- Rotator cuff tear is a common cause of shoulder pain and weakness.
- Degenerative tears are more common than traumatic tears.
- Many patients improve with physiotherapy; surgery is needed selectively.
What is a Rotator Cuff Tear?
The rotator cuff consists of four muscles — supraspinatus, infraspinatus, teres minor and subscapularis — that stabilize the shoulder joint. A rotator cuff tear refers to partial or complete disruption of these tendons, most commonly involving the supraspinatus tendon.
Anatomy and Biomechanics
The rotator cuff functions as a dynamic stabilizer, maintaining the humeral head centered within the glenoid during motion. Hypovascularity in the critical zone predisposes to degeneration. Subacromial impingement contributes to tendon wear.
- Supraspinatus – abduction initiation
- Infraspinatus – external rotation
- Teres minor – external rotation
- Subscapularis – internal rotation
Types of Rotator Cuff Tears
- Partial thickness tear
- Full thickness tear
- Massive tear involving multiple tendons
- Acute traumatic tear
- Chronic degenerative tear
Causes and Risk Factors
- Age-related degeneration
- Repetitive overhead activity
- Sports injuries
- Trauma such as fall on outstretched arm
- Subacromial impingement
Symptoms
- Shoulder pain during overhead movement
- Night pain
- Weakness lifting arm
- Painful arc between 60–120 degrees
Clinical Examination
- Neer Impingement Test
- Hawkins-Kennedy Test
- Drop Arm Test
- Empty Can (Jobe) Test
- External rotation lag sign
Investigations
X-ray
Assess acromial morphology and superior migration.
Ultrasound
Useful dynamic assessment.
MRI
Gold standard to evaluate tear size and muscle quality.
Treatment Options
Non-Surgical Treatment
- Physiotherapy focusing on scapular stabilization
- NSAIDs
- Activity modification
- Subacromial injections
Surgical Treatment
- Arthroscopic rotator cuff repair
- Subacromial decompression (selected cases)
- Tendon transfer for irreparable tears
- Reverse shoulder arthroplasty (massive tear arthropathy)
Preparing for exams or want to reinforce arthroscopy concepts? Practice here:
Recovery Timeline
- Immobilization: 4–6 weeks
- Gradual physiotherapy progression
- Return to activities after several months
When Should You See an Orthopaedic Surgeon?
- Pain lasting more than 6 weeks
- Weakness after injury
- Loss of shoulder function
Book appointment with Dr Subhajit Maji
Written by: Dr Subhajit Maