Shoulder condition
Rotator cuff tears
A common source of shoulder pain, weakness, and difficulty lifting the arm.
The rotator cuff is a group of four tendons that helps center the ball in the shoulder socket and power arm movement. A tendon can tear suddenly after an injury or gradually as the tissue wears over time. Not every tear needs surgery; the right plan depends on the tear, your symptoms, your health, and how you use your shoulder.
See the anatomy and imaging
Anatomy: four tendons, one coordinated unit
The supraspinatus, infraspinatus, teres minor, and subscapularis blend into a cuff around the humeral head. Together they compress and center the ball in the shallow socket while larger muscles move the arm. Tears most often involve the supraspinatus, but may extend into neighboring tendons.
How it happens
Acute tears may follow a fall, shoulder dislocation, or forceful lifting event. Degenerative tears develop more slowly and are more common with age, repetitive overhead use, bone spurs, and reduced tendon blood supply.
Symptoms and examination
Pain commonly travels down the outer upper arm, worsens overhead or at night, and may be accompanied by weakness. Examination compares active and passive motion, strength in different tendon positions, shoulder-blade rhythm, and the neck. A tear on MRI does not automatically explain pain; findings must match the history and examination.
How we evaluate it
The evaluation begins with a focused history and examination of motion, strength, and shoulder mechanics. X-rays show the bones and arthritis. Ultrasound or MRI may be used to define the tendon involved, tear size, retraction, muscle quality, and other shoulder problems.
Treatment
- Activity modification and anti-inflammatory medication when medically appropriate
- Physical therapy to restore motion, shoulder-blade control, and remaining cuff strength
- An injection in selected cases to reduce pain and help rehabilitation
- Arthroscopic repair when symptoms, weakness, tear features, age, activity goals, and tissue quality support surgery
When surgery is considered
Surgery may be appropriate for an acute traumatic tear, persistent pain or weakness despite nonsurgical care, progression of a repairable tear, or loss of function that interferes with work, sleep, or recreation. Recovery is gradual because the repaired tendon must heal back to bone.
What recovery involves
After repair, a sling protects the tendon while early motion is carefully controlled. Active motion and strengthening are added in stages. Tear size, tissue quality, associated repairs, health, and work demands all affect the timeline; meaningful improvement continues for many months.
Evidence and further reading
- AAOS OrthoInfo: Rotator Cuff Tears
- AAOS 2025 Clinical Practice Guideline: Management of Rotator Cuff Injuries
- AAOS OrthoInfo: Surgical Treatment Options
Educational content is reviewed for patient clarity and is not a substitute for an examination or individualized medical advice.
PIA Shoulder MD