Rotator Cuff Tear

Rotator Cuff Tear

John Miller Physiotherapist

Article by John Miller

What is a Rotator Cuff Tear?

A rotator cuff tear is merely a tear within your shoulder’s rotator cuff tendons. A rotator cuff tear can occur in two ways:

  • trauma, and
  • repeated microtrauma.

Traumatic rotator cuff tears occur quickly or under heavy load, e.g. a fall or lifting a heavyweight. However, the most common cause of a rotator cuff tear is repeated microtrauma, which can occur over several weeks, months or years.

Repeated rotator cuff injury from straining or pinching the rotator cuff tendons will injure the soft tissue resulting in bruising or swelling. Since only a few millimetres are separating your rotator cuff tendons from a bony hood (acromion), the additional swelling causes a quicker impingement, catching or squeezing of the rotator cuff tendons.

What are the Symptoms of a Rotator Cuff Tear?

Your rotator cuff tears may be partial or full-thickness tears. You will notice that your shoulder pain and weakness increase with the severity of your rotator cuff tear. More importantly, it is the reduction in your shoulder function.

Partial rotator cuff tear may only present with mild shoulder pain, clicking during shoulder elevation, and mild shoulder weakness lifting your hand above shoulder height or reaching behind your back.

Full-thickness rotator cuff tear will typically present with severe shoulder pain and an inability to lift your elbow away from your body. However, in some cases, the rotator cuff tear is so severe that a significant number of your pain fibres are torn, which can make them less painful but very weak.

When you have a small rotator cuff tear, you can often still raise your arm with or without pain. Moderate tears are usually very painful, and you’ll have difficulty moving your arm. Most patients can’t sleep due to the relentless pain. When a massive rotator cuff tear occurs, you may find that you cannot lift your arm at all.

What is the Rotator Cuff?

Your shoulder’s rotator cuff is a group of four small shoulder muscles that stabilise, control and move your shoulder joint. The four muscles collectively known as the rotator cuff are your subscapularis, supraspinatus, infraspinatus and teres minor muscles. When your rotator cuff muscles work in isolation, they exhibit rotational motion at the glenohumeral (shoulder) joint, which we describe as the rotator cuff.

How is a Rotator Cuff Tear Diagnosed?

Your physiotherapist or sports doctor will suspect a rotator cuff tear based on your clinical history and the findings from a series of clinical tests.

A diagnostic ultrasound scan is the most accurate method to diagnose the size and location of your rotator cuff tear. MRIs may show a rotator cuff tear but have also missed a tear. X-rays are of little diagnostic value when a rotator cuff tear is suspected.

Please consult your trusted shoulder physiotherapist or doctor for specific advice regarding your rotator cuff tear.

What is the Best Treatment for Rotator Cuff Injury?

Small and medium-sized rotator cuff tears usually heal successfully with appropriate conservative management and rotator cuff physiotherapy treatment. Physiotherapy is often one of the first treatment options your doctor or shoulder specialist suggests.

If early treatment methods have failed to settle your symptoms or you have an added shoulder bursitis, your health professional may recommend a corticosteroid injection. These injections may improve your pain while sleeping or allow you to perform your rotator cuff exercises. Corticosteroid injections are known to weaken your tendons potentially, so your doctor will inform the prescription of a dose.

Unfortunately, more massive rotator cuff tears may require rotator cuff surgery (arthroscopic or open) if physiotherapy treatment fails to assist. Massive rotator cuff tears may require shoulder replacement or reverse shoulder arthroplasty to restore some of your shoulder function. Post-operative physiotherapist guided rehabilitation will be necessary to regain your shoulder function safely.

Early rotator cuff tear treatment is essential. Delay will result in retracting your rotator cuff tendon, making healing or rotator cuff repair surgery more complex and less successful. The best rotator cuff tear results occur when the rotator cuff injury is fresh.

Rotator Cuff Tear Treatment

Rotator cuff tears are a common problem. Rotator cuff injury deteriorates further if you return to sport or work too quickly – especially if you didn’t complete a thorough rehabilitation program. They are also regularly poorly treated by inexperienced shoulder practitioners.

