Rotator Cuff Tear: Symptoms, Treatment and Recovery

What is the rotator cuff?

The rotator cuff is a group of four muscles and their tendons that wrap around the top of the upper arm bone. Together they keep the shoulder stable and help it move.¹

Rotator cuff injuries are a common cause of shoulder pain. They range from a minor strain through to a partial or complete tear of a tendon.¹

Symptoms of a rotator cuff tear

• Pain in the shoulder and upper arm¹
• Weakness when lifting or turning the arm¹
• Reduced movement¹
• Pain or difficulty with anything above head height, such as washing or brushing your hair¹

Pain when sleeping on the affected side is common too.¹

What causes a tear?

• General wear and tear with age¹
• Repeated lifting or overhead work. Sports such as tennis and swimming, and jobs such as painting¹
• An accident, such as a fall¹

Tears are common, and most do not hurt

This is the most useful thing to know before you look at a scan report.

In a Japanese study that scanned the shoulders of 664 residents of one village, 22.1 per cent had a full-thickness tear. Nobody under 50 had one. The figure was 10.7 per cent of people in their 50s, 15.2 per cent in their 60s, 26.5 per cent in their 70s and 36.6 per cent in their 80s. About two thirds of the tears were causing no symptoms.²

A pooled analysis reached the same conclusion from a different angle. Rotator cuff abnormalities were found in 9.7 per cent of people aged 20 and under and 62 per cent of people aged 80 and over. The authors concluded that this is common enough to be considered a normal part of ageing, and that it makes it hard to know whether a tear seen on a scan is new or is the cause of the pain.³

So a tear on a scan is not automatically the source of your symptoms, and it is not by default a reason for surgery.

How is it diagnosed?

A doctor will ask about your symptoms and examine how the shoulder moves and how strong it is. Tests can include:¹

• An X-ray, to check for other causes of shoulder pain
• An ultrasound scan
• An MRI, to look at the rotator cuff in detail if you are not improving with treatment

Treatment without surgery

Physiotherapy is usually the first treatment. It involves stretching, rehabilitation and strengthening exercises, resting from the activities that make the pain worse, and cold packs. Pain relief and anti-inflammatory medicines can help.¹

It works for most people. In a study of 452 people with full-thickness tears that had come on without an injury, a physiotherapy program was effective for about 75 per cent over two years. Fewer than a quarter chose to have surgery, and most of those who did made the decision within the first 6 to 12 weeks.⁴

If the pain continues, a doctor may suggest a steroid injection.¹

When is surgery considered?

Surgery may be suggested if the shoulder has not improved with other treatment. Your age and how active you are come into the decision.¹

The evidence that surgery beats physiotherapy is weaker than many people assume. A Cochrane review of nine trials with 1,007 participants concluded that it is uncertain whether repair surgery gives meaningful benefits to people with painful tears, and that it may provide little or no important benefit for pain, function or quality of life compared with treatment without surgery.⁵

The people in those trials were mostly in their late 50s and 60s and had had symptoms for many months.⁵ The findings say less about a sudden tear after a significant injury. If you lose strength in the shoulder straight after a fall or accident, get it assessed promptly.

After surgery, most people need several months of rehabilitation with exercises and physiotherapy.¹

Can you live with a torn rotator cuff?

Often, yes. The aim of treatment is a shoulder that is comfortable and does what you need, and many people get there with the tear still present. About two thirds of tears in the general population cause no symptoms, and physiotherapy alone was enough for around three in four people in the study above.^2,4

When to see a doctor

• You have injured your shoulder, or have trouble moving it¹
• Shoulder and arm pain that has not gone away after a few weeks¹
• Night pain that is disturbing your sleep
• A shoulder that is hot, red and swollen, or pain with a fever

Shoulder or arm pain with chest tightness, breathlessness or sweating can be a heart attack. Call 000.⁶

See also our guides to shoulder pain, shoulder bursitis, frozen shoulder and tendonitis.

References

1. healthdirect. Rotator cuff injury.
2. Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop. 2013;10(1):8-12.
3. Teunis T, Lubberts B, Reilly BT, et al. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014;23(12):1913-1921.
4. Kuhn JE, Dunn WR, Sanders R, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013;22(10):1371-9.
5. Karjalainen TV, Jain NB, Heikkinen J, et al. Surgery for rotator cuff tears. Cochrane Database Syst Rev. 2019;12(12):CD013502.
6. healthdirect. Heart attack.