Rotator cuff tear
What is a rotator cuff tear?
The rotator cuff is a group of tendons that stabilise the shoulder and help lift, rotate and control the arm. A rotator cuff tear occurs when one or more of these tendons pulls away from the bone. Tears may develop gradually from tendon wear, or occur suddenly after a fall, lifting injury, shoulder dislocation or sporting trauma.
Small tears may cause pain but preserve strength. Larger or more complex tears can cause weakness, night pain, difficulty lifting the arm, loss of confidence using the shoulder and progressive loss of function.
Common symptoms
Common symptoms include pain over the side of the shoulder or upper arm, pain with reaching or overhead activity, night pain, weakness with lifting, and difficulty returning to gym, work or sport. Some people can still move the arm despite a tear, while others develop marked weakness or stiffness.
Diagnosis and imaging
Diagnosis combines the history, shoulder examination and imaging. X-rays help assess the joint and look for arthritis or bone spurs. Ultrasound or MRI can confirm the tear, assess tendon quality and determine whether the tear is partial-thickness, full-thickness or retracted.
MRI is often useful when planning repair because it shows tendon retraction, muscle quality and fatty change. This helps determine whether a tear is repairable and whether any associated shoulder problems need to be addressed.
Non-surgical treatment
Not every rotator cuff tear requires surgery. Some tears can be managed with physiotherapy, activity modification, anti-inflammatory medication when appropriate and selected injections. Treatment aims to reduce pain, restore shoulder mechanics and improve strength.
Non-surgical treatment is more suitable when symptoms are manageable, strength is preserved, the tear is small or degenerative, or surgery is not the best option for the patient's health or goals.
When is surgery considered?
Surgery may be considered when pain, weakness or functional limitation remains unacceptable despite appropriate non-surgical treatment, or when a traumatic tear causes significant weakness in an active patient.
The decision depends on tear size, tendon retraction, tissue quality, muscle condition, age, activity goals and the risk of the tear becoming less repairable over time. Where repair is appropriate, the goal is to restore the tendon to bone and improve shoulder strength, comfort and function.
Recovery and follow-up
Recovery depends on the size and quality of the tear and whether surgery is required. After rotator cuff repair, the tendon needs time to heal back to bone. A sling is usually used initially, followed by staged physiotherapy to restore movement, strength and control.
Most patients improve gradually over months rather than weeks. A structured rehabilitation plan and realistic expectations are important, particularly for larger tears or revision situations.
Rotator cuff tear FAQs
Does every rotator cuff tear need surgery?
No. Some tears can be managed without surgery, particularly if pain is controlled, strength is acceptable and function remains good.
Surgery is more likely to be considered for traumatic tears, larger tears, progressive weakness, or symptoms that remain unacceptable despite appropriate non-surgical care.
What imaging is best for a rotator cuff tear?
Ultrasound can confirm many rotator cuff tears and may be useful as an initial test.
MRI provides more detail about tendon retraction, muscle quality, fatty change and associated shoulder pathology. It is particularly helpful when surgery is being considered.
Can a rotator cuff tear get bigger over time?
Some tears can enlarge over time, particularly larger full-thickness tears. As tears enlarge, the tendon can retract and the muscle can lose quality, which may make repair more difficult.
This is why assessment should consider both symptoms and imaging, especially after a traumatic injury or when weakness is increasing.
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