A rotator cuff tear is a tear in one of the tendons that surround the shoulder joint and help lift and rotate the arm. This page explains its symptoms, causes and treatment options.
Note: Shoulder pain that persists, or comes with weakness lifting the arm, deserves an assessment by an orthopedic surgeon.
Symptoms
These symptoms may appear, and they need an examination to explain:
- Shoulder pain, especially when lifting the arm
- Night pain that disturbs sleep on the affected side
- Weakness when lifting or rotating the arm
- Difficulty with tasks like combing hair or reaching a shelf
- Clicking or grating when moving the shoulder
- Sudden pain with a tearing feeling after a fall or heavy lift
Causes
A tear may develop from:
- Gradual wear of the tendon with age
- Repeated overhead movements at work or in sport
- A sudden injury such as a fall on the arm or lifting something heavy
- Dislocation or other shoulder injuries
- Long-term rubbing of the tendon against the shoulder bone
Diagnosis
The doctor checks shoulder movement, strength and where it hurts. An X-ray helps assess the bones and causes of rubbing.
An MRI or an ultrasound scan shows the tendons and helps establish the size and type of the tear.
Treatment options
Non-surgical treatment
Not every tear needs surgery. Many patients improve with non-surgical care, especially with partial tears or lower activity demands.
- Rest and changing painful activities
- Physiotherapy to strengthen the shoulder muscles and improve movement
- Cold packs wrapped in a cloth to ease pain
- Injections in some cases, at the doctor's discretion
Surgical treatment
Surgery may be considered for full-thickness tears, recent injuries in active people, or when pain and weakness do not improve with non-surgical care. It is usually done arthroscopically through small incisions to re-attach the tendon to the bone.
Some very large tears may need other approaches, including shoulder replacement in selected cases. The surgeon decides the right option after assessment.
Recovery and rehabilitation
Recovery time depends on the size of the tear and the type of treatment, and the surgeon sets it for each patient. After surgery, following instructions protects the tendon while it heals.
- Protecting the shoulder in a sling after surgery
- Controlling pain and swelling
- Passive, then assisted movement under a therapist's guidance
- Gradual strengthening of the muscles
- Returning to daily activity, work or sport with the surgeon's approval
When to see the doctor
See a doctor if:
- Shoulder pain continues despite rest
- Pain wakes you at night
- You feel weakness lifting the arm
- Sudden pain and weakness follow a fall or heavy lift
- Symptoms of tendinitis have not improved, see shoulder tendinitis and bursitis