Rotator Cuff Tear

A rotator cuff tear is a partial or complete split in one or more tendons that help move and stabilise the shoulder.

The tear may develop gradually as tendon tissue becomes less resilient, or occur after a fall, forceful lift or sudden shoulder movement. The location and size of the tear influence pain, strength and treatment choices.

A rotator cuff tear commonly presents with shoulder weakness, shoulder pain, pain when lifting the arm, night pain and shoulder stiffness. Some people notice a sudden loss of strength after an injury, while others develop symptoms slowly.

Pain can be felt at the front or side of the shoulder and may worsen when reaching overhead, dressing or lying on the affected side. Symptoms alone cannot show whether a tendon is torn; several shoulder conditions can feel similar.

Repeated overhead loading can gradually wear the tendon. A traumatic event, such as landing on an outstretched hand or trying to stop a heavy object, can also injure it. Rotator cuff tendinitis may irritate the same tendon group without a tear, while shoulder osteoarthritis can change joint mechanics and add strain.

Symptoms may settle with activity adjustment and rehabilitation, or remain when the tendon is repeatedly overloaded. A clinician considers whether weakness is improving, whether movement is becoming more limited and whether pain interferes with sleep or work. Progress is individual and does not depend on pain alone.

Risk is higher with repeated overhead work or sport, a previous shoulder injury, age-related tendon changes and smoking. Poor shoulder control or prolonged inactivity may also make return to lifting harder. These factors do not confirm a tear; examination and, when needed, imaging are used to clarify the cause.

Assessment usually starts with the history of onset, pain pattern and affected activities. The clinician compares both shoulders, checks active and assisted movement, and uses resisted tests to assess individual tendon function.

Ultrasound or magnetic resonance imaging can show tendon damage and help distinguish a partial tear from a complete tear. An X-ray may help identify bone or joint changes, although it does not show the tendon itself.

Treatment is matched to tear type, symptoms, strength, activity needs and general health. Physiotherapy may use graded mobility, strengthening and movement retraining. Pain relief, temporary activity changes and a cortisone injection may be discussed in selected cases; an injection does not repair a torn tendon.

Rotator cuff repair may be considered when weakness or pain persists, particularly after an acute injury or when everyday function remains limited. For severe shoulder damage with poor tendon function, reverse shoulder replacement may be an option. A specialist explains expected rehabilitation and alternatives before a decision.

Keep the shoulder moving within a comfortable range unless a clinician has given different instructions. Break overhead tasks into shorter periods, keep loads close to the body and use the other arm for heavier work while strength is limited. Follow the rehabilitation plan consistently and report a new, marked loss of movement or strength.

Persistent pain, weakness and stiffness can reduce work, sport and self-care. A large or longstanding tear may lead to muscle wasting and altered shoulder mechanics. Prompt assessment after a significant injury is sensible when the arm suddenly becomes difficult to lift.

Build overhead strength gradually, warm up before demanding activity and vary repetitive tasks. Use lifting technique that keeps objects close and avoid increasing training load abruptly. Early attention to ongoing shoulder pain can help prevent repeated aggravation.

An orthopaedic shoulder specialist, sports-medicine clinician or physiotherapist can assess symptoms and function. Bring details of the injury, movements that trigger pain, sleep disruption and any previous scans. The right assessment links imaging findings to how the shoulder actually works.