Torn Rotator Cuff: How to Tell, Treatment and Recovery

01Anatomy

What the rotator cuff does

The four rotator cuff muscles, supraspinatus, infraspinatus, teres minor and subscapularis, surround the shoulder joint, keeping the ball centred in the socket while the larger muscles move the arm. The supraspinatus tendon, at the top of the shoulder, is the most commonly torn.

02Signs

How to tell if you have a torn rotator cuff

• Pain on the outer shoulder and upper arm.
• Pain lifting the arm, especially between shoulder and head height.
• Weakness when lifting or rotating the arm.
• Night pain, especially lying on the affected side.
• A crackling sensation when moving the shoulder.
• After an injury, a sudden tear and difficulty lifting the arm.

Similar symptoms can come from tendinopathy without a tear; see shoulder impingement.

03Types

Types of tears

• Partial-thickness: the tendon is damaged but not torn through.
• Full-thickness: a hole in the tendon.
• Acute (traumatic): from a fall, dislocation or heavy lift.
• Degenerative: gradual wear, often in both shoulders, common after 60.

04Diagnosis

Diagnosis

A physiotherapist or doctor examines movement and strength. Ultrasound or MRI confirms the tear and its size. Because tears are common in people without symptoms, scan findings are interpreted together with symptoms and examination.

05Heal

Can a torn rotator cuff heal naturally?

A full-thickness tear does not reattach on its own, but many people regain good function and lose their pain with time and exercise, as the other muscles compensate. Partial tears may improve. Some tears enlarge over time, so persistent weakness should be reviewed.

06First steps

First steps

• Rest from aggravating activities, but keep the arm moving gently.
• Use ice or heat for pain.
• Take simple painkillers if appropriate.
• Sleep with a pillow under the arm or on the other side.
• Avoid heavy lifting and overhead work for a while.

07Exercises

Rehabilitation exercises

• Pendulum swings: lean forward and let the arm swing gently.
• Isometric rotation: press the hand into a wall without moving.
• External and internal rotation with a band.
• Shoulder blade squeezes and rows.
• Assisted arm raises with a stick or the other hand.
• Anterior deltoid strengthening lying down, progressing to sitting.

See rotator cuff exercises.

08Injection

Injections

A steroid injection can relieve pain for several weeks to allow rehabilitation. Repeated injections are avoided, as they may weaken tendons. Other injections, such as platelet-rich plasma, have uncertain benefit.

09Surgery

When surgery is considered

• Acute traumatic tears with weakness in active people, ideally repaired within weeks.
• Large tears in younger patients.
• Persistent pain and weakness after 3 to 6 months of rehabilitation.

Surgery is usually arthroscopic. A sling is worn for about 4 to 6 weeks, followed by staged rehabilitation. Full recovery takes 6 to 12 months.

10Recovery

Recovery time without surgery

With physiotherapy, many people improve significantly within 6 to 12 weeks, though full recovery can take several months. Consistency with exercises is key.

11Massive

Large, irreparable tears

Some large, long-standing tears cannot be repaired. Physiotherapy to strengthen the deltoid and remaining muscles can still restore useful function. Other surgical options, including tendon transfers or shoulder replacement, are considered for severe cases with arthritis.

12Prevention

Keeping shoulders healthy

• Regular rotator cuff and shoulder blade strengthening.
• Gradual increases in overhead work or sport.
• Good lifting technique.
• Stopping smoking, which impairs tendon healing.

14Summary

Key points to remember

• Rotator cuff tears cause shoulder pain, night pain and weakness.
• Degenerative tears are common with age and often improve with exercise.
• Acute tears with weakness may need early surgical repair.
• Rehabilitation focuses on strengthening the surrounding muscles.