Quick Answer
A rotator cuff tear is a partial- or full-thickness injury to one or more tendons that move and center the shoulder joint. Tears may follow an acute injury or develop gradually with age-related tendon degeneration. Not every tear requires surgery; pain, strength, function, tear characteristics and patient goals are considered together.
Symptoms
- Pain when lifting or reaching with the arm
- Night pain and difficulty lying on the affected shoulder
- Weakness with elevation or external rotation
- Sudden pain and loss of function after a traumatic tear
- Some small or chronic tears may cause few symptoms
Diagnosis
Examination assesses motion, strength and pain-provoking maneuvers. X-rays do not show the tendon tear but help evaluate bone and joint pathology. Ultrasound and MRI can assess rotator cuff tendons. Imaging alone does not determine treatment because some tears can be minimally symptomatic.
Treatment Approach
Nonsurgical Treatment
Many patients begin with activity modification, pain control and exercise/physical therapy aimed at restoring movement and muscle function. The 2025 AAOS guideline emphasizes choosing treatment according to patient characteristics and tear pattern. Injections may be used for pain in selected situations, but their risks and benefits should be considered in the context of tendon biology and any potential surgical plan.
Surgical Treatment
Surgery may be considered for persistent pain and functional loss despite appropriate rehabilitation, meaningful weakness, an acute traumatic full-thickness tear in an active patient, or a repairable tear where progression is a concern. Arthroscopic repair aims to restore tendon attachment to bone. No single repair construct is universally best; tear size, tendon quality, retraction and muscle changes influence planning.
Recovery
Tendon repair requires biological healing and recovery takes months. Early protection of the repair is followed by restoration of motion and then progressive strengthening. Return to heavy work or sport depends on tear size, the procedure performed, healing, function and sport-specific load. Time alone should not determine clearance.
When Should Assessment Be Prioritized?
Prompt assessment is appropriate after a fall or sudden load when the arm can no longer be lifted, when new marked weakness develops, or when significant loss of function follows a shoulder dislocation.
Frequently Asked Questions
Does every MRI tear need surgery?
No. Symptoms, strength, function, age, activity goals and tear characteristics are considered together. Some tears can be managed without surgery.
Does physical therapy close the tear?
The goal of therapy is to improve pain, motion and shoulder function. Clinical improvement and structural tendon healing are separate issues and do not always match one-to-one.
When can I return to sport?
There is no single timetable. Tear size, tendon healing, range of motion, strength and the demands of the sport all matter.
Sources
- AAOS — 2025 Clinical Practice Guideline: Rotator Cuff Injuries
- AAOS OrthoInfo — Rotator Cuff Tears: Surgical Treatment Options
This page is for general patient education and does not replace an individual medical examination or treatment plan.
Evidence sources checked: 7 August 2026.