Rotator Cuff Tears

The shoulder is one of the most flexible joints in the body, allowing you to reach, lift, throw, and rotate your arm in many directions. At the core of this movement is the rotator cuff, a group of four muscles and their tendons that surround the head of the upper arm bone (humerus). These muscles—the supraspinatus, infraspinatus, teres minor, and subscapularis—work together to stabilize the shoulder joint and keep the arm centered in its socket. Without the rotator cuff, the shoulder would lack strength and stability, making everyday activities such as combing hair, lifting groceries, or reaching overhead very difficult.

What is the function of the rotator cuff?

The rotator cuff serves two primary functions. First, it stabilizes the ball of the shoulder joint, preventing it from slipping out of the socket. Second, it provides the strength and coordination needed for arm movements. Each of the four muscles has a specialized role in moving the arm upward, outward, or inward, and they function together to produce smooth motion. When one or more of these tendons becomes damaged, the balance of the shoulder is disrupted, leading to pain, weakness, and limited range of motion.

What is a rotator cuff tear

A rotator cuff tear occurs when one of the tendons becomes partially frayed or completely detached from the bone. Tears can be classified as partial-thickness, where the tendon is damaged but not completely severed, or full-thickness, where the tendon pulls away from the bone entirely. Some tears are small and cause only minor symptoms, while others are large and lead to significant loss of function. These injuries may develop suddenly after trauma or gradually from wear and tear over time.

What are the causes of rotator cuff tears?

There are two main causes that lead to rotator cuff tears: acute injury and degeneration.

• Acute injuries often occur after a fall on an outstretched arm, lifting something too heavy, or a sudden jerking motion. These tears are more common in younger or active individuals and can cause immediate pain and weakness.
• Degenerative tears develop gradually as a result of repetitive overhead movements, age-related tendon thinning, or reduced blood supply to the area. Athletes who play baseball, tennis, or swim are particularly at risk due to repeated stress on the shoulder. Occupations that require frequent overhead lifting, such as painting or construction, also increase the likelihood of developing this condition.

What are the risk factors?

Certain factors make rotator cuff tears more likely. Age is a major risk factor, with the likelihood increasing significantly after age 40. Repetitive overhead activity from sports or work also increases stress on the tendons. Poor posture, smoking, and family history of shoulder problems may further contribute to weakened tendons. Men and women are equally at risk, but people who are more physically active with overhead motions tend to experience tears earlier in life.

What are the symptoms of a rotator cuff tear?

The symptoms vary depending on the severity of the tear. Common signs include:

• Persistent pain in the shoulder, often worse at night or when lying on the affected side
• Weakness when lifting or rotating the arm
• Difficulty performing routine activities such as reaching overhead or behind the back
• A cracking or popping sensation with certain movements
• Limited range of motion and stiffness in the shoulder

Some tears cause sudden, sharp pain and immediate weakness, while others present gradually with dull, aching discomfort that worsens over time.

How are rotator cuff tears diagnosed?

A diagnosis begins with a thorough evaluation by an orthopedic specialist. The physician will review the patient’s history, ask about symptoms, and perform a physical examination to test shoulder strength and mobility. Special maneuvers can help determine which tendon may be involved.

Imaging studies are often used to confirm the diagnosis. X-rays do not show the rotator cuff itself but can reveal bone spurs or changes that suggest a tear. Magnetic resonance imaging (MRI) is the most effective tool for visualizing soft tissues, allowing the physician to see the size and location of the tear. Ultrasound is another useful method that can provide a dynamic view of the tendon as the shoulder moves.

An accurate diagnosis is important to distinguish rotator cuff tears from other shoulder conditions such as arthritis, bursitis, or labral injuries. Early identification can help guide appropriate treatment and prevent the problem from worsening.

A rotator cuff tear can significantly impact daily life. Many people find it difficult to sleep due to shoulder pain, while others struggle with routine tasks such as driving, cooking, or dressing. Athletes may lose the ability to compete at their previous level, and workers who rely on their arms for overhead lifting may face job limitations. Because the rotator cuff is essential for shoulder strength and stability, untreated tears often lead to ongoing pain, progressive weakness, and long-term shoulder dysfunction.

If you are experiencing shoulder pain, weakness, or difficulty with arm movements, it is important not to ignore these symptoms. Early evaluation can make a significant difference in preserving shoulder function and preventing further damage. Dr. Brian Waterman, a Board-Certified and Fellowship-Trained Orthopedic Surgeon and Sports Medicine Expert in Winston Salem, North Carolina, specializes in diagnosing and treating rotator cuff tears. With advanced training in sports medicine and shoulder care, Dr. Waterman provides comprehensive evaluation and individualized treatment options to help patients restore strength, mobility, and quality of life.

Do not let shoulder pain keep you from enjoying your favorite activities. Contact Dr. Waterman’s office today to schedule a consultation and take the first step toward recovery.