Rotator cuff tears: understanding your treatment options

Shoulder pain can interfere with dressing, reaching and a comfortable night’s sleep. A rotator cuff tear is one possible cause, but treatment depends on how the injury occurred, the condition of the tendon and the activities you want to return to.

What does the rotator cuff do?

The rotator cuff is a group of muscles and tendons that helps move the arm and keep the shoulder joint stable. A tear can develop suddenly after an injury or gradually as the tendon changes with age and use. These different patterns can call for different treatment decisions.

Symptoms may include pain around the shoulder or upper arm, weakness and difficulty lifting or rotating the arm. A clinical assessment helps distinguish a rotator cuff tear from other causes of shoulder pain.

Why the way an injury happens matters

A fall followed by marked weakness or difficulty raising the arm deserves prompt assessment. An acute injury may need a different approach from symptoms that have developed gradually over months. Tell your clinician when the problem began and whether your strength changed suddenly.

Your GP or surgeon may recommend imaging to answer a specific question about the tendon. The findings are considered alongside your symptoms and examination, rather than used in isolation to decide on surgery.

Starting with rehabilitation

Many people with gradually developing symptoms can improve through non-surgical treatment. Physiotherapy may focus on comfortable movement, shoulder control and progressive strengthening. Pain management and temporary changes to aggravating activities can help you participate in rehabilitation.

Improvement takes time, and the exercise programme should match your shoulder’s tolerance. If an exercise repeatedly increases pain or function is getting worse, ask your treating clinician to review the plan.

When surgery may be considered

Surgery may be discussed when pain or weakness continues despite appropriate rehabilitation, or when the type of injury makes early repair worth considering. The size and pattern of the tear, tendon quality, general health and personal goals all matter.

Ask what a repair is expected to improve and what restrictions would follow. Recovery after rotator cuff repair usually involves a period of protection followed by staged rehabilitation. Returning to heavier work or sport can take months, with progress varying between people.

Set goals that reflect everyday life

Being able to sleep, reach a shelf or return to a physical job may be more useful goals than aiming for a particular date alone. Discuss these priorities with your surgeon and physiotherapist so the treatment plan addresses the activities that matter to you.

Rotator cuff assessment and treatment

Dr Jason Ward discusses traumatic and gradually developing rotator cuff tears and the role of rehabilitation and repair.

Read more about shoulder care or Dr Jason Ward.