Involve?

Recovery depends on the severity of the tear and whether surgery is needed. Most recovery plans involve:

• Rest
• Immobilization (use of a sling for surgical patients)
• Physical therapy
• Gradual return to normal activities

Adhering to your rehabilitation plan is essential for long-term success, especially after surgery.

How Long Does Rotator Cuff Tear Recovery Take?

Recovery times vary based on the treatment strategy used.

• Nonoperative recovery: 6 to 12 weeks
• Post-surgical recovery: 4 to 6 months (sometimes up to 1 year for full strength)

For the best outcomes and fastest recovery, it’s important to follow your care plan.

What Is the Outlook for a Rotator Cuff Tear?

Most people recover well with the right treatment. Full-thickness rotator cuff tears do NOT heal and are at risk for progressing.  Partial thickness tears can often be treated non-operatively, but should be monitored with a follow-up MRI in 6-12 months (or sooner if symptoms warrant).