A rotator cuff tear is damage to one or more of the four tendons that hold your shoulder joint together and allow you to lift and rotate your arm. These tears range from minor fraying to a complete split through the tendon, and they’re remarkably common: imaging studies show that over half of people older than 60 have a partial or complete tear, and many don’t even know it.
The Four Tendons That Make Up the Rotator Cuff
Your rotator cuff is a group of four muscles and their tendons that wrap around the ball of your shoulder joint, keeping it stable inside a shallow socket. Each one has a slightly different job. The supraspinatus sits on top of the shoulder and helps you lift your arm. The infraspinatus and teres minor both help you rotate your arm outward, like when you wind up to throw a ball. The subscapularis sits in front and lets you hold your arm away from your body.
Together, these tendons act like a cuff that holds the ball of your upper arm bone snugly against the shoulder blade. When one or more of them tears, the joint loses some of that stability, and movements that were once effortless can become painful or weak.
Partial Tears vs. Full-Thickness Tears
Rotator cuff tears are classified by how deep the damage goes into the tendon. A partial tear goes only part of the way through. These can be as shallow as 1 millimeter (roughly 10 percent of the tendon’s thickness) or extend more than halfway through. A full-thickness tear goes all the way through, creating a hole or split in the tendon.
On MRI, the line between these categories isn’t always crisp. Radiologists sometimes have difficulty distinguishing a partial tear from simple tendon irritation, or a deep partial tear from a full-thickness one. That’s why your doctor may combine imaging results with a physical exam and your symptoms to get the full picture.
What Causes a Tear
There are two main paths to a rotator cuff tear: a sudden injury or gradual wear over time. Most tears fall into the second category.
An acute tear can happen when you fall on an outstretched arm, catch yourself during a slip, or lift something heavy with a jerking motion. These injuries sometimes occur alongside a broken collarbone, dislocated shoulder, or wrist fracture.
Degenerative tears develop slowly as the tendon wears down with age. Two factors accelerate this process. First, repetitive overhead motions stress the tendon over years. This affects athletes in sports like baseball, tennis, and rowing, but it’s just as common in people whose jobs or daily routines involve repeated overhead reaching. Second, blood supply to the rotator cuff tendons naturally decreases as you get older. With less blood flow, the body’s ability to repair small areas of damage slows down, and minor fraying can gradually progress to a tear.
How Common Tears Are by Age
Rotator cuff tears become dramatically more prevalent with age. In one MRI study of people with no shoulder complaints at all, only 4 percent of those under 40 had a tear, while 54 percent of those over 60 did. Among people who do have shoulder symptoms, the numbers follow a similar curve: roughly 11 percent of people in their 50s, 15 percent in their 60s, 26 percent in their 70s, and 37 percent of those over 80. A large ultrasound study of a mixed population found that the prevalence of full-thickness tears reached 80 percent in people over 80.
The key takeaway from these numbers is that having a tear on imaging doesn’t automatically mean you need treatment. Many tears, especially degenerative ones, cause no symptoms at all.
How It Feels
The hallmark symptom is a dull ache deep in the shoulder. It’s not always sharp or stabbing, which surprises people who expect a torn tendon to feel dramatic. The pain tends to worsen at night, particularly when you lie on the affected side, and it can disrupt sleep significantly.
You may also notice weakness when lifting your arm or rotating it, difficulty combing your hair, and trouble reaching behind your back. In acute tears from an injury, the onset is sudden and often accompanied by a snapping sensation and immediate weakness. In degenerative tears, symptoms creep in over weeks or months and may start as mild discomfort that you write off as normal aging.
How Doctors Diagnose a Tear
Diagnosis typically starts with a physical exam. Your doctor will move your arm into specific positions to test for pain and weakness. Two common tests are the “empty can” test, where you hold your arms out at an angle with thumbs pointing down while the doctor pushes against them, and the “drop arm” test, where you slowly lower your arm from a raised position to see if it drops suddenly. Neither test alone is definitive. The empty can test picks up about 69 percent of actual tears, while the drop arm test catches only about 21 percent but is highly specific, meaning if it’s positive, a tear is very likely.
When a tear is suspected, MRI is the standard imaging tool. It shows the size and location of the tear, the condition of the surrounding tendon and muscle, and whether the muscle has started to shrink from disuse.
Non-Surgical Treatment
Many rotator cuff tears, especially partial tears and smaller full-thickness tears, respond well to conservative treatment. This usually involves a combination of rest, anti-inflammatory medication, and sometimes a steroid injection into the space above the tendon to reduce pain and swelling. Once the acute inflammation calms down, physical therapy becomes the centerpiece of treatment: stretching, range-of-motion exercises, and progressive strengthening of the rotator cuff and the muscles around the shoulder blade.
Success rates for conservative treatment vary widely, from about 33 percent to 88 percent depending on the study and the population. In one series of 123 shoulders, about 53 percent improved without surgery. The odds improve significantly when certain favorable factors are present, including preserved range of motion, minimal muscle wasting, and the absence of impingement signs during the exam. When at least three of those factors were present, the success rate jumped to 87 percent.
When Surgery Makes Sense
Surgery enters the conversation when pain persists despite several months of non-surgical treatment, typically after 6 to 12 months. Other factors that may tip the decision toward repair include a large tear (more than 3 centimeters), significant weakness or loss of function, an acute tear from a recent injury, or high physical demands from work or sport.
The most common approach today is arthroscopic repair, where a small camera and miniature instruments are inserted through tiny incisions. The surgeon reattaches the torn tendon to the bone without needing to cut through the outer shoulder muscle. This is usually done as a same-day outpatient procedure. For large or complex tears, an open repair through a larger incision may be needed to give the surgeon better access. In the end, patients rate both methods equally for pain relief, strength improvement, and overall satisfaction.
What Recovery Looks Like
After surgical repair, you’ll wear a sling for at least four weeks to protect the repair while it heals. During that time, you won’t be able to drive or use the arm for daily tasks. Passive motion exercises, where a therapist moves your arm for you, typically begin within the first few weeks to prevent stiffness.
Active movement and gradual strengthening ramp up over the following months. By around six months, most people can handle all normal daily activities without restriction. Noncontact sports are generally cleared at that point too. Contact sports and heavy overhead work take longer, usually 9 to 12 months after surgery. The timeline varies based on tear size, repair quality, and how consistently you follow through with rehabilitation.