Rotator cuff problems are relatively common, with over 2 million people in the United States experiencing a tear.

Unfortunately, the risk increases with age. Degenerative tears develop over time, while acute tears occur suddenly, often after a dislocation or accident. Degenerative tears are more common in people over 50, with the risk of an acute tear around 40. 

“There is an overlap as well,” says orthopaedic sports medicine surgeon Richard Amendola, MD. “A person may have a degenerative tear that’s starting to fray, become partially torn, and then later experience a fall and tear the whole thing. Even though most of the damage and degeneration was done years before, their shoulder went from one that was functioning with an intact rotator cuff to having a big tear.”

Rotator cuff tears typically don’t occur under the age of 30. Problems at this age are more related to instability unless there’s been a fracture where the rotator cuff attaches, such as with an accident or sports injury.

The two main rotator cuff tear types include:

• A partial or incomplete tear where the tendon remains somewhat attached to the bone.
• A complete tear where the tendon separates from the bone entirely.

Rotator cuff tear symptoms: What does it feel like?

Symptoms may not be noticeable and feel different from person to person, depending on how the injury has occurred. With a degenerative tear, weakness and pain may progress to a deep, dull ache or stabbing pain in the shoulder or lateral arm with reaching or overhead activities.  A sudden tear is more likely to cause immediate shoulder pain and weakness. Pain at night is common.

Rotator cuff tears do not typically cause pain beyond the elbow or in the hand.

Symptoms may include:

• Chronic or sharp pain in or close to the shoulder joint or on the side of your arm.
• Trouble raising, lowering or rotating your arm.
• Weakness or pain when reaching out and away from your body or over your head.
• Popping or clicking when moving an arm in certain positions.
• Pain that worsens at night or keeps you from sleeping.

What could cause a rotator cuff tear?

Degenerative tears may occur due to:

• Bone spurs, which can cause friction between the bone and tendon.
• Overuse and repeated shoulder movement over the years.
• Lower blood flow that decreases as a person ages.

Sudden tears may occur as a result of a fall or other type of accident that may include a bone fracture or dislocated shoulder. 

Rotator cuff tear treatment options

If pain has been affecting your work, daily routine or sleep for more than four to six weeks, it may be time for an evaluation with an orthopaedic doctor. A sudden injury or shoulder dislocation should be examined within a week or two.

In an exam, your doctor will ask you to move your arm into different positions to test the muscles and range of motion while looking for signs of weakness.

Can a rotator cuff injury heal on its own?

“The structure will not heal back to the bone on its own,” says Dr. Amendola. “But you can lower the inflammation to the point where you'll have no symptoms. Even though it doesn't necessarily grow back to the bone, the pain might go away, … with time, physical therapy or a steroid injection.”

For many patients, nonsurgical treatments may effectively manage rotator cuff tear symptoms. The goal is to restore you to essential function, even if the tear does not fully heal. Giving conservative treatments a chance while monitoring for any worsening is generally recommended before pursuing surgery.

“A degenerative rotator cuff tear that’s developed over time often just needs time to calm down,” adds Dr. Amendola. “Everyone is a little different, though. If there’s a sudden tear or an acute injury where a person has a noticeable change in function, a discussion about surgery is appropriate.” 

Nonsurgical treatment options:

• Rest, applying ice and heat, and nonsteroidal anti-inflammatory drugs.
• Modify activities for a while to promote healing.
• Physical therapy.
• Steroid injections may help with pain and swelling.

Outpatient rotator cuff tear surgery depends heavily on a person’s circumstances and preferences. Factors like the patient's age, tear size, and overall health are all considered, as surgery recovery can be pretty painful, and healing can take many months.

Research shows that most rotator cuff repairs are performed on people ages 60 to 64, and a 10-year follow-up study found that only 30% of people with tears went on to have surgery of any kind.

Surgical options include:

• Arthroscopic surgery, or more rarely, open surgery.
• A reverse total shoulder may be recommended for tears that can’t be repaired.