Rotator Cuff Tears: Causes, Symptoms & Treatment (2023)


Rotator Cuff Tears: Causes, Symptoms & Treatment (1)

What is the rotator cuff?

The rotator cuff is a group of muscles and tendons in your shoulder. They help you lift and move your arms away from your body. The rotator cuff keeps the ball of the upper arm bone (humerus) in the shoulder blade socket.

What is a rotator cuff tear?

The shoulder is a ball-and-socket joint that’s part of the skeletal system. It’s like a golf ball sitting on a golf tee. Rotator cuff tears occur when tendons pull away from the arm bone. A tear may result from overuse or another injury.

What are the types of rotator cuff tears?

Types of torn rotator cuffs include:

  • Partial: With an incomplete or partial tear, the tendon still somewhat attaches to the arm bone.
  • Complete: With a full-thickness or complete tear, the tendon separates completely from the bone. There’s a hole or rip in the tendon.

How common are rotator cuff tears?

More than two million Americans experience some type of rotator cuff problem every year. Rotator cuff tears affect people of all ages and genders, but the problem is more common in adults.

Symptoms and Causes

What causes a rotator cuff tear?

An accident, such as a fall, can cause a broken collarbone or dislocated shoulder that tears the rotator cuff.

More commonly, rotator cuff tears occur over time as the tendon wears down with age and use (degenerative tear). People over 40 are most at risk.

Causes of degenerative tears include:

  • Bone spurs: Bony growths can form on the top of the shoulder bone. These bone spurs rub against the tendon when you lift your arm. This shoulder impingement creates friction between the bone and tendon. Eventually, a partial or complete tear may occur.
  • Decreased blood flow: Blood flow to the rotator cuff decreases as you get older. Your muscles and tendons need a healthy blood supply to repair themselves. If blood doesn’t nourish the tendons, they can tear.
  • Overuse: Repetitive shoulder movements during sports or on the job can stress muscles and tendons, causing a tear.

What are risk factors for rotator cuff tears?

Anyone can experience a rotator cuff tear. These factors may increase your risk:

  • Family history of shoulder problems or rotator cuff injuries.
  • Poor posture.
  • Smoking.
  • Being age 40 or older.

Degenerative tears are more common among people who do the same repetitive shoulder movements, such as:

  • Carpenters.
  • Mechanics.
  • Painters.
  • Recreational and professional athletes who play baseball, softball and tennis or are part of a rowing crew.

Do rotator cuff tears affect both shoulders?

Tears tend to occur on your dominant side, but can be on either side. Having a tear in one shoulder increases the likelihood of a tear in the opposite shoulder. You might not have shoulder pain on the opposite side, but tests may indicate a tear. The opposite may also be true: you may have a tear but have no pain or symptoms.

What are the symptoms of a rotator cuff tear?

Sudden tears from accidents cause immediate, intense shoulder pain and arm weakness. With degenerative tears, you may have mild pain that improves with over-the-counter pain relievers. Over time, the pain gets worse, and pain relievers don’t help. Not everyone has pain, but most people have some degree of arm and shoulder weakness.

Signs of a rotator cuff tear include:

  • Difficulty and pain caused by raising your arm.
  • Popping or clicking sounds or sensations when moving your arm.
  • Shoulder pain that worsens at night or when resting your arm.
  • Shoulder weakness and struggling to lift items.

Diagnosis and Tests

How is a rotator cuff tear diagnosed?

Your healthcare provider will perform a physical exam to check for shoulder tenderness, range of motion and arm strength.

To confirm a diagnosis, you may get:

  • An X-ray to check for arthritis or bone spurs.
  • An MRI or ultrasound to look for tendon tears.

Management and Treatment

What are the complications of a rotator cuff tear?

A rotator cuff tear can get worse without treatment. A complete tear can make it almost impossible to move your arm. Without treatment, you may have chronic shoulder pain and find it very difficult to use the injured arm.

What are nonsurgical treatments for rotator cuff tears?

Rotator cuff tears do not heal on their own without surgery, but many patients can improve functionally and decrease pain with nonsurgical treatment by strengthening their shoulder muscles. Just because there is a tear, does not necessarily mean a surgery is needed. About eight out of 10 people with partial tears get better with nonsurgical treatments. It can take up to a year for the condition to improve.

Nonsurgical treatments include:

  • An arm sling and rest to give your shoulder time to heal. You may need to modify activities and stop certain work or sports for a period of time.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to minimize pain and swelling.
  • Physical therapy to learn strengthening and stretching exercises.
  • Steroid injections to ease pain and swelling.

What are the surgical treatments for rotator cuff tears?

Your healthcare provider may recommend surgery if you have a complete tear or nonsurgical treatments don’t help a partial tear. You may also have surgery if your job or athletic interests affect the shoulder.

Most rotator cuff surgeries take place arthroscopically through small incisions. The surgery is an outpatient procedure. You go home the same day, but the overall recovery after this surgery is very substantial and can take up to a year or more.

Some tears are not repairable due to the size and/or age of the tear, and may necessitate reverse shoulder replacement, tendon transfer, or a debridement of scar tissue without repair.

During surgery, your healthcare provider:

  • Inserts an arthroscope (small camera) through a small incision in your shoulder.
  • Refers to images from the arthroscope to perform the procedure.
  • Inserts tiny instruments into small incisions in your shoulder to remove bone spurs and reattach the tendon to the upper arm bone.

For a partial tear, your healthcare provider may only need to trim fraying pieces of a partially torn tendon. This debridement procedure keeps the shoulder ball and socket from catching on the tendon and tearing it more.

