Rotator cuff tear

3 things to know first

1. It is not usually an emergency. Most rotator cuff tears can be evaluated and treated in an outpatient setting.
2. Size and symptoms matter most. A small tear with manageable pain is often treated differently than a large tear with significant weakness.
3. It is often found after shoulder pain or an injury. Many tears are discovered on imaging after weeks of aching or a sudden lifting or twisting episode.

What it is

The rotator cuff is a group of four tendons — supraspinatus, infraspinatus, teres minor, and subscapularis — that wrap around the shoulder joint and help lift and rotate the arm. A rotator cuff tear means one or more of these tendons is partially or completely separated from the bone.

Tears are often described as partial-thickness (incomplete) or full-thickness (complete). They may occur suddenly after a fall or lifting injury, or develop gradually from repetitive use and age-related wear.

Why it appears on your report

Radiologists mention a rotator cuff tear when they see a gap, fraying, retraction, or abnormal fluid signal in the tendon on shoulder MRI or ultrasound. The report may also describe which tendon is involved and whether the tear is partial or full-thickness.

How serious is it

Many people with rotator cuff tears continue to use their shoulder. Seriousness depends on:

• Size of the tear. Small partial tears often respond well to conservative care. Large or complete tears may lead to ongoing weakness.
• Which tendon is torn. The supraspinatus tendon is most commonly affected.
• Symptoms. Pain at night, difficulty lifting the arm, or weakness are clues that guide treatment.
• Age and activity level. Younger, active people may need different management than older adults with gradual wear.

Your doctor will consider these factors together rather than relying on the image alone.

When to seek care urgently

Seek urgent care if you have:

• Sudden, severe shoulder pain after an injury with an inability to lift the arm
• Visible deformity or a "dropped" shoulder
• Numbness, tingling, or coldness in the arm or hand
• Signs of infection such as fever, redness, and warmth around the shoulder after an injection or procedure

What usually happens next

1. Clinical exam. Your doctor will test shoulder strength and range of motion.
2. Imaging review. The MRI or ultrasound images are correlated with your symptoms.
3. Initial conservative treatment. This often includes rest, activity modification, physical therapy, and possibly a pain-relief injection.
4. Surgical referral if needed. Large tears, complete tears in active people, or cases that do not improve after several months of therapy may be referred to an orthopedic surgeon.

A simple analogy

Think of the rotator cuff tendons like the straps of a backpack. If one strap frays or snaps, the bag still hangs on your shoulder but may feel unstable or painful. A small fray can often be reinforced; a completely snapped strap may need to be reattached.

Further reading

• Mayo Clinic — Rotator cuff injury
• NHS — Rotator cuff tear