One of the most common middle-age complaints is shoulder pain. A frequent source of that pain is a torn rotator cuff.1
This article provides a detailed overview of rotator cuff tears: how they develop, common symptoms, who is most at risk, how doctors diagnose them, and which tests correspond to specific tendon injuries.
What Is the Rotator Cuff and What Does It Do?
Four tendons attach muscles from the shoulder blade and ribs to the upper arm bone. Because these tendons help to rotate the arm within its socket, this sleeve of tendons is called the rotator cuff.2
Your rotator cuff helps you lift your arm, rotate it, and reach up over your head.1
What Causes a Rotator Cuff Tear?
Injury and degeneration are the two main causes of rotator cuff tears.3
An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand. 3
It may also develop over time due to repetitive activities. Rotator cuff tears can also happen due to the breakdown (degeneration) of the tissues, which may happen as part of the aging process.3
Rotator cuff tears come in all shapes and sizes. They typically occur in the tendon.
Partial tears. Many tears do not completely sever the soft tissue.1
Full thickness tears. A full or “complete” tear will split the soft tissue into two, sometimes detaching the tendon from the bone.1
Who is at risk of a Rotator Cuff Tear?
Rotator cuff tears are most common in people over 40 who participate in activities that have repetitive overhead motions.
Baseball, tennis, and weightlifting are some sports examples. Many jobs and routine chores can cause overuse tears, as well.
Rotator cuff tears in younger people are usually caused by an accident, like a fall.
Overuse tears caused by sports or overhead work also occur.
What are the symptoms of a rotator cuff tear?
Symptoms may be a bit different for each person. Symptoms may include3
- Pain that keeps coming back, especially when doing certain things, such as lifting over your head
- Pain that prevents you from sleeping on your injured side
- Grating or cracking sounds when moving your arm
- Limited ability to move your arm
- Muscle weakness
The symptoms of a rotator cuff tear may be caused by other conditions or health problems. Always talk with your healthcare provider for a diagnosis.
When to reach out for your doctor?
A doctor should evaluate shoulder symptoms that last for more than one week.
How Is a Rotator Cuff Tear Diagnosed?
A rotator cuff injury usually is diagnosed by physical examination. Your doctor will rotate your arm on the shoulder and then will raise your arm. If this type of motion causes pain, the rotator cuff may be inflamed.2
If a tear is suspected, a magnetic resonance imaging (MRI) scan can confirm the diagnosis. 2
An alternative diagnostic test is a shoulder arthrogram. An arthrogram is an X-ray of a joint following injection of dye into the joint. Because MRIs provide excellent pictures without putting a needle into a joint, arthrograms are done less frequently today. 2
How can I prevent Rotator Cuff Tears?
In many cases, a rotator cuff injury can be avoided. To avoid reaching over your head repeatedly, use a step stool or ladder during projects. Avoid using your arms to push off from a chair.
For people who are in poor athletic shape or who have arthritis in the knees, exercises to strengthen the quadriceps muscles in the thighs can be very helpful, so that it is not necessary for you to use your arms to get up from sitting.
People who are dependent on their arms to rise out of a chair can raise the seat of their favorite chair with a thick folded blanket or a short platform to make it easier to get up.
Exercises that strengthen the rotator cuff muscles also are an important part of prevention. Some of the rotator cuff muscles pull down on the upper arm bone as they work, widening the space that the tendons travel through. Physical therapy that strengthens the rotator cuff muscles can make your shoulder less vulnerable to injury.
How Are Rotator Cuff Tears Treated?
Treatment will depend on your symptoms, age, and general health. It’ll also depend on how bad the condition is.
Treatment may include:
- Rest
- Nonsteroidal anti-inflammatory drugs
- Strengthening and stretching exercises
- Ultrasound therapy
- Corticosteroid shot (injection)
- Surgery for severe injuries or tears
Finally,
Persistent shoulder pain, weakness, or difficulty moving your arm could be signs of a rotator cuff tear. Talk to your doctor for an accurate diagnosis and the right treatment plan.3
Frequently asked questions
Does every rotator cuff tear require surgery?
Treatment options depend on the severity of the tear and whether your surgeon determines if it can be repaired. There are several non-surgical and surgical options for a torn rotator cuff.4
What does a rotator cuff tear feel like?
A torn rotator cuff often feels like a deep, aching pain in the shoulder, which can worsen at night or when lying on the affected side.4
References
- American Academy of Orthopaedic Surgeons (2019) Rotator cuff tears. OrthoInfo Basics. Available at: https://www.orthoinfo.org/globalassets/pdfs/rotator-cuff-tears.pdf (Accessed: 1 October 2026).
- Harvard Health Publishing (n.d.) Rotator cuff injury. Available at: https://www.health.harvard.edu/a_to_z/rotator-cuff-injury-a-to-z (Accessed: 1 October 2026).
- Johns Hopkins Medicine (n.d.) Rotator cuff injury. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/rotator-cuff-injury (Accessed: 1 October 2026).
- UC Davis Health (2025) Torn rotator cuff symptoms, causes and how to know if you need surgery. 16 April. Available at: UC Davis Health article (Accessed: 1 October 2026).
