What are the symptoms of Rotator Cuff Tear?

Common symptoms include: Shoulder pain, often worse at night or when lying on the affected side; Pain with overhead activities or reaching behind the back; Weakness when lifting or rotating the arm; Difficulty raising the arm above shoulder level; Crackling or popping sensation (crepitus) with shoulder movement.

What are the treatment options for Rotator Cuff Tear?

Treatment options range from conservative measures to surgical interventions, including: Rest and activity modification to reduce pain-provoking movements; Physical therapy focusing on strengthening, range of motion, and scapular mechanics; NSAIDs for pain and inflammation management; Corticosteroid injections may provide temporary symptom relief; Ice or heat application for symptom management.

Rotator Cuff Tear

Also known as: Torn rotator cuff, Shoulder cuff tear, RCT (rotator cuff tear), Supraspinatus tear, Rotator cuff tendon tear

Last updated: December 18, 2024

A rotator cuff tear is damage to one or more of the four tendons that surround and stabilize the shoulder joint. Tears can be partial or complete and may develop after an acute injury or gradual degeneration. Symptoms may include shoulder pain (often worse at night or when lying on the affected side), pain with overhead activity or reaching behind the back, and weakness when lifting or rotating the arm. Many partial tears and some full-thickness tears may be managed without surgery.

Key Facts

•A rotator cuff tear is damage to one or more of the four tendons that surround and stabilize the shoulder joint
•Shoulder pain, worse at night or when lying on the affected side
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

A rotator cuff tear is damage to one or more of the four tendons that surround and stabilize the shoulder joint. Tears may be partial or complete and can result from acute injury or gradual degeneration. The rotator cuff is essential for shoulder movement and stability, and tears may cause pain, weakness, and reduced range of motion.

Affected Anatomy

This condition affects several structures in and around the joint:

•Supraspinatus tendon (most commonly torn)
•Infraspinatus tendon
•Teres minor tendon
•Subscapularis tendon
•Greater and lesser tuberosities of the humerus
•Subacromial bursa
•Glenohumeral joint capsule

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Shoulder pain, often worse at night or when lying on the affected side
•Pain with overhead activities or reaching behind the back
•Weakness when lifting or rotating the arm
•Difficulty raising the arm above shoulder level
•Crackling or popping sensation (crepitus) with shoulder movement
•Pain that may radiate down the upper arm
•Gradual or sudden onset depending on cause
•Loss of active range of motion with intact passive motion

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Acute injury from a fall, heavy lifting, or sudden jerking motion
•Chronic degeneration of tendon tissue with aging
•Repetitive overhead activities leading to cumulative microtrauma
•Impingement of the rotator cuff tendons beneath the acromion
•Reduced blood supply to the tendons with aging
•Bone spurs (osteophytes) causing mechanical abrasion

Risk Factors

•Age over 40, with increasing prevalence in older adults
•Occupations or activities requiring repetitive overhead movements
•Participation in sports such as baseball, tennis, or swimming
•Previous shoulder injury or surgery
•Family history of rotator cuff disease
•Smoking may impair tendon healing and increases risk
•Certain anatomical variations such as hooked acromion

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Medical history focusing on symptom onset, mechanism of injury, and functional limitations
•Physical examination including strength testing, range of motion assessment, and special tests (Jobe, drop arm, lift-off)
•X-rays may show bone spurs, calcifications, or high-riding humeral head suggesting chronic tear
•MRI is the preferred imaging study for visualizing tear size, location, and muscle quality
•Ultrasound can be used as an alternative for experienced operators
•Assessment of muscle atrophy and fatty infiltration on imaging helps guide treatment

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Rest and activity modification to reduce pain-provoking movements
•Ice or heat application for symptom management

Physical Therapy and Exercise

•Physical therapy focusing on strengthening, range of motion, and scapular mechanics
•Postoperative rehabilitation is essential for optimal outcomes

Medications

•NSAIDs for pain and inflammation management

Injections and Office-Based Procedures

•Corticosteroid injections may provide temporary symptom relief

Surgery

•Surgical repair may be considered for acute tears, failed conservative treatment, or significant functional limitation
•Arthroscopic or open surgical techniques can be used depending on tear characteristics

Prognosis and Recovery

The course of this condition varies between individuals:

•Many partial tears and some full-thickness tears may be managed successfully without surgery
•Outcomes after surgical repair vary based on tear size, chronicity, and tissue quality
•Smaller tears and earlier intervention typically have better surgical outcomes
•Recovery after surgery may require 4 to 6 months or longer
•Re-tear rates after surgical repair vary and depend on multiple factors
•Some individuals may have persistent symptoms despite treatment

Rotator Cuff Repair(Procedure)
Shoulder Arthroscopy(Procedure)
Shoulder Impingement Syndrome(Condition)

Frequently Asked Questions

Diagnosis typically involves: Medical history focusing on symptom onset, mechanism of injury, and functional limitations; Physical examination including strength testing, range of motion assessment, and special tests (Jobe, drop arm, lift-off); X-rays may show bone spurs, calcifications, or high-riding humeral head suggesting chronic tear; MRI is the preferred imaging study for visualizing tear size, location, and muscle quality.