Rotator Cuff Tears

A rotator cuff tear is one of the most common causes of shoulder pain and weakness. The rotator cuff is a group of four muscles and their tendons: supraspinatus, infraspinatus, teres minor, and subscapularis, that surround the shoulder joint, hold the humeral head in the glenoid socket, and control lifting and rotation of the arm.

Anatomy

Supraspinatus

Most commonly torn. Runs over the top of the joint and is responsible for initiating arm elevation.

Infraspinatus

Posterior cuff muscle controlling external rotation. The second most commonly torn tendon

Teres Minor

Assists infraspinatus in external rotation. Less commonly torn in isolation.

Subscapularis

Located at the front of the joint. Controls internal rotation. Torn in about 30% of full cuff tears.

Types of Tear

Partial tear

Only part of tendon thickness is torn. Tendon remains attached to bone. Can be bursal-sided, articular-sided, or intrasubstance.

Full-thickness tear

Complete tear through the full tendon thickness. The tear may be small and contained or large with significant retraction.

Massive tear

Involves two or more tendons, typically >5 cm. The muscle belly can retract and develop fatty infiltration over time.

Acute vs chronic

Acute tears occur from a fall or heavy lift. Chronic tears develop gradually from repeated micro-trauma and wear.

Symptoms

  • Pain at rest and at night - particularly when lying on the affected shoulder

  • Weakness lifting the arm above shoulder height or reaching behind the back

  • Clicking or crackling sensation when moving the shoulder

  • Limited range of movement - difficulty reaching overhead, behind your head, or across the body

⚠ Seek prompt assessment if you experience sudden, sharp pain after a fall or heavy lift combined with an immediate inability to raise the arm - this may indicate an acute full-thickness tear requiring urgent evaluation.

Diagnosis

Your surgeon will take a history and perform specific shoulder tests (Jobe's, empty can, external rotation resistance). MRI is the gold standard to confirm the diagnosis, identify tendons involved, tear size, and muscle quality, all of which guide treatment decisions.

Treatment Options

Physiotherapy & Rehabilitation

For partial tears and lower-demand patients. Strengthens remaining cuff muscles and scapular stabilisers. Reduces pain and improves function without surgery.

1

Steroid Injection

A corticosteroid injection into the subacromial space reduces inflammation and pain, facilitating engagement with physiotherapy. Not a long-term solution for structural tears.

2

Arthroscopic Repair

Keyhole surgery using small incisions, a camera, and suture anchors to reattach the torn tendon to bone. Standard of care for full-thickness tears in active, working-age patients.

3

Reverse TSR

For massive irreparable tears or elderly patients with concurrent arthritis. A reverse total shoulder replacement restores function.

4

RECOVERY AFTER SURGERY

  • Arm in a sling. Gentle pendulum and passive range-of-movement exercises only. Protect the repair, no active use of the arm.

  • Sling removed. Active-assisted exercises begin. Physiotherapy focused on restoring shoulder movement.

  • Progressive strengthening of the rotator cuff and scapular muscles. Most patients regain comfortable daily use.

  • Return to sport and manual work. Full tendon healing takes 6-12 months, compliance with rehabilitation is essential.

FREQUENTLY ASKED QUESTIONS

  • Partial tears may stabilise with physiotherapy, but tendon tissue has poor blood supply and does not regenerate. Full-thickness tears will not heal without surgery. Early repair generally gives better outcomes as tendon quality deteriorates over time.

  • Around 85-90% of patients report significant improvement in pain and function. Re-tear rates vary with tear size: small tears <10%, massive tears up to 40%. Rehabilitation compliance strongly influences outcomes.

  • Non-surgical management can relieve pain effectively, particularly in older patients. However, full-thickness tears tend to enlarge over time and the muscle can develop fatty degeneration, making future repair technically harder.

This guide is intended for patient education purposes and does not replace a formal surgical consultation. Treatment decisions are always individualised based on your specific history, examination findings, and imaging. Please discuss your symptoms and management plan directly with your orthopaedic surgeon.