After surgery, you need to wear a sling to immobilize your arm for four to six weeks. You can then start physical therapy. Most people regain shoulder function and strength within four to six months after surgery, but full recovery may take up to 12-18 months.


How can I prevent a rotator cuff tear?

To prevent a rotator cuff tear, it’s important to keep your muscles and tendons flexible. Your healthcare provider can teach you stretching and strengthening exercises to do at home.

Outlook / Prognosis

What is the prognosis (outlook) for people who have a rotator cuff tear?

Most people see improvements with nonsurgical treatments. Recovery takes time because your body needs time to heal. Most people who have surgery to repair a torn rotator cuff regain function.

It’s possible to tear the same tendon again, especially if the first tear was bigger than 1 inch. A re-tear that causes severe pain or loss of movement may require surgery.

Living With

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

  • Chronic shoulder and arm pain.
  • Pain that worsens at night or interferes with sleep.
  • Redness, swelling, or tenderness in the shoulder joint area.
  • Shoulder or arm weakness.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

  • What caused the rotator cuff tear?
  • What is the best treatment for me?
  • What can I do to lower the risk of getting another rotator cuff tear?
  • Should I look out for signs of complications?
  • Which signs of complications?

A note from Cleveland Clinic

If you work a very physical job or you’re an athlete, a rotator cuff injury will likely bench you, but it doesn’t have to be the end of your career. Talk to your healthcare provider about the best treatment options, whether nonsurgical or surgical. Your shoulder may be weak and painful for a while, but it will eventually heal.


Rotator Cuff Tears: Causes, Symptoms & Treatment? ›

A partial or complete rotator cuff tear makes it difficult to raise and move your arm. You may have shoulder pain and arm weakness. Rotator cuff injuries are common, especially as you get older. Rest, pain relievers and physical therapy can help.

What are the 2 most common causes of rotator cuff tears? ›

There are 2 main causes of rotator cuff tears: injury and degeneration. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand. It may also develop over time due to repetitive activities. Rotator cuff tears may also happen due to aging, with degeneration of the tissues.

Where do you feel pain if you have a torn rotator cuff? ›

Typically, you will feel pain in the front of your shoulder that radiates down the side of your arm.

Does a torn rotator cuff hurt all the time? ›

Rotator cuff tendon tears often cause pain at night. The pain may even wake you. During the day, the pain is more tolerable, and usually only hurts with certain movements, such as overhead or reaching toward the back.

Can you tell if you have a rotator cuff tear without an MRI? ›

Ultrasound does have the ability to identify rotator cuff tendon tears but with certain limitations. One factor is that it requires special training for the staff, as this is a less commonly performed imaging test. Second, the tendons may not be adequately seen in obese patients or those with a limited range of motion.

How do doctors tell if you tore your rotator cuff? ›

Your doctor uses imaging tests to help diagnose a rotator cuff injury. An X-ray helps to rule out bone spurs or osteoarthritis as a cause of your symptoms. An MRI scan enables your doctor to see the soft tissue in the shoulder and determine if you have a rotator cuff tear and whether it is partial or full thickness.

How long does it take for a torn rotator cuff to heal without surgery? ›

Usually, mild rotator cuff tears or sprains will heal within four weeks. In other severe cases, the recovery might take 4 to 6 months or even longer based on several factors such as the severity of the tear, age, and other health complications.

How do I know if it's a rotator cuff tear or tendonitis? ›

Tendonitis pain and chronic rotator cuff tendon pain can be gradual and can worsen overtime with continued use of the shoulder joint. In contrast, an acute rotator cuff tear will typically present with sharp, immediate pain and weakness in the shoulder joint.

How to tell the difference between a rotator cuff tear and strain? ›

There are a few key differences between a rotator cuff strain and tear. A rotator cuff strain is a stretching or micro-tearing of the tendons and muscles surrounding the shoulder joint while a tear is a complete or partial tearing of one or more of the tendons in the shoulder.

Does rotator cuff pain radiate down arm? ›

Can a rotator cuff injury cause pain in your arm and hand, too? Yes. Typically, the pain starts as a dull aching pain in your shoulder. As the injury progresses, it can cause radiating pain down the arm and into your hands.

What type of doctor do I see for a rotator cuff injury? ›

If you have any of these symptoms, you should request evaluation from an orthopedic shoulder specialist immediately. People over 50 years of age who experience any of these symptoms are considered high risk for rotator cuff tear.

What does a completely torn rotator cuff feel like? ›

The pain associated with a rotator cuff injury may: Be described as a dull ache deep in the shoulder. Disturb sleep. Make it difficult to comb your hair or reach behind your back.

Can you make a rotator cuff tear worse? ›

Delaying treatment of a torn rotator cuff can increase the risk of the shoulder sustaining even more damage because the tendons and muscles cannot heal properly. The overused muscles will start fraying, and additional tears can develop.

What happens if you don t do anything about a torn rotator cuff? ›

Without any treatment—either rest and rehabilitation or surgery—rotator cuff disorders may get worse. Over time, you may have more pain. You may lose range of motion and strength in your shoulder, making it harder to do your daily activities.

How to tell the difference between a rotator cuff tear and a tendon tear? ›

Tendonitis pain and chronic rotator cuff tendon pain can be gradual and can worsen overtime with continued use of the shoulder joint. In contrast, an acute rotator cuff tear will typically present with sharp, immediate pain and weakness in the shoulder joint.

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