Rotator Cuff Tear Treatment & Rehabilitation

What Causes a Rotator Cuff Tear?

Rotator cuff tears can occur suddenly following an injury or develop gradually as the tendon changes over time.

Possible causes and contributing factors include:

• Falling onto the shoulder or outstretched arm
• Suddenly lifting or pulling a heavy object
• Sports injuries
• Repeated overhead work or activity
• Age-related changes within the rotator cuff tendons
• Previous shoulder injury

A tear may be partial, affecting only part of the tendon, or full thickness, where the tear extends through the tendon. The size and location of a tear do not always correspond directly with the amount of pain or disability someone experiences.

What Are the Symptoms of a Rotator Cuff Tear?

Symptoms vary considerably depending on how the tear occurred, its extent and the individual.

Possible symptoms include:

• Pain around the outside or front of the shoulder
• Pain when lifting or reaching with the arm
• Weakness when raising or rotating the arm
• Difficulty lifting objects
• Pain when lying on the affected shoulder
• Difficulty reaching overhead or behind your back
• Reduced ability to work, exercise or play sport

Some people have substantial tears with relatively little pain, while others experience significant symptoms with much smaller tendon changes. This is one reason why the clinical assessment is important.

Is a Rotator Cuff Tear the Same as Shoulder Impingement?

No. The terms describe different findings, although the symptoms can overlap.

Rotator cuff-related shoulder pain or “shoulder impingement” commonly causes pain when raising the arm without necessarily involving a significant tendon tear. A rotator cuff tear means that part or all of a tendon has actually torn.

You can read more about this on our Shoulder Impingement & Rotator Cuff Pain page.

How Is a Rotator Cuff Tear Diagnosed?

Assessment usually begins with your medical history and an examination of the shoulder.

We may assess:

• Active and passive shoulder movement
• Rotator cuff strength
• Movements that reproduce your symptoms
• Shoulder blade movement and control
• The neck and upper back where appropriate
• The nervous system if there are symptoms suggesting nerve involvement

If a significant tear is suspected, imaging such as ultrasound or MRI may be appropriate. Imaging findings should be interpreted alongside the examination because tendon changes and even rotator cuff tears can be present without causing symptoms.

Does a Rotator Cuff Tear Always Need Surgery?

No. Many people with rotator cuff tears can improve with non-surgical management, particularly when the tear has developed gradually and useful shoulder strength and function remain.

A structured rehabilitation programme can aim to improve shoulder strength, movement and the capacity of the remaining rotator cuff and surrounding muscles.

However, surgical assessment may be appropriate in some circumstances. A substantial tear following a significant injury, sudden marked loss of strength or function, or symptoms that fail to improve with appropriate conservative management may require further investigation or specialist opinion.

The appropriate approach depends on factors including your age, activity requirements, symptoms, examination findings and the nature of the tear.

How Can a Rotator Cuff Tear Be Treated Without Surgery?

Management is tailored to the individual and usually involves progressively restoring movement, strength and function.

Depending on the assessment, this may include:

• Advice about temporarily modifying painful activities
• Progressive rotator cuff strengthening
• Exercises to improve shoulder blade control
• Gradual strengthening of the shoulder and upper limb
• Mobilisation or manual treatment where restricted movement is contributing
• Soft-tissue techniques where appropriate
• Progressive return to work, sport or gym activity

Exercise and rehabilitation are particularly important because the aim is to improve what your shoulder can comfortably do rather than simply treating the appearance of the tendon on a scan.

Can I Exercise With a Rotator Cuff Tear?

In many cases, yes. Having a rotator cuff tear does not necessarily mean that the shoulder should be rested completely.

The type and amount of exercise should be matched to your symptoms, strength and the nature of the tear. Initially, some painful or heavily loaded activities may need to be modified, while other movements and exercises can often continue.

As strength and function improve, exercises can be progressively increased to prepare the shoulder for the activities you want to return to.

How Long Does a Rotator Cuff Tear Take to Improve?

There is no single recovery time. Improvement depends on the type and extent of the tear, how long symptoms have been present, your starting strength and movement, general health and the activities you need the shoulder to perform.

Recovery from a significant tendon injury can take time. We therefore monitor changes in pain, movement, strength and function rather than promising improvement within a fixed number of treatments.

When Should a Rotator Cuff Tear Be Investigated Further?

Prompt assessment is particularly important if shoulder pain began after a significant injury and you suddenly cannot lift the arm normally or have developed substantial weakness.

Further medical investigation may also be appropriate if symptoms are worsening, there is significant loss of function or appropriate conservative treatment is not producing the expected progress.

Seek prompt medical advice if shoulder symptoms are accompanied by severe swelling, redness, fever or feeling seriously unwell. Chest pain, breathlessness, sweating or unexplained pain spreading into the arm or jaw requires urgent medical attention.

Rotator Cuff Tear and Shoulder Pain Treatment

A rotator cuff tear is one possible cause of shoulder pain and weakness. You can read about other causes, assessment and treatment options on our Shoulder Pain Treatment & Chiropractic Care page.

If you would like an assessment, chiropractic care is available at our Milton Keynes Chiropractic Clinic, Northampton Chiropractic Clinic and Aylesbury Chiropractic Clinic.

What Happens at My First Appointment?

We will discuss how your shoulder problem began, your symptoms, activities and medical history before examining the shoulder. Where appropriate, we may also assess the neck, upper back and nervous system.

We will explain what we think may be contributing to your symptoms and whether treatment and rehabilitation are appropriate. If the examination suggests that imaging, medical assessment or specialist referral would be more appropriate, we will explain this and advise you on the next step.