Shoulder condition
Rotator cuff tears
The rotator cuff is a group of four muscles and tendons that surround the shoulder and help lift and rotate the arm. Rotator cuff tears range from partial to full-thickness, and many can initially be treated without surgery. This page explains what a rotator cuff tear is, how it's evaluated, and how a treatment decision is approached, so you can understand your situation.
General orthopedic education — not medical advice. Decisions about your care should be made with a qualified clinician.
What the rotator cuff is
The rotator cuff is a group of four muscles and tendons that surround the shoulder. They help lift and rotate the arm and keep the ball of the shoulder centered in the socket.
Types of rotator cuff tears
A partial-thickness tear involves only part of the tendon's thickness. A full-thickness tear extends through the tendon. Tears vary in size, location, chronicity, retraction, and tissue quality, all of which can affect treatment.
Traumatic and degenerative tears
Some tears occur suddenly after an injury, while others develop gradually as the tendon changes over time. Acute traumatic tears and chronic degenerative tears may behave differently and require different treatment discussions.
Symptoms, and how imaging fits in
Symptoms may include pain—often at night or with overhead activity—weakness, difficulty lifting the arm, and loss of function. Some people have rotator cuff abnormalities on imaging without significant symptoms, so MRI findings must be interpreted together with the examination and the patient's experience.
- Pain, often at night or with overhead activity
- Weakness
- Difficulty lifting the arm
- Loss of function
How a rotator cuff tear is evaluated
Evaluation begins with the history and physical examination. X-rays assess the bones, arthritis, and shape of the shoulder. MRI is sometimes used to provide additional detail about the rotator cuff tendons, tear size and retraction, muscle quality, and other structures. Ultrasound may also evaluate the rotator cuff in selected situations.
Nonsurgical treatment
Many rotator cuff tears can initially be treated without surgery.
Many rotator cuff tears can initially be treated without surgery. Options may include activity modification, physical therapy, medication or other measures for pain, and sometimes an injection. The goal is to improve comfort, strength, and function.
When surgery may be considered
Surgery may be considered when pain or weakness persists despite appropriate nonsurgical treatment, when loss of function interferes with important activities, or after certain acute traumatic tears. The decision also considers tear characteristics, tissue and muscle quality, associated problems, overall health, and the patient's goals.
Progression and repairability
Some rotator cuff tears can enlarge over time, and chronic tears may develop tendon retraction, muscle atrophy, or fatty change. These changes can affect whether a tear can be repaired, but progression is individual and cannot be predicted from one factor alone.
Preparing for your visit
Questions worth discussing at your evaluation
Bringing a few questions can make the first conversation more useful. You might ask:
- Is my rotator cuff partially or fully torn, and which tendon is involved?
- Do my symptoms seem to be coming from the cuff, or could something else be contributing?
- What are my nonsurgical and surgical options, and what are the trade-offs of each?
- If we try nonsurgical care first, how will we know whether it's working?
- For my situation, what would influence whether surgery is considered, and what would recovery generally involve?
Common questions
Rotator cuff tear FAQs
- Does a rotator cuff tear always need surgery?
No. Many rotator cuff tears can initially be treated without surgery, using measures such as activity modification, physical therapy, medication or other measures for pain, and sometimes an injection. Surgery may be considered when pain or weakness persists despite appropriate nonsurgical treatment, when loss of function interferes with important activities, or after certain acute traumatic tears.
- Do I need an MRI to diagnose a rotator cuff tear?
Not always. Evaluation begins with the history and physical examination, and X-rays assess the bones, arthritis, and shape of the shoulder. MRI is sometimes used to provide additional detail about the tendons, tear size and retraction, and muscle quality, and ultrasound may evaluate the cuff in selected situations. Imaging findings are interpreted together with your examination and experience.
- What's the difference between a partial and a full-thickness tear?
A partial-thickness tear involves only part of the tendon's thickness, while a full-thickness tear extends through the tendon. Tears also vary in size, location, chronicity, retraction, and tissue quality, all of which can affect treatment.
Related treatment
If treatment becomes part of the conversation, here is the procedure most often discussed for this injury.
Related resources & next steps
- Shoulder pain (including subacromial pain)Cuff and subacromial problems often occur together — this covers subacromial pain and bursitis.
- Shoulder instabilityA different shoulder problem — when the joint slips out of place or feels unstable.
- Return to PlayHow a safe, criteria-based return to sport and activity is approached.
- Resources & patient guidesRehabilitation protocol overviews, guides, and FAQs.
Next step
Want to understand your shoulder and options?
If you've hurt your shoulder or have ongoing shoulder pain or weakness, you can request an appointment to talk through your evaluation and the paths available to you. This website is not monitored for emergencies — for a medical emergency, call 911.