Your rotator cuff is an essential group of control and stability muscles that maintain the “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This centralisation prevents other shoulder injuries such as rotator cuff impingement or shoulder dislocation.

Researchers have concluded that there are mostly seven stages that need to be covered to rehabilitate rotator cuff tears and prevent recurrence effectively.

These are:

  1. Early Injury Protection: Pain Relief & Anti-inflammatory Tips
  2. Regain Full Shoulder Range of Motion
  3. Restore Scapular Control
  4. Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
  5. Restore Rotator Cuff Strength
  6. Restore High Speed, Power, Proprioception & Agility
  7. Return to Sport or Work

Your physiotherapist will discuss your goals, time frames and training schedules to optimise you for a complete return to sport or work.

The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a thorough rehabilitation program has minimised your chance of future injury.


There is no specific time frame for when to progress from each rotator cuff treatment stage to the next. During your physiotherapist’s clinical assessment, many factors will determine your rotator cuff rehabilitation status.

In most cases, you’ll find that your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves. It is also important to note that your physiotherapist must supervise your progression as attempting to move too soon to the next level can lead to re-injury and frustration.

Don’t hesitate to get in touch with your shoulder physiotherapist for more specific advice about your rotator cuff injury.[/vc_column_text]

What about Corticosteroid Injections?

Corticosteroid injections may relieve pain and promote tendon healing. Cortisone’s primary function is to increase blood sugar, suppress your immune system, and aid in fat, protein and carbohydrate metabolism.

There are side effects, and corticosteroid injections should be used cautiously, especially with diabetics. It also decreases bone formation and leaves you vulnerable to future tendon rupture.

Researchers generally find an excellent short-term benefit from corticosteroids, but some long-term side effects may be less desirable. Some patients report good initial relief before a recurrence of symptoms. As with all medications, please discuss the pros and cons of corticosteroid injection with your doctor.

Rotator Cuff Repair Surgery

An option is rotator cuff repair surgery for full-thickness and partial-thickness tears that do not heal with physiotherapy. Most shoulder surgeons will recommend at least six weeks of physiotherapy before contemplating rotator cuff repair surgery.

Post-operative physiotherapy rehabilitation is comprehensive and regular for your best outcome. Your post-operative rotator cuff repair recovery commonly takes between six to twelve months.

During rotator cuff repair surgery, your surgeon will attempt to sew your torn tendon back together. The best results occur when the tear is fresh rather than older damage.

Most rotator cuff repairs take approximately six months of rehabilitation to regain as complete as possible range of motion, shoulder strength and function.

It is essential to follow your physiotherapist’s exercise prescription and the surgeon’s post-operative advice. In our experience, about 90% have an excellent outcome at 12 months postoperatively.

As with all surgery, there are associated risks or complications. These can include infection, stiffness, blood clot formation, and nerve injury. The dangers of significant joint stiffness are less than 5%, and the risk of nerve injury is low – approximately 1 in 10000.

Shoulder Replacement Surgery

Using a routine rotator cuff repair, some massive rotator cuff tears will be irreparable. In these instances, a total shoulder replacement is an option for you and your surgeon.

Please seek your trusted shoulder physiotherapist or doctor for their specific advice.

Shoulder Pain FAQs & Products

Common Shoulder Pain & Injury Conditions

Shoulder problems are a common source of discomfort and disability, affecting individuals of all ages and lifestyles. The shoulder joint, one of the most mobile joints in the human body, is prone to various issues arising from injuries, overuse, or underlying conditions.

Common shoulder problems include: rotator cuff tears, shoulder impingement, frozen shoulder (adhesive capsulitis), shoulder instability, and arthritis.

These conditions can result in symptoms such as pain, stiffness, weakness, limited range of motion, and difficulty performing everyday activities.

Early diagnosis and appropriate treatment, which may involve physiotherapy, medications, injections, or in some cases, surgery, can help alleviate the pain and restore function to the shoulder joint.

