Accessibility View
Skip Header
Skip Content
Home / Specialties / Shoulder

Rotator Cuff Tear

The rotator cuff is a group of four muscles and their tendons that stabilize the shoulder joint and allow you to lift, rotate, and move your arm in many directions. These muscles include the supraspinatus, infraspinatus, teres minor, and subscapularis, which originate in the shoulder blade (scapula) and attach to the top of the upper arm bone (humerus).

When one or more of these tendons are injured or torn, it can cause pain, weakness, and limited shoulder movement. Rotator cuff tears are one of the most common causes of shoulder pain, especially in middle-aged and older adults.

There are several types of rotator cuff tears, each with unique causes, symptoms, and treatment options, these include:

What are the Causes of Rotator Cuff Tears? 

Rotator cuff injuries can occur suddenly or develop gradually. Common causes include:

  • Repetitive overhead arm movements (sports, painting, construction work)
  • Trauma from a fall or accident
  • Heavy lifting
  • Bone spurs that rub against the tendons
  • Degeneration and weakening of tendons due to aging
  • Overuse injuries from sports like baseball, tennis, or swimming

What are the Symptoms of Rotator Cuff Tears?

Symptoms can vary depending on the severity of the tear, but may include:

  • Pain in the shoulder and upper arm
  • Pain at rest and at night, especially when lying on the affected shoulder
  • Weakness or difficulty lifting and rotating the arm
  • Stiffness and reduced range of motion
  • Crackling or popping sensation with certain movements
  • Swelling and tenderness in the front of the shoulder

How is a Rotator Cuff Tear Diagnosed?

Your orthopedic specialist will review your symptoms and medical history, perform a physical examination, and may order imaging tests:

  • X-rays to check for bone spurs or joint abnormalities
  • Ultrasound to evaluate tendon movement and integrity
  • Magnetic resonance imaging (MRI) to confirm the tear size, location, and any associated muscle changes

What are the Types of Rotator Cuff Tears?

Rotator cuff injuries range from partial damage to complete tears involving multiple tendons. Below are the main variations and their unique considerations.

  • Partial Rotator Cuff Tear
  • Massive Retracted Rotator Cuff Tear
  • Rotator Cuff Re-tear

Partial Rotator Cuff Tear

A partial tear means the tendon is damaged but not completely severed. The tear can occur on the top, bottom, or inner side of the tendon.

Causes

  • Aging (most common)
  • Overhead activities
  • Sports injuries
  • Falls onto an outstretched arm

Symptoms

Some people have no symptoms, while others may experience:

  • Pain when lifting the arm or sleeping on the affected side
  • Weakness in the shoulder
  • Stiffness or reduced mobility

Treatment

Many partial tears can be managed without surgery:

  • Rest and activity modification
  • Anti-inflammatory medications
  • Cortisone injections to reduce pain and inflammation
  • Physical therapy to improve strength and range of motion

If more than 90% of the tendon is damaged, arthroscopic surgery may be recommended to remove damaged tissue and repair the tendon.

Prevention Tips

  • Avoid repetitive overhead activities when possible
  • Maintain good posture
  • Strengthen shoulder muscles with regular exercise
  • Quit smoking and limit alcohol use

Massive Retracted Rotator Cuff Tear

A massive tear involves two or more completely torn tendons, or a tear larger than 5 cm. These tears may retract (pull away) from the bone, making repair more complex.

Causes

  • Sudden trauma or heavy lifting
  • Degeneration from years of overuse
  • Bone spurs causing tendon damage
  • Sports and occupations involving frequent overhead motion

Symptoms

  • Severe shoulder pain (often worse at night)
  • Significant weakness and loss of function
  • Pain even at rest
  • Difficulty lifting the arm or performing daily activities

Complications

  • Fatty infiltration of muscles (reducing elasticity)
  • Partial dislocation of the humeral head
  • Tissue impingement
  • Shoulder arthritis

Treatment

Surgery is typically recommended to restore function:

  • Arthroscopic repair using small instruments and a camera
  • Removal of damaged tissue
  • Mobilization of the muscle to its original attachment site
  • Tendon reconstruction with grafts if needed
  • Suture anchors to secure the tendon to the bone

Non-surgical treatment may be considered for older patients with limited activity goals.

Rotator Cuff Arthropathy

Large, chronic rotator cuff tears can cause rotator cuff arthropathy, a form of arthritis due to instability and abnormal joint mechanics. The humeral head can migrate upward, rubbing against the socket rim, leading to cartilage wear.

Symptoms:

  • Pain, swelling, grinding or catching sensations
  • Loss of motion and strength
  • Difficulty with daily activities like dressing or eating

Diagnosis:

  • Physical exam for motion loss and muscle wasting
  • X-rays to detect high-riding humeral head
  • MRI or CT to confirm tear and arthritis

Treatment:

  • Non-surgical: ice/heat, anti-inflammatories, steroid injections, physical therapy
  • Surgical:

Rotator Cuff Re-tear

A rotator cuff re-tear can occur months or years after an initial repair. It may result from tendon degeneration, trauma, poor healing, or overuse.

Causes

  • Natural tendon degeneration with age
  • Large initial tear
  • Inflammatory arthritis
  • Inadequate healing or rehabilitation
  • New trauma or overuse injury

Symptoms

  • Recurring shoulder pain
  • Weakness when lifting or rotating the arm
  • Pain when lying on the affected side
  • Crackling sensation with movement

Treatment

  • Conservative care: rest, pain medications, cortisone injections, and physical therapy (stretching, strengthening, pendulum exercises)
  • Revision surgery: reattaching the tendon, sometimes with advanced healing techniques like microfracture, platelet-rich plasma (PRP), stem cells, or collagen grafts

Prevention

  • Adhering strictly to post-surgery rehab protocols

What are the Treatment Options for Rotator Cuff Tears?

Treatment depends on tear size, severity, patient age, and activity level.

Conservative treatment for Rotator Cuff Tears

The conservative treatment options for rotator cuff tears are:

  • Rest and activity modification
  • Shoulder sling for support
  • Pain and anti-inflammatory medications
  • Cortisone injections for pain relief
  • Physical therapy to improve mobility and strength

Surgery for Rotator Cuff Tears 

Rotator cuff repair may be performed by open or arthroscopic surgery. In arthroscopy, the space for rotator cuff tendons will be increased and the cuff tear is repaired using suture anchors. These anchor sutures help in attaching the tendons to the shoulder bone. Following the surgery, you may be advised to do post-surgical rehabilitation to practice motion and strengthening exercises to restore function.

Prevention of Rotator Cuff Injuries

  • Warm up before exercise or sports
  • Strengthen rotator cuff and shoulder muscles
  • Avoid repetitive overhead lifting without breaks
  • Maintain proper posture at work and during daily activities

If you’re experiencing shoulder pain, weakness, or limited movement, our orthopedic specialists at the Orthopedic Institute of North Texas can provide an accurate diagnosis and a personalized treatment plan to help you recover. Whether your injury is recent or you’re dealing with a long-standing issue, timely care can make all the difference in restoring function and preventing further damage.

Rotator cuff injuries range from partial tears to massive, complex tears that can progress to arthritis. Early evaluation and tailored treatment are key to preserving shoulder strength and mobility. If you’re experiencing shoulder pain, weakness, or limited range of motion, a specialist can help identify the cause and recommend the best treatment plan.