What is a rotator cuff tear?

The rotator cuff is a group of four muscles and their tendons around the shoulder: supraspinatus, infraspinatus, subscapularis and teres minor. Together, they help lift and rotate the arm while controlling the ball of the shoulder joint during movement.

A rotator cuff tear means that part or all of one or more of these tendons has torn.

• Partial-thickness tear: only part of the tendon thickness is affected.
• Full-thickness tear: the tear extends through the tendon.
• Larger or multi-tendon tear: a greater area or more than one tendon may be involved.

These structural descriptions can help guide treatment decisions, but they are only part of the picture. Symptoms, strength, movement and functional loss also matter.

What are the symptoms of a rotator cuff tear?

Symptoms vary considerably. Some people have substantial pain with a relatively small tear, while others have a tear on imaging with few or no symptoms.

Common symptoms may include:

• pain when reaching overhead or away from the body
• night pain or discomfort when lying on the affected shoulder
• weakness when lifting or rotating the arm
• reduced endurance during work, gym or sport
• difficulty reaching behind your back or above shoulder height
• a painful arc during arm elevation
• clicking or catching in some shoulders
• sudden pain and weakness after an injury

Is a rotator cuff tear serious?

Not every rotator cuff tear is serious, and not every tear needs surgery. Many people regain useful strength and function with non-surgical management.

However, earlier assessment becomes more important when a tear follows significant trauma, you suddenly lose strength, you cannot actively lift your arm, or normal shoulder function changes substantially.

What causes a rotator cuff tear?

Rotator cuff tears generally occur through either a sudden injury or gradual tendon change. In practice, these mechanisms can overlap.

Traumatic rotator cuff tears

A traumatic tear can follow a fall, sudden pull, heavy lift, shoulder dislocation or other forceful event. Pain and weakness usually begin around the time of the injury.

A sudden inability to lift the arm after trauma deserves prompt assessment because the management pathway may differ from a longstanding degenerative tear.

Age-related and degenerative tears

Rotator cuff tendons commonly change with age. Repeated loading, tendon health and previous shoulder symptoms may also contribute. Sometimes a relatively minor event brings attention to a tendon that already had structural change.

Factors associated with rotator cuff tearing can include:

• increasing age
• repetitive overhead work or sport
• previous shoulder injury
• smoking
• reduced tendon quality
• repeated high shoulder loads

Other shoulder problems can occur at the same time. These include rotator cuff tendinopathy, shoulder bursitis, frozen shoulder and shoulder joint disorders.

How is a rotator cuff tear assessed?

A physiotherapist or doctor will usually start with your history and a physical examination. The assessment may examine active and passive shoulder movement, strength, symptom behaviour and your ability to complete relevant functional tasks.

No single physical test can determine everything about a rotator cuff tear. Instead, clinicians combine several examination findings with the history to estimate whether a tear is likely and whether further investigation would change management.

Do you always need a scan?

No. Imaging is not automatically required at the first appointment. Many people can start an appropriate management plan after a clinical assessment.

Imaging becomes more useful when the diagnosis remains uncertain, substantial weakness follows trauma, symptoms are not improving as expected or surgery is being considered.

• Ultrasound: can identify many partial and full-thickness tendon tears.
• MRI: can show the rotator cuff and surrounding structures in more detail and may assist surgical planning.
• X-ray: does not show the rotator cuff tendon itself but can identify fractures, arthritis and other bone or joint changes.

For more detail, see Do You Need an MRI for a Torn Rotator Cuff?.

How can physiotherapy help a rotator cuff tear?

Physiotherapy commonly forms part of non-surgical rotator cuff tear management. Treatment aims to improve comfortable shoulder movement, strength, load tolerance and confidence using the arm.

Your plan should match the type of tear, how irritable the shoulder feels, current strength, daily demands and the activities you want to return to.

A physiotherapy program may include:

• temporary modification of painful or excessive loads
• comfortable shoulder movement exercises
• graduated rotator cuff strengthening
• shoulder blade and upper-limb strengthening
• progressive lifting and reaching tasks
• work or sport-specific loading where relevant
• advice about sleep, activity and symptom management
• manual therapy where it provides useful short-term symptom or movement support

You can also read our broader Rotator Cuff Injury guide and our dedicated Rotator Cuff Exercises page.

What does rotator cuff rehabilitation involve?

1. Settle the irritated shoulder

   Reduce or modify the loads that clearly aggravate symptoms while keeping the shoulder moving within a manageable range.

