What it is

A rotator cuff tear is a partial or complete thickness disruption of tendon fibres. Tears follow a sudden load or develop gradually on a background of tendon change. Many people regain function without surgery. Others benefit from repair when weakness and night pain persist.

Decision-making balances symptoms, strength, goals, and imaging.

What happens when it occurs

The tendon loses continuity, and the shoulder offloads painful ranges. Scapular muscles work harder to lift and control the arm. Timed progressive loading restores capacity. Repair reconnects the tendon when indicated and then requires a longer staged rehabilitation.

Common causes and risk factors

  • Traction or sudden lift in sport or work
  • Age-related tendon changes
  • Previous shoulder symptoms or stiffness
  • Smoking and metabolic health factors

Who is most affected

Adults over forty and anyone with a traumatic lifting injury.

Typical symptoms

  • Sudden pain and weakness after a lift or catch
  • Night pain and difficulty lying on the side
  • Painful arc during elevation

When to seek care

After a sudden loss of strength or when night pain persists despite rest.

How we diagnose

History and examination with strength deficits, as well as specific tests. Ultrasound or MRI defines the pattern and aids planning.

Management

  • Education and load modification
  • Heavy slow resistance for cuff and scapular muscles within tolerance
  • Range and thoracic mobility
  • Injections for short-term pain control when needed
  • Surgical repair for persistent weakness and pain or for larger traumatic tears

Rehabilitation milestones

Conservative: phases as for tendinopathy with slower progress into overhead work.

Post repair:

Phase 1 weeks 0 to 6: sling use, protected passive range, hand and elbow work.

Phase 2 weeks 6 to 12: active range and light isometrics.

Phase 3 months 3 to 6: progressive strengthening and work tasks.

Phase 4 months 6 to 9: return to sport after testing.

Readiness to progress

  • Night pain controlled
  • Strength and endurance within 90 per cent
  • Work or sport tasks completed without the next day increase

Prevention

  • Build a base of strength before overhead seasons
  • Plan lifting technique at work
  • Prioritise sleep and recovery

Australia snapshot

  • Frequent in manual workers and overhead sports
  • Public and private services offer imaging, therapy, and repair
  • Return to work planning is common in allied health pathways

Latest insights

Function is the north star. Many tears perform well with targeted strength.

Post-repair success depends on patient adherence to staged loading.

Frequently Asked Questions

No. Decisions weigh function, weakness, goals, and imaging. Most resolve with physiotherapy, injections and exercise.

Commonly, several weeks to months with gradual increases in movement as advised.

Some enlarge with time. Strength and load control improve function either way.

Used for pain relief when needed. It does not repair the tear.

Yes, with a staged plan and strength testing.

Often, yes, after strength, range, and control milestones are met.

Sudden loss of strength after a pop needs review.