Rotator Cuff Tear – Symptoms, Causes and When to Seek Treatment

The rotator cuff is a group of muscles and tendons that stabilise the shoulder and allow smooth, controlled movement of the arm. If you're lifting your arm to put on a jacket or reaching up to put something on a shelf, you’ll be using these muscles. 

A tear occurs when one of these tendons becomes damaged (either partially or completely) which can affect strength, movement, and overall shoulder function.

Rotator cuff tears typically develop in one of two ways:

Gradual Degeneration

Over time, the tendon can weaken due to repeated use, reduced blood supply, and age-related changes. This is the most common cause.

Acute Injury

A tear can also occur suddenly, such as after a fall, lifting something heavy, or a sudden pulling movement.

Guidance from the AAOS¹ supports that rotator cuff tears are commonly linked to both age-related wear and repetitive overhead activity.

Symptoms can vary depending on the size and type of tear, but commonly include:

• Shoulder pain, particularly when lifting or lowering the arm
• Weakness, especially with overhead movement
• Difficulty with everyday activities, such as dressing or reaching
• Pain at night, often worse when lying on the affected side
• Reduced range of motion or stiffness

MedlinePlus² notes that pain and weakness, particularly when they affect daily activity, are key indicators of a rotator cuff injury.

Diagnosis begins with a clinical assessment of shoulder movement, strength, and pain. If a tear is suspected, imaging such as an ultrasound or MRI scan may be recommended.

• Ultrasound → uses sound waves to create real-time images of the shoulder, helping assess tendon movement and detect tears or inflammation
• MRI scan → uses magnetic imaging to provide detailed pictures of the soft tissues, allowing a more precise assessment of the size, location, and severity of the tear

These imaging methods help confirm the diagnosis and determine the nature of the injury, guiding the most appropriate treatment.

Some smaller or partial tears can be managed without surgery.

Treatment focuses on:

• Reducing pain by avoiding aggravating movements, modifying activity levels, and using anti-inflammatory strategies
• Restoring movement through progressive range of motion exercises to regain normal shoulder mobility
• Strengthening surrounding muscles by building strength in the rotator cuff and shoulder stabilisers to reduce strain on the injured tendon

While symptoms can improve significantly, the tendon itself may not fully heal; which is why structured rehabilitation is important.

Early assessment is recommended if symptoms are not settling. You should consider seeking advice if:

• Pain persists beyond a few weeks
• You notice weakness or loss of strength
• Symptoms are affecting sleep
• Daily activities are becoming difficult

Treatment always needs to be tailored to the individual and depends on the severity of the tear, symptoms, and functional goals. 

Where possible, treatment focuses on non-surgical management first.

Non-Surgical Treatment

This may include:

• Targeted physiotherapy
• Activity modification
• Strengthening programmes

➡️ Learn more about our Non-Surgical Treatment options

Rotator cuff repair is typically performed using minimally invasive (arthroscopic) techniques. This uses small incisions and a camera to guide the whole procedure.

The aim is to repair the damaged tendon and restore the normal mechanics of the shoulder, helping to reduce pain and improve strength and function.

➡️ Learn more about our Rotator Cuff Repair Surgery