A rotator cuff tear is a tear in one of the tendons that hold your shoulder in place. It can be PARTIAL (part way through) or FULL thickness (all the way through).
Tears are very common with age, and many cause no pain at all. Over 60, a tear with no symptoms is about twice as common as a painful one.
Most painful tears that come on gradually get better with physio. About 3 in 4 people avoid surgery. A tear from a sudden injury with real weakness is different, and it’s more urgent.
Symptoms
- Pain at night and at rest, often waking you
- Pain lifting or turning the arm
- Weakness, especially lifting the arm or turning it outward
- Sometimes crackling or grinding
- Slow onset with wear-and-tear tears, sudden onset after a fall or heavy lift
Partial vs full thickness
- Partial: the tendon is frayed part way through but still attached to bone
- Full thickness: a hole goes all the way through. It can still be small, or the tendon can be fully detached
- Size matters less than two other things on your scan: how far the tendon has pulled back, and whether the muscle has started turning to fat. Fatty muscle doesn’t reverse, even after repair
What your scan result means
- Tears get more common every decade: about 1 in 10 people in their fifties, 1 in 4 in their seventies, and over 1 in 3 in their eighties
- Many of those people have NO pain
- So a tear on your scan is a finding to interpret, not automatically the cause of your pain or a reason for surgery
- Silent tears can become painful later. About half did within three years in one study
A torn tendon usually won’t heal. The shoulder usually still gets better. Both are true.
Does it heal? Does it get bigger?
- The tear itself doesn’t knit back to bone. Tears more often grow than shrink
- Full thickness tears: about 1 in 5 get bigger within two years, about half within five
- Partial tears: slower. About 1 in 3 get bigger within five years
- Over 60, tears are more likely to grow large
- But symptoms often improve anyway, even when the tear grows. The tear and the pain don’t always track together
Physio first, for most people
- In a large study of people with gradual-onset full thickness tears, a home-based physio program worked for about 3 in 4 over two years, and most were still doing well at seven years
- Strengthening the remaining cuff and shoulder blade muscles is the core. See the 12-week shoulder program
- A single steroid injection can help pain for a few months. If surgery might be on the cards, ask your surgeon before having repeated injections, as they may affect a later repair
When surgery makes more sense
- A sudden tear after an injury, especially under 60, with real weakness. Repair is usually best within about three months, before the tendon pulls back and the muscle weakens
- Younger people with larger tears. In a ten-year trial, repair did better than physio for tears up to 3 cm, and people who switched to surgery later did worse than those repaired first
- Six to twelve months of physio haven’t helped
- Older people with small wear-and-tear tears: in a trial of people around 70, repair added little over physio
For the full trade-offs, see is rotator cuff surgery worth it.
If you have a repair, will it hold?
- Small and medium tears: about 2 in 3 fully heal
- Large tears: about half
- Massive tears: about 1 in 4
- Age is the biggest factor, more than tear size. Diabetes and high blood sugar also make re-tears more likely
- Many people feel much better even when the repair doesn’t fully heal
If you’re having surgery, see rotator cuff surgery recovery week by week.
When you can’t lift your arm at all
- Most weakness is pain holding the muscle back. Settle the pain and strength often returns
- If you can’t lift the arm yourself but someone else can lift it fully, that’s a different, mechanical problem. It needs a shoulder specialist
- Left long-term, it can lead to arthritis. See cuff tear arthropathy
See a doctor urgently if
- You suddenly can’t lift or turn the arm outward after a fall or heavy lift. Ask for a specialist referral quickly
- You’re over 40 and dislocated your shoulder. About 4 in 10 also tear the cuff. See dislocated shoulder over 40
- Your shoulder is hot and swollen and you have a fever
Get it checked if
- Night pain keeps waking you despite treatment
- The arm is getting weaker over time
- Three to six months of physio haven’t helped
- You have a history of cancer with constant pain, night sweats or a lump
Related: rotator cuff tendinitis · shoulder impingement · subacromial bursitis
Gradual tear: physio first. Sudden tear with weakness: see a surgeon within weeks, not months.