2. Restore comfortable movement

   Gradually regain useful shoulder movement for dressing, reaching, sleep and daily activity.

3. Rebuild rotator cuff strength

   Use progressive resistance to improve shoulder strength, control and load tolerance.

4. Return to higher-level tasks

   Progress lifting, overhead activity, work, gym or sport according to your goals and response.

Can exercise help a torn rotator cuff?

Yes. Exercise can improve pain, strength and function for many people with symptomatic rotator cuff tears. Importantly, rehabilitation aims to improve how the shoulder performs; it does not require the tendon to look normal on a scan before function can improve.

The appropriate starting point varies. A highly irritable shoulder may initially need low-load movement and strengthening. Later, resistance and movement demands can increase as strength and confidence improve.

Doing too much too soon can aggravate symptoms. Conversely, prolonged complete rest can contribute to loss of strength and movement. A graded loading plan usually provides a more useful middle ground.

When is surgery considered for a rotator cuff tear?

Surgery is not automatically required because a scan shows a rotator cuff tear. The decision depends on the type of tear, how it occurred, weakness, functional loss, tendon characteristics, age, general health and the demands you place on your shoulder.

An orthopaedic opinion may be considered earlier when there is:

• a recent traumatic full-thickness tear
• marked weakness after an injury
• major loss of shoulder function
• difficulty actively lifting the arm following trauma
• a large tear or involvement of several tendons
• high physical work or sporting demands
• persistent symptoms despite an appropriate rehabilitation program

For many symptomatic small-to-medium tears, both non-operative treatment and surgery can improve pain and function. Therefore, the best pathway depends on the individual rather than tear size alone.

Can a rotator cuff tear get bigger without surgery?

Some tears remain relatively stable, while others can enlarge over time. Longer-term structural progression may include increasing tear size and changes within the rotator cuff muscles.

That does not mean everyone with a tear needs surgery. Instead, ongoing symptoms, strength, function, goals and imaging findings should be considered together when reviewing progress.

What about shoulder injections?

An injection may sometimes be considered when pain substantially limits sleep, movement or rehabilitation. However, an injection does not reconnect torn tendon fibres.

The potential benefits and risks depend on the individual situation and the type and timing of the injection. Discuss this with your treating clinician or doctor if pain is preventing rehabilitation from progressing.

How long does rotator cuff tear recovery take?

There is no single recovery time. Some people notice useful improvement over several weeks, while meaningful strength and functional recovery commonly takes several months.

Larger tears, longstanding weakness, high physical demands and post-operative rehabilitation can require considerably longer.

Your progress depends on factors such as:

• the type and size of the tear
• whether the injury was traumatic or gradual
• your starting strength and movement
• pain irritability
• general health and tendon quality
• work, gym and sporting demands
• how consistently loading is progressed
• whether surgery is required

What should you avoid with a rotator cuff tear?

You usually do not need to stop using your shoulder completely. Instead, temporarily reduce activities that clearly provoke significant pain or weakness while maintaining comfortable movement.

Early on, this may mean modifying:

• repeated painful overhead lifting
• sudden heavy lifting
• high-load pressing or pulling that causes a flare
• repetitive work above shoulder height
• exercises that produce a clear loss of control or marked worsening afterwards

As capacity improves, these activities can often be reintroduced progressively.

When should you seek medical help promptly?

Related shoulder information

Rotator Cuff Tear FAQs

What to do next

If shoulder pain or weakness is affecting sleep, work, exercise or everyday use of your arm, consider a physiotherapy assessment.

Your physiotherapist can assess your movement and strength, explain whether a rotator cuff tear appears likely, start an appropriate rehabilitation plan and advise whether imaging or medical review may add value.

References

1. American Academy of Orthopaedic Surgeons. Management of Rotator Cuff Injuries Clinical Practice Guideline. AAOS. 2025.
2. Desmeules F, et al. Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care and Rehabilitation: A Clinical Practice Guideline. J Orthop Sports Phys Ther. 2025.
3. Longo UG, et al. Conservative Management of Partial Thickness Rotator Cuff Tears: A Systematic Review. Sports Med Arthrosc Rev. 2023.
4. Longo UG, Ambrogioni LR, Candela V, et al. Conservative versus surgical management for patients with rotator cuff tears: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2021;22:50.
5. Healthdirect Australia. Rotator cuff injury. Healthdirect Australia.