What is a Rotator Cuff Tear?
The rotator cuff is a group of four muscles and tendons that help stabilise and move the shoulder. A rotator cuff tear occurs when one or more of these tendons become damaged or detached from the bone.
Rotator cuff tears are a common cause of shoulder pain, weakness and loss of function.
They may occur following:
an injury,
a fall,
heavy lifting,
sporting activities,
or gradual age-related degeneration.
Common Symptoms
Symptoms may include:
Shoulder pain
Pain when lifting the arm
Night pain
Difficulty sleeping on the affected side
Weakness
Reduced range of motion
Difficulty reaching overhead
Difficulty lifting objects
Some patients experience symptoms gradually, while others notice a sudden loss of strength following an injury.
Causes
Rotator cuff tears may occur through:
Acute injury
Falls onto the shoulder
Heavy lifting injuries
Sporting injuries
Degenerative tendon wear over time
The risk of rotator cuff tearing increases with age.
Diagnosis
Diagnosis is usually made through:
Clinical assessment
Physical examination
X-rays
Ultrasound
MRI scans
Imaging helps determine:
Tear size
Tendon quality
Tendon retraction
Muscle atrophy
Associated shoulder conditions
Non-Surgical Treatment
Many patients improve without surgery.
Treatment options may include:
Physiotherapy
Activity modification
Anti-inflammatory medication
Corticosteroid injection
Strengthening exercises
Non-operative treatment is often appropriate for smaller tears, degenerative tears and patients with manageable symptoms.
Physiotherapy plays an important role in restoring shoulder strength, movement and function, and may be particularly beneficial for patients with rotator cuff tears, shoulder weakness and associated shoulder impingement.
Rotator Cuff Repair Surgery
Rotator cuff repair is usually performed arthroscopically (keyhole surgery).
During surgery, the torn tendon is mobilised and reattached to the bone using specialised suture anchors.
The procedure aims to:
Restore tendon attachment
Improve shoulder strength
Improve function
Reduce pain
In selected patients, additional procedures such as biceps tenodesis, subacromial decompression or distal clavicle excision may also be considered.
Massive Rotator Cuff Tears
Some rotator cuff tears are too large, chronic or retracted to be fully repaired. In these situations, alternative treatment options may be considered depending on symptoms, shoulder function and patient goals.
Treatment options may include:
Partial rotator cuff repair
Tendon transfer procedures
Reverse shoulder replacement
In patients with severe rotator cuff deficiency and associated shoulder arthritis, a reverse shoulder replacement may provide the most reliable improvement in pain and function.
The most appropriate treatment depends on age, activity level, tendon quality, muscle condition and the presence of associated shoulder arthritis.
Recovery After Surgery
Recovery depends on tear size and the procedure performed.
Most patients require:
Sling immobilisation
Physiotherapy
Gradual range of motion exercises
Progressive strengthening
Improvement continues for many months following surgery.
Full recovery may take six to twelve months.
Related Rehabilitation Protocols
Rotator cuff repair rehabilitation
Shoulder arthroscopy rehabilitation
Biceps tenodesis rehabilitation
Shoulder rehabilitation protocols
Frequently Asked Questions
Will a rotator cuff tear heal on its own?
A full-thickness tendon tear does not usually heal back to the bone naturally. However, many patients can achieve excellent symptom control without surgery.
Do all rotator cuff tears require surgery?
No. Many patients improve with physiotherapy and non-operative treatment.
When should surgery be considered?
Surgery may be recommended when pain, weakness or loss of function persist despite appropriate treatment, or following certain acute injuries.
Is rotator cuff repair performed using keyhole surgery?
Most repairs are performed arthroscopically using small incisions and specialised instruments.
How long is recovery after rotator cuff repair?
Recovery varies depending on tear size and patient factors, but improvement commonly continues for six to twelve months after surgery.
Related Shoulder Conditions
Shoulder Impingement
Biceps Tendon Disorders
Shoulder Arthritis
Referral Information
Francis Ting is an upper limb surgeon who provides specialist assessment and treatment of rotator cuff tears, shoulder pain and shoulder injuries in New Plymouth and the wider Taranaki region.
Patients are typically referred by their GP, physiotherapist, sports physician or another healthcare professional. Referral is generally required for ACC and private insurance funding pathways.
