Rotator Cuff Tear
Also known as: Torn rotator cuff، Shoulder cuff tear، Rotator cuff injury
The rotator cuff is a group of 4 tendons that stabilize and move the shoulder. A tear in one or more tendons causes shoulder pain and weakness, particularly when lifting the arm. Tears can be acute (injury) or degenerative (age-related wear).
Common Symptoms
- Pain at the top and outer side of the shoulder
- Pain at night, often preventing sleep on the affected side
- Weakness when lifting the arm (especially overhead)
- Difficulty reaching behind back (e.g., fastening a bra, reaching back pocket)
- Crackling or popping sensation when moving the shoulder
- Limited range of motion in specific directions
- Pain when carrying objects with the affected arm
Causes & Risk Factors
- Acute injury — fall on outstretched arm, lifting something heavy, sports injury
- Degenerative wear (most common in patients over 50)
- Repetitive overhead activities (painting, swimming, throwing sports)
- Occupational risk (carpentry, construction, heavy lifting)
- Smoking (reduces tendon blood supply)
- Family history
- Bone spurs in the shoulder rubbing against the tendons (impingement)
Treatment Options
Rest and activity modification
Avoid overhead activities and movements that cause pain. Doesn't mean immobilize — gentle range-of-motion exercises help prevent stiffness.
Physical therapy
Strengthening the remaining intact rotator cuff and surrounding shoulder muscles. Particularly effective for partial tears and small full-thickness tears. 6-12 weeks of structured PT.
NSAIDs
Short course to control pain and inflammation, especially during flare-ups. Topical NSAIDs (diclofenac gel) for ongoing management with fewer side effects.
Cortisone injection
Sub-acromial (under the shoulder bone) cortisone injection can provide significant pain relief for weeks to months. Limited to 2-3 per year. Best for partial tears or pre-surgery pain control.
Arthroscopic rotator cuff repair
Keyhole surgery to reattach the torn tendon to the bone. Highest success for full-thickness tears in patients with good tissue quality. Recovery: sling 4-6 weeks, PT 3-6 months, return to overhead activities 6-12 months. About 85-90% of patients regain near-full function.
When to See a Doctor
- Shoulder pain persisting more than 4-6 weeks
- Inability to lift the arm above shoulder height
- Significant weakness in the arm
- Shoulder pain after a specific injury (fall, lifting)
- Night pain disturbing sleep
- Limited shoulder motion affecting daily activities
Frequently Asked Questions
Do all rotator cuff tears need surgery?
No. Small partial tears in older patients with low physical demands often respond well to physical therapy and injections. Surgery is recommended for full-thickness tears, large tears, tears in younger active patients, and tears causing significant weakness unresponsive to conservative care.
How long is recovery after rotator cuff surgery?
Sling for 4-6 weeks. Passive physical therapy starts immediately. Active strengthening at 6-12 weeks. Return to most daily activities at 3-4 months. Full strength and return to overhead athletics at 6-12 months. Patience and PT compliance are critical.
Can a rotator cuff tear heal on its own?
Partial tears can heal partially with rest and PT — the tear itself doesn't fully close, but symptoms can resolve. Full-thickness tears almost never heal naturally because the tendon ends retract and tendons have poor blood supply.
What's the difference between rotator cuff tear and frozen shoulder?
Rotator cuff tear: limited active motion (can't lift arm yourself) but normal passive motion (doctor can lift it). Frozen shoulder: limited BOTH active and passive motion. Treatment differs substantially.
Can I delay rotator cuff surgery?
Small tears can be observed. Large or full-thickness tears tend to enlarge over time as the tendon retracts. Delaying surgery for years may make repair more difficult or impossible. If surgery is recommended, the best window is within 3-6 months.