Rotator Cuff Tears: 5 essential questions answered.

The rotator cuff is the most commonly injured structure in the shoulder.  

Just as if your car breaks down, it’s most likely your engine (except for some rare cases). If you have shoulder pain your rotator cuff is likely involved (with rare exceptions). 

What are the rotator cuff muscles?

The rotator cuff is made up of 4 muscles. The Supraspinatus, Infraspinatus, Subscapularis and Teres Minor. Now if you don’t know your teres minor from a Morris Minor read on. 

These 4 muscles connect your humerous (the upper arm bone) to your shoulder blade. They form a “cuff” around the ball and keep the ball stable and in the centre of the socket. The rotator cuff muscles essentially stabilise the shoulder joint while it is moving. 

What causes a rotator cuff tear

There are 2 types of rotator cuff tear:- 

Acute tear: This is where there has been a mechanism of injury such as a fall onto an outstretched hand, a slip from a latter while holding on or an onset while performing a lifting task. These tears can occur when there is other injuries such as a collar bone fracture or AC joint dislocation. 

Degenerative tear:  Just as her hair goes grey as we get older, our rotator cuff tendons wear out. Our rotator cuff gradually wears out overtime. Recent studies have shown that 100% of people over the age of 80 have a rotator cuff tear. 

The main causes of these tears is repetitive use, particularly with overhead lifting activities and single arm dominant sports such as tennis and throwing sports full stop. Blood supply is also an issue, as we get older the blood supply to our rotator cuff tendons decreases. 

Rotator cuff tears tend to fall into two categories. 

Partial thickness tears: these occur where the tendon is worn down and the fibers are not completely severed. 

Full thickness tears: This can also be called a complete tear. These occur when there is a disruption of the rotator cuff fibres and they’re separated from the bone. When this occurs there is essentially a “hole” in the tendon.  The “hole” may be small or large. 

How do you know if I have a Rotator cuff tear? 

What are the symptoms of rotator cuff tear?

The symptoms of a rotator cuff tear how many and varied. The most common symptom is pain in the shoulder. The pain may also radiate into the upper arm. 

Night pain is also a common feature of a rotator cuff tear. king 

Acute tears may also be associated weakness with shoulder elevation, above head movements and lifting. 

Do i need an xray, ultrasound or MRI for my rotator cuff tear?

Your doctor may order some scans for your shoulder:  the most common thing for a doctor to prescribe would be an X ray an ultrasound of the shoulder. 

The gold standard to show any rotator cuff tear is an MRI scan. Ultrasound scans are notoriously inaccurate at predicting rotator cuff tears. An X ray will not show a rotator cuff tear as he only shows bony structures. 

Treatment for  Rotator cuff tear? 

Only a small number of people who have rotator cuff tears will require surgery. Only large acute tears require urgent surgery. 

The vast majority of rotator cuff tears will recover with non-surgical management.  

The mainstays of therapy are:- 

Rest from aggravating activities for a short period. 

Simple analgesia or anti inflammatory medications. 

Physiotherapy interventions focusing on improving the overall function of you shoulder structures and strengthening your Rotator cuff muscles.  

Steroid (commonly cortisone) injections to settle down any inflammatory process. This may be recommended if your symptoms last beyond 6 weeks. 


The decision to operate on a shoulder is not as clear cut as it may seem. The decision is down to the individual taking all individual factors into consideration. The main factors to consider when recommending surgery are; 

Age of patient. 

Size of tear. 

Quality of surrounding tissues. 

How significant the loss of function is.  

An example of this would be a 70 year old man with minor pain and a large tear electing to not have surgery as he is capable of playing golf 3x weekly without pain vs a 20 y.o elite swimmer with a small tear having surgery as the pain impacts her ability to train at full capacity. 

Will your Rotator cuff tear get worse if you don’t have surgery? 

There is no clear evidence that rotator cuff tears get worse if not treated. A small tear will not necessarily become a large tear.  

By Peakhurst Physio

Caring for the whole person, not just the injury

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