Understanding Rotator Cuff Tears: What They Are and How They’re Treated 💪🦴

lukedaviesphd
Dec 1
2 min read

Shoulder pain is incredibly common, especially as we get older — and one of the most frequent causes is a rotator cuff tear. You may have heard the term from a friend, a physiotherapist, or even your doctor, but what does it actually mean?

What Is the Rotator Cuff? 🎯

The rotator cuff is a group of four muscles and tendons that help lift and rotate your arm and keep your shoulder stable. These tendons can become irritated, weakened, or torn over time, a bit like a rope fraying after years of use.

Most tears develop gradually as part of ageing (yes, just like greying hair!), and many people don’t even know they have one because they’re often painless.

How Common Are Rotator Cuff Tears? 📊

Very common — especially after age 50. Research shows:

20–25% of adults over 55 have a full-thickness tear
Many tears cause no symptoms at all
The likelihood increases steadily with age

Repetitive overhead work, heavy lifting, and certain sports can add to the risk.

What Causes a Tear? ⚠️

1. Wear and tear over time (most common)

Ageing, decreased blood supply, and years of shoulder use gradually weaken the tendon.

2. Sudden injury

A fall, heavy lift, or sudden movement can cause an acute tear — even in younger people.

Other risk factors include diabetes, smoking, and high cholesterol.

Common Symptoms 🛑

Not everyone with a tear has pain, but when symptoms do occur, they often include:

Pain when lifting the arm or reaching overhead
Night pain (especially lying on the affected shoulder)
Weakness when lifting or rotating the arm
Difficulty with everyday tasks

Because these symptoms overlap with conditions like frozen shoulder, proper assessment is important.

How Are Rotator Cuff Tears Treated? 🩺

✔️ Physiotherapy (the first choice for most patients!)

Most people improve significantly with a structured physio program. Exercises focus on:

Restoring movement
Strengthening shoulder and upper-back muscles
Improving posture
Re-training how the shoulder moves

Over 70% of people feel better with physiotherapy alone.

✔️ Medications

Short-term use of paracetamol or anti-inflammatories can help manage pain.

✔️ Corticosteroid Injections

These can reduce pain temporarily, especially if pain is limiting sleep or exercise. However, repeated injections are not recommended.

✔️ Platelet-Rich Plasma (PRP)

Popular but inconsistent. Current evidence doesn’t strongly support routine use.

When Is Surgery Needed? 🛠️

Surgery is usually considered when:

Pain persists despite months of physiotherapy
The tear is large or the result of trauma
There is significant weakness
Daily function is affected

Modern surgery is minimally invasive, but healing depends on factors such as age, tear size, and muscle quality. In cases where the tear can’t be repaired, often in older adults, a reverse shoulder replacement may offer excellent relief.

Can You Prevent Rotator Cuff Tears? 🏃‍♀️

While not all tears are preventable, you can lower your risk by:

Strengthening shoulder and upper-back muscles
Avoiding repetitive heavy overhead lifting
Not smoking
Staying active without overloading the shoulder

The Bottom Line 💡

Rotator cuff tears are very common and often not as scary as they sound. Most people get better without surgery, using physio-based treatment, lifestyle adjustments, and simple self-care.

If you're experiencing shoulder pain especially at night or with overhead movement a physiotherapist can help you get back on track.