What is a rotator cuff tear?
The rotator cuff is a group of four muscles and their tendons that wrap around the top of the arm bone, holding it in the shoulder socket and powering lifting and rotation.
A tear means one or more of these tendons has partially or completely pulled away from the bone. It may happen suddenly — from a fall or lifting injury — or develop gradually as the tendon wears thin with age, which is far more common.
Signs and symptoms
- checkPain on the outer shoulder, often worse at night and when lying on that side.
- checkWeakness lifting or rotating the arm, especially overhead.
- checkDifficulty with overhead tasks — reaching a shelf, brushing hair, dressing.
- checkA crackling sensation when moving the shoulder in certain positions.
- checkLoss of strength that can make the arm feel unreliable.
Causes & risk factors
- Age-related tendon degeneration (most common over 50).
- Repetitive overhead activity — painting, construction, certain sports.
- A single traumatic injury, such as a fall onto the arm.
- Reduced blood supply to the tendon with age.
- Bony spurs that rub and fray the tendon over time.
How it is diagnosed
Examination tests the strength and range of each cuff muscle to localise the problem. Ultrasound and MRI both visualise the tendons — confirming whether a tear is partial or full-thickness, its size, and the quality of the muscle, all of which guide treatment.
Treatment options
Many tears — particularly partial and degenerative ones — are managed successfully without surgery. The decision balances tear size, your age, activity and how much the shoulder limits you.
Physiotherapy
A structured programme strengthens the surrounding muscles to compensate and reduce pain — effective for many partial tears.
Arthroscopic repair
The torn tendon is reattached to the bone through keyhole incisions, restoring strength for larger or full-thickness tears.
Larger acute tears in active patients are often best repaired sooner rather than later — a long-standing tear can retract and become harder to fix. A timely assessment keeps your options open.
Recovery & outlook
After a repair, the shoulder is protected in a sling while the tendon heals to the bone — this early protection is essential. A staged programme then rebuilds motion and strength over three to six months. Most patients regain comfortable, functional shoulders and return to the activities that matter to them.