Shoulder conditions
Rotator cuff tears
A common and treatable cause of shoulder pain, weakness, and lost motion, from sudden injuries in active adults to gradual, age-related wear.
Tendon injury
Most common over age 40
Often treated without surgery
What is a rotator cuff tear?
The rotator cuff is a group of four muscles and their tendons that wrap around the top of the shoulder, keeping the ball of the upper arm centered in its socket and powering overhead and rotational movement.
A tear happens when one or more of those tendons is partially or completely pulled away from the bone, from small, partial-thickness fraying to large, full-thickness tears. Some cause sudden pain after an injury; many develop slowly and are felt as a deep ache and growing weakness.
Overview
At a glance
The good news
Many rotator cuff tears improve with non-surgical care, and when surgery is needed, modern arthroscopic repair is minimally invasive with a high success rate.
Symptoms & signs
How a rotator cuff tear feels
Symptoms vary with the size of the tear. Pain at night is one of the most telling signs.
A dull, deep ache that often radiates down the outside of the upper arm
Pain that worsens at night and makes sleeping on that side difficult
Weakness when lifting, reaching overhead, or rotating the arm
Difficulty with everyday tasks like combing hair or reaching a seatbelt
A crackling or catching sensation in certain positions
Causes & risk factors
Why rotator cuff tears happen
Tears fall into two broad groups, sudden injuries and gradual wear. Many patients have a mix of both.
Acute injury
A fall onto an outstretched arm or lifting something too heavy can tear a healthy tendon.
Age-related wear
Tendons lose blood supply and elasticity with age, making tears far more common after 40.
Repetitive overhead use
Overhead reaching, including with exercise or lifting related to one's work, place years of repeated stress on the cuff.
Bone spurs
Spurs on the underside of the shoulder blade can rub and gradually fray the tendon.
Treatment options
How rotator cuff tears are treated
Most patients begin with non-surgical care. Surgery is considered for larger tears and active patients who want to restore full strength.
- Activity modification and rest from aggravating motions
- Anti-inflammatory medication for pain and swelling
- A structured physical therapy program
- A targeted corticosteroid or PRP injection when needed
- Minimally invasive, through small portal incisions
- The torn tendon is trimmed to the healthy portion and reattached to the bone with anchors
- For full-thickness tears or when therapy fails
- Usually a same-day outpatient procedure
Related procedure
When repair is the right choice, Dr. Cohn performs an arthroscopic rotator cuff repair.
Recovery
What recovery looks like
Below is a general timeline for recovery. Smaller tears may be rehabilitated more quickly, whereas larger tears may take more time. Dr. Cohn tailor’s your recovery to the nature of your tear and repair.
Protect & calm
A sling protects the repair while gentle passive motion keeps the joint supple.
Restore motion
Therapy progresses from passive to active motion as the tendon knits to the bone.
Build strength
Strengthening exercises gradually load the cuff and surrounding muscles.
Return to activity
Most patients return to sport and demanding work, with strength improving up to a year.
FAQ
Common questions
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Torn tendons do not grow back together on their own, but in some cases, strengthening the healthy portion of the rotator cuff can take stress off of the torn portion and symptoms will improve. Larger tears and active patients tend to do better with repair.
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Night pain, weakness lifting the arm, and trouble reaching overhead are classic signs. Dr. Cohn confirms the diagnosis with an exam and imaging such as an MRI.
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Typically once you're out of the sling, off strong pain medication, and can safely control the wheel with both hands, usually around 4–6 weeks after a repair.
Related procedures