The rotator cuff is a group of four muscles and their associated tendons that stabilizes the shoulder joint and allows for a wide range of arm movements. These muscles are:

• Supraspinatus
• Infraspinatus
• Teres minor
• Subscapularis

Together, these muscles form a cuff over the head of the humerus (the upper arm bone), helping to keep it securely within the shallow socket of the shoulder blade (scapula).

A rotator cuff tear occurs when one or more of the tendons are torn, either partially or completely, away from the bone. Tears can happen suddenly (acute) or develop gradually over time due to wear and tear (degenerative).

Types of Rotator Cuff Tears

• Partial Tear: The tendon is damaged but not completely severed.
• Complete Tear: The tendon is fully detached from the bone, often creating a hole in the tendon.

Acute Injury

Sudden injuries—such as falling on an outstretched arm, lifting something too heavy, or a direct blow to the shoulder—can cause an immediate tear.

Degenerative Wear and Tear

Most rotator cuff tears are the result of age-related degeneration. Factors that contribute include:

• Repetitive shoulder motions (common in sports like tennis or baseball)
• Poor posture
• Bone spurs
• Decreased blood flow with age, which limits the tendon's ability to repair itself

Occupational Risk

Jobs that require frequent overhead movements, such as painters, carpenters, and construction workers, are at increased risk.

Rotator cuff tears do not always cause pain immediately. Some people may not even realize they have one until the damage worsens. Common symptoms include:

• Persistent shoulder pain, especially at night
• Weakness in the shoulder
• Crackling or popping sensation when moving the arm
• Difficulty lifting or rotating the arm
• Pain that worsens with activity or while lying on the affected shoulder

To determine if a tear is present, your healthcare provider will start with a detailed medical history and physical examination. They may also recommend imaging tests, such as:

• X-rays: While X-rays don’t show soft tissues like tendons, they can rule out other causes of pain, such as arthritis or bone spurs.
• Ultrasound: This imaging test provides a real-time look at the rotator cuff, showing tears and inflammation.
• MRI (Magnetic Resonance Imaging): An MRI provides a detailed view of both soft tissues and bones, helping to confirm the size and location of the tear.

The best treatment for a rotator cuff tear depends on several factors, including the size of the tear, the patient’s age, activity level, and overall health.

Non-Surgical Treatment

Many people with partial tears or small full-thickness tears can be treated successfully without surgery. Options include:

• Rest and Activity Modification: Avoiding activities that aggravate the shoulder can allow inflammation to subside.
• Physical Therapy: Customized exercises can strengthen shoulder muscles, improve flexibility, and restore range of motion.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce pain and swelling.
• Corticosteroid Injections: These can provide temporary relief from pain and inflammation, especially if physical therapy alone isn't effective.

Surgical Treatment

Surgery may be necessary if:

• The tear is large or complete
• Symptoms persist despite conservative treatment
• The patient has significant loss of function

Common Surgical Procedures

• Arthroscopic Tendon Repair: A minimally invasive technique using small incisions and a camera to reattach the torn tendon to the bone.
• Open Tendon Repair: Used for larger or more complex tears; involves a larger incision to directly visualize and repair the tendon.
• Tendon Transfer: If the torn tendon is too damaged to be repaired, a nearby tendon may be used to restore shoulder function.
• Shoulder Replacement: In cases with extensive damage, particularly in older adults, a reverse total shoulder replacement may be considered.

Whether surgical or nonsurgical, recovery from a rotator cuff tear involves patience and commitment to rehabilitation.

Phases of Recovery:

• Immobilization (0–6 weeks): The shoulder is often kept in a sling to allow the tendon to heal.
• Passive Range of Motion (6–12 weeks): A therapist moves the arm gently to prevent stiffness.
• Active Movement and Strengthening (3–6 months): The patient gradually regains control and strengthens the shoulder muscles.
• Return to Full Activity (6+ months): Most patients can return to normal activities, though returning to high-impact sports may take longer.

While not all rotator cuff tears can be prevented, you can reduce your risk with these strategies:

• Warm up and stretch before any physical activity
• Strengthen shoulder and upper back muscles
• Avoid repetitive overhead motions when possible
• Use proper lifting techniques
• Maintain good posture

Seek medical attention if you experience:

• Persistent shoulder pain lasting more than a few weeks
• Weakness or inability to lift the arm
• Shoulder pain that interrupts sleep
• A sudden, sharp pain following an injury

A rotator cuff tear can significantly impact your quality of life, making even simple tasks painful and difficult. However, with early diagnosis and appropriate treatment—whether conservative or surgical—most people experience significant improvement and can return to their daily activities.

If you're dealing with shoulder pain or weakness, don’t ignore it. A proper evaluation by a medical professional can lead to a treatment plan tailored to your needs and lifestyle.

Need help with shoulder pain?