Rotator Cuff Tears
A rotator cuff tear is when one of the four tendons that lift and rotate your shoulder pulls partly or completely away from the bone — a common cause of shoulder pain, weakness, and trouble reaching overhead.
What is the rotator cuff?
The rotator cuff is a group of four muscles and their tendons that surround the ball of the shoulder. Together they lift and rotate the arm and, just as importantly, keep the ball centered in the socket while the larger muscles do the heavy work. When one of these tendons tears, the shoulder loses some of that control — which is why a cuff tear causes both pain and weakness.
Tears are described by how deep they go. A partial-thickness tear involves only part of the tendon; a full-thickness tear goes all the way through, separating the tendon from the bone. They are also described by which tendon is involved and how large the tear is — details your surgeon uses to recommend treatment.
How do they happen?
Sudden (acute) tears
A fall onto an outstretched arm, lifting something too heavy, or a shoulder dislocation can tear the cuff in an instant. These often cause immediate pain and noticeable weakness, and in active patients they're more likely to need timely repair.
Gradual (degenerative) tears
Far more common. Tendons wear and weaken over years of use, and a tear can develop slowly with little or no specific injury. These build over time and may respond well to non-surgical care.
Symptoms to watch for
- Pain over the outside or front of the shoulder, often radiating down the upper arm
- Pain at night, especially when lying on the affected side — a classic sign
- Weakness lifting the arm, reaching overhead, or carrying objects
- Difficulty with behind-the-back motions (reaching a back pocket, fastening a bra)
- A catching, cracking, or weak feeling when raising the arm
How a tear is diagnosed
Diagnosis starts with your story and a physical exam, where specific strength and motion tests point to which tendon is involved. Imaging confirms it:
- X-rays don't show the tendon itself but rule out arthritis and reveal the bony anatomy.
- MRI is the gold standard — it shows the tear's size, location, and tendon quality, which guide whether and how to repair it.
- Ultrasound can be a quick, dynamic way to see the cuff move in some cases.
Non-surgical treatment usually comes first
Many rotator cuff tears — particularly partial and degenerative tears — improve without surgery. The shoulder can often compensate well when the surrounding muscles are strong. A reasonable first course includes:
- Physical therapy to strengthen the remaining cuff and shoulder-blade muscles and restore motion
- Activity modification — temporarily easing off the motions that aggravate it
- Anti-inflammatory medication for pain control
- A cortisone injection in select cases to calm inflammation enough to make therapy productive
When surgery is worth considering
Repair tends to be recommended when a tear is unlikely to do well on its own or when non-surgical care hasn't restored function. Common reasons include a sudden full-thickness tear in an active person, significant or worsening weakness, a tear that fails several months of good conservative treatment, or a larger tear in a younger patient where waiting risks the tendon retracting and becoming harder to fix later.
The repair is done arthroscopically — through small incisions with a camera — reattaching the tendon to the bone with anchors and sutures. Dr. Hachadorian reviews your imaging, activity level, and goals together with you to decide whether and when surgery makes sense.
Think you may have a rotator cuff tear?
Learn about the repair, or schedule an evaluation with Dr. Hachadorian.
Common questions
Torn tendon does not grow back to bone on its own, but many people become pain-free and functional without surgery because the surrounding muscles compensate. The goal of non-surgical care is a comfortable, working shoulder — not necessarily "closing" the tear.
Most degenerative tears are not emergencies and there's time to try therapy first. Sudden tears from an injury in active patients are more time-sensitive, because waiting too long can let the tendon retract and become harder to repair. An evaluation helps sort out which situation you're in.
A sling for roughly 4–6 weeks, gradual motion, then strengthening — with most people returning to lighter daily activities by 6–8 weeks and fuller activity over 4–6 months. Full tendon healing takes time. The recovery pathway lays out each milestone.
Some tears stay stable for a long time; others slowly enlarge. New or increasing weakness, or pain that's escalating, is a reason to be re-evaluated rather than to keep waiting.
This page is for general education and isn't a substitute for an in-person evaluation. Your specific diagnosis and treatment plan should come from Dr. Hachadorian based on your exam and imaging.