Rotator Cuff Tear
Treatment of tears affecting the shoulder tendons, using rehabilitation or surgery depending on the tear and symptoms
What is rotator cuff tear?
The rotator cuff is a sheet formed by four tendons that wrap over the ball at the top of the arm bone. Their job is to hold the ball centred in its shallow socket while the larger muscles swing the arm, so they work continuously and under load whenever the arm is away from the body.
Tears come in two forms. A degenerate tear develops slowly in a tendon that has thinned with age and repeated use, and it often appears without any single incident. A traumatic tear happens in one moment, usually a fall onto the arm or a sudden pull, and it can occur in a much younger shoulder.
A tear does not close on its own. The torn edge sits in joint fluid, the muscle behind it pulls it steadily further away, and over months that muscle shortens and fills with fat. That process is the reason time matters here more than it does in most shoulder problems.
What you might notice
- Shoulder pain when reaching overhead
- A shoulder that will not move through its range
How it is diagnosed
The examination isolates each tendon by putting the arm in a position where only that tendon can produce the movement, then testing power against resistance. Weakness in a specific position, and not simply discomfort, is what distinguishes a tear from a tendon that is inflamed.
Ultrasound is a quick and accurate first test in experienced hands, and it has the advantage of showing the tendon moving. MRI is the fuller assessment: it measures how big the tear is, how far the torn edge has pulled back, and how much fat has replaced the muscle belly, and that last measure predicts whether a repair will hold better than the size of the tear does.
X-rays are taken as well, mostly to see whether the ball has drifted upwards, which indicates a cuff that has been failing for a long time.
Recovery
For a tear managed without surgery, the programme is three to six months of graded work aimed at the remaining tendons and at the muscles that control the shoulder blade. A great many people regain a usable arm this way even with a tear still present.
After a repair, the sequence is fixed by biology. The tendon is held to the bone by stitches while the two grow together, and that takes six to twelve weeks. The arm is in a sling for around six weeks with movement done for you, then active movement, then strengthening from about three months.
Full strength takes six months to a year. Sleeping is often the hardest part of the first few weeks, and most people find they need to sleep propped up instead of flat for a while.
If it is left untreated
A partial tear in someone who has adapted, particularly an older adult with modest demands, can be left alone and managed with physiotherapy. That is a reasonable and common plan.
A full-thickness tear behaves differently. It enlarges over time in a measurable proportion of people, the edge retracts, and the muscle behind it undergoes changes that do not reverse even if the tendon is later repaired. A tear that is repairable now may not be repairable in a year.
If the cuff fails entirely, the ball drifts upwards against the bony arch and grinds against it, and that end stage cannot be treated by repairing anything. The younger the shoulder and the more recent the tear, the more the timing of the decision matters.
Questions about rotator cuff tear
Can a torn rotator cuff heal on its own?
A full-thickness tear does not close by itself. The torn edge sits in joint fluid, which washes away the clot that healing would otherwise start from, and the muscle behind the tendon pulls the edge steadily further from the bone. What can happen is that the shoulder becomes comfortable and usable again even though the tear is still there, because the remaining tendons and the muscles controlling the shoulder blade take over the work. That is a real and common outcome and it is the goal of treatment without surgery. Whether it is enough depends on how big the tear is and what you need the arm to do.
Does it matter how soon a tear is repaired?
For a tear that happened in one identifiable moment, particularly in a younger person, yes. Tears enlarge over time in a proportion of people, the torn edge retracts towards the socket, and the muscle behind it gradually fills with fat. That fatty change does not reverse even if the tendon is later stitched back, and it is the single best predictor of whether a repair will hold. Most surgeons therefore prefer to repair a traumatic full-thickness tear within a few months. For a degenerate tear that developed slowly, a trial of physiotherapy first is entirely reasonable and is what most guidelines advise.
Why is sleeping so difficult with this?
Lying down takes away the support the arm gets from gravity and from the muscles holding it during the day, and the shoulder settles into a position that loads the torn tendon and compresses the space it runs through. Most people find lying flat on the back is the worst position and that being propped up at around forty-five degrees, in a recliner or with several pillows, is much better, with a pillow under the elbow so the arm is not hanging. Lying on the affected side is best avoided. This is one of the things that improves fairly early after a repair, though the first few weeks afterwards are also broken.
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InpatientTalk to a care coordinator about rotator cuff tear
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one