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What is a rotator cuff tear?
Rotator cuff tendons connect shoulder blade muscles to the upper arm bone. A tear interrupts some of their fibres and may affect one or several tendons. The supraspinatus tendon, which contributes to lifting the arm, is commonly involved.
A partial tear affects part of a tendon’s thickness. A full-thickness tear passes through its depth, but does not necessarily mean the entire tendon or whole cuff has detached. Its width, how far the tendon has pulled back and the condition of the muscles provide additional information.
Chapter sources [1]
Understand the picture
Depth and width are different
Intact tendon
Fibres connect muscle and bone.
Partial tear
Part of the tendon thickness remains continuous.
Full-thickness tear
The tear crosses its depth over a variable width.
Chapter sources [1]
What symptoms are possible?
Outer upper-arm pain, difficulty lifting objects and night discomfort are possible. Certain movements may feel weak. After a fall or sudden effort, marked new weakness or inability to lift the arm deserves prompt assessment.
Some gradually developing tears cause few symptoms. Severe pain does not prove a large tear, and little pain does not exclude one. Pain itself can also limit strength. Examination helps distinguish these possibilities and relate them to your actual difficulties.
Chapter sources [1]
Why does a tendon tear?
An accident can suddenly exceed a tendon’s capacity. Tendon structure can also change with age, allowing a tear to develop with little trauma. Repeated demands at work or in sport may contribute to the background.
The first painful day does not always reveal when the tear formed. An event can make an existing change noticeable. This distinction matters because a recent traumatic tear and a longstanding degenerative tear may need different assessment and treatment timelines.
What do examination and imaging show?
The clinician assesses difficult movements, available strength, stiffness and the effect on daily tasks. They also consider other explanations, including the neck and nerves when unusual sensations extend down the arm. Bring previous reports to help compare findings.
Ultrasound or MRI can describe the tear. X-rays mainly assess bones and the joint. Ask which tendon is involved, whether the finding explains your symptoms and what it changes about care. The report alone does not determine whether you need surgery.
When is prompt assessment important?
Sudden weakness after falling or pulling the arm should not wait for several weeks of exercises. Prompt assessment checks for a traumatic tear, fracture or dislocation. HAS recommendations distinguish this from gradual tears and call for surgical advice without delay for a traumatic tear in a previously healthy tendon.
A deformed shoulder, cold or pale hand, loss of feeling, a red shoulder with fever or associated chest symptoms also needs urgent help. Do not test the tendon by lifting weights while waiting to be assessed.
Can treatment help without surgery?
Non-surgical care can reduce pain and improve how you use the arm. It may include activity changes, pain treatment agreed with the doctor and progressive rehabilitation. Available muscles and better shoulder coordination can help restore useful tasks.
This does not promise that the tear closes. A tear can change over time, making follow-up important if weakness or function deteriorates. The decision considers your limitations, general health, tear characteristics and goals rather than one scan measurement alone.
In everyday life
From a report to a decision
Understand
Clarify whether there was a recent accident or gradual change.
Connect
Relate findings to limitations and goals.
Decide together
Discuss options, their limits and appropriate follow-up.
When is surgery discussed?
Repair usually aims to reattach the tendon to bone. For a degenerative tear, surgery may be discussed when disabling pain or functional difficulty persists despite appropriate non-surgical treatment. HAS generally specifies at least six months in this context; this waiting period does not apply to a traumatic tear requiring prompt advice.
Ask about expected benefits, risks, restrictions afterwards and alternatives. Surgery cannot guarantee a perfect recovery. Tendon and muscle quality, other health conditions and the activities you hope to regain all influence the decision.
What are the exercise limits?
Have a suddenly weak shoulder assessed before starting strengthening. When non-surgical rehabilitation is appropriate, exercises match mobility, available strength and the response after effort. Goals can be practical, such as placing a cup or brushing your hair more comfortably.
After repair, protecting the tendon takes priority. Permission for assisted movement does not automatically permit lifting the arm unaided, carrying a bag or pushing out of a chair. General exercises on this site never replace the surgeon’s rehabilitation instructions.
How does recovery develop?
Without surgery, progress is usually assessed over weeks or months and may require adjustments. Following repair, healing and rebuilding strength generally take several months. Steps depend on the operation: there is no single week when everyone can resume sport or heavy lifting.
Record what becomes possible and what remains difficult. Less pain does not necessarily mean the tissues are ready for a heavy effort. Lasting deterioration, new weakness or stalled progress warrants discussion with the treating team.
How can you prepare for follow-up?
Choose two or three concrete goals: sleeping, dressing, carrying shopping or returning to work tasks. Explain the actual loads, repetition and opportunities to adapt. These details help more than asking for a “normal shoulder” without defining what that means to you.
If surgery is planned, organise help at home, dressing and transport. Ask for written instructions about the sling, permitted movements and who to contact with a problem. Communication between the doctor, surgeon and physiotherapist helps prevent conflicting advice.
Your questions
Does full-thickness mean the whole rotator cuff is torn?
No. It describes the depth of the tear at that location. Its width, the tendons involved and muscle condition also matter.
Chapter sources [1]
Can physiotherapy stick the tendon back together?
Rehabilitation primarily aims to improve function, available strength and symptoms. It cannot promise anatomical repair of the tear.
Can I wait six months after a fall?
Not with new weakness or major difficulty lifting the arm. A period discussed for degenerative tears does not apply to an acute traumatic tear.
Sources and references
- [1] AAOS OrthoInfo · Rotator cuff tears
- [2] HAS · Épaule douloureuse et coiffe des rotateurs, mise à jour 2026
- [3] NHS · Shoulder pain
- [4] CGDIS Luxembourg · 112
- [5] NHS Inform · Exercises for shoulder problems
- [6] NHS · Heart attack
Text updated on
Medical review: awaiting Hasib Selimovic.