Introduction
Rotator cuff injury includes tendinopathy, partial tears, and full-thickness tears of the four muscles/tendons stabilizing the shoulder (supraspinatus most commonly). Overuse, age-related degeneration, and acute trauma cause pain and weakness lifting the arm.
Night pain lying on affected shoulder and painful arc between 60–120 degrees elevation are common. Small partial tears often respond to physical therapy; large traumatic tears in active adults may need arthroscopic repair.
Chronic massive tears may lead to cuff tear arthropathy with arthritis. Early evaluation prevents prolonged disability.
This page explains symptoms, diagnosis, and treatment options.
Overview
Differentiate from frozen shoulder, impingement without tear, and cervical radiculopathy referring to shoulder.
Ultrasound or MRI confirms tear size and retraction when surgery considered.
- Tendon injury of shoulder stabilizing cuff
- Pain and weakness with overhead activity
- Night pain common
- Physical therapy helps many partial tears
- MRI guides surgical decision
- Age and activity level drive treatment choice
What happens in the body
Repeated microtrauma and hypovascular zone of supraspinatus tendon cause degeneration. Acute overload may complete partial tear. Loss of cuff function allows humeral head migration causing impingement pain.
- Tendon degeneration and partial tearing
- Full-thickness tear reduces active elevation strength
- Positive impingement signs on exam
- Muscle atrophy chronic large tears
- Progressive tear enlargement without treatment sometimes
Signs and symptoms
Pain and weakness with arm use:
- Deep shoulder ache worse at night
- Weakness lifting arm overhead or reaching behind back
- Painful arc mid-elevation
- Clicking or catching sensation
- Difficulty sleeping on affected side
- Sudden weakness after fall in acute tear
- Gradual symptoms in degenerative tears
Causes and risk factors
Degeneration and trauma:
- Age-related tendon wear over 40
- Repetitive overhead work or sports
- Acute fall on outstretched arm or heavy lift
- Bone spur under acromion contributing impingement
- Smoking and diabetes impair tendon healing
- Traumatic tear in younger athletes less common
Diagnosis and evaluation
Exam plus imaging when indicated:
- Special tests: empty can, drop arm, external rotation lag
- Strength testing compared to opposite side
- X-ray for acromial spur or arthritis
- Ultrasound or MRI for tear size, location, retraction
- Exclude cervical nerve root causing similar weakness
- Injections diagnostic in selected cases
Treatment and management
Rehab first; surgery for appropriate tears:
- Physical therapy: rotator cuff and scapular stabilization exercises
- Activity modification avoiding painful overhead loading initially
- NSAIDs or short steroid injection for pain flares
- Arthroscopic rotator cuff repair for symptomatic full-thickness tears failing rehab especially in active patients
- Partial tears often managed nonoperatively initially
- Reverse total shoulder replacement for cuff tear arthropathy elderly
- Postoperative immobilization then graduated rehab months
Prevention, self-care, and lifestyle
Not every condition is fully preventable, but the steps below may lower risk or recurrence:
- Strengthen shoulder girdle for overhead athletes
- Ergonomics for repetitive overhead jobs
- Avoid smoking to protect tendon healing
Possible complications
Delay, missed care, or unsafe self-medication can raise the chance of complications in some cases:
- Tear progression and fatty infiltration reducing repair success
- Frozen shoulder during prolonged immobilization
- Failed repair re-tear rates significant in large tears
- Cuff tear arthropathy with irreparable massive tear
When to see a doctor or seek emergency care
Seek prompt medical advice or emergency care if any of the following apply—it is safer not to wait and see:
- Weakness after shoulder trauma unable to lift arm
- Night pain and weakness persisting months
- Sudden snap with severe weakness after lift
- No improvement after 6–12 weeks guided therapy
Living with the condition
Many live well with partial tears using maintained strength program. Post-surgical recovery takes 4–6 months for moderate tears. Compliance with rehab determines outcome as much as surgery.
Frequently asked questions
Do all tears need surgery?
No. Partial and some full tears in less active people improve with therapy. Surgery considered for persistent symptoms, significant weakness, acute traumatic tears in active patients.
How long is recovery after repair?
Typically months—immobilization then progressive strengthening. Full return to overhead sport may take 6–12 months.
Important caution
This article is general health education in English. It is not personal medical advice.
Acute shoulder trauma with inability to raise arm needs prompt orthopedics evaluation.
Injection and surgical decisions should involve a shoulder specialist.