Rotator Cuff

Adhesive Capsulitis

Shoulder Bursitis

Shoulder Instability

Acromioclavicular Joint

Bone Injuries

Post-Operative Physiotherapy

Muscle Conditions

Systemic Conditions

Referred Pain

Shoulder Products & FAQs

Shoulder Pain FAQs

Your Comprehensive Guide to Understanding and Managing Shoulder Injuries

Welcome to the "Shoulder Pain FAQs" page, your go-to resource for understanding various aspects of shoulder pain, injuries, and how to manage them effectively. The shoulder is a complex joint that allows for a wide range of movements, but it is also susceptible to various injuries and conditions that can cause discomfort and limitations in daily activities.

In this comprehensive guide, we will explore the most common shoulder injuries, their causes, and how to identify and treat them. We'll also address frequently asked questions about specific shoulder conditions, providing you with valuable insights into your shoulder health.

When Should You Worry About Shoulder Pain?

Shoulder pain can be caused by numerous factors, ranging from minor strains to more severe injuries. Knowing when to seek medical attention is crucial to prevent further damage and facilitate timely recovery.

More info: When Should You Worry About Shoulder Pain?

6 Common Shoulder Injuries

We'll swing into six of the most prevalent shoulder injuries, shedding light on their causes, symptoms, and appropriate treatment options.

More info: 6 Common Shoulder Injuries

What Causes Shoulder Pain?

Understanding the root causes of shoulder pain is fundamental to addressing the issue effectively. We'll explore the various factors that can lead to shoulder discomfort and how to mitigate them.

More info: What Causes Shoulder Pain?

What is Your Scapulohumeral Rhythm?

The scapulohumeral rhythm plays a vital role in shoulder function and movement. We'll explain what it is and its significance in maintaining a healthy shoulder.

Rotator Cuff: An In-Depth Analysis

The rotator cuff is a critical group of muscles and tendons in the shoulder. We'll dive into its anatomy, functions, and common problems associated with it.

Identifying a torn rotator cuff can be challenging, but we'll provide you with essential signs to look out for and when to seek professional evaluation.

Find out about diagnostic methods for a torn rotator cuff, including whether an MRI is always necessary for accurate diagnosis.

Discover the limitations and challenges you may face if you have a torn rotator cuff and how to manage arm movement during the healing process.

Learn about the possible relationship between a torn rotator cuff and shoulder blade pain, and what it indicates about your shoulder health.

Cortisone injections are sometimes used for shoulder pain, but their effectiveness in treating a torn rotator cuff is a point of interest we'll explore.

We'll provide practical tips and strategies to aid in the healing process of a torn rotator cuff and restore shoulder function more rapidly.

Shoulder Bursitis: Understanding the Condition

What is shoulder bursitis, and how does it differ from other shoulder injuries? Get insights into this inflammatory condition and how to manage it.

Recognising the distinct symptoms of shoulder bursitis can assist in early detection and prompt treatment.

Shoulder Impingement: Causes and Solutions

Understand the concept of the shoulder impingement zone and the factors contributing to rotator cuff impingement and bursitis.

Frozen Shoulder: Overcoming the Stiffness

Discover how to unfreeze a frozen shoulder and regain a full range of motion through effective therapeutic approaches.

Shoulder Dislocation/Instability: Seeking Stability

Explore the causes of shoulder dislocation and instability, and the fastest ways to promote healing and prevent future occurrences.

Find out about treatment options to address shoulder instability and regain stability in the joint.

AC Joint: Identifying and Managing Injuries

Learn how to recognise an injured AC joint and what steps to take for proper care and recovery.

Swimmers Shoulder: Causes and Remedies

If you're a swimmer or engage in repetitive overhead activities, understanding the causes of swimmer's shoulder and how to prevent it is essential.

We hope this comprehensive guide will prove invaluable in your journey to understand and manage shoulder pain and injuries. However, it's essential to consult a healthcare professional for personalised advice and treatment based on your specific condition. Let's dive into the world of shoulder health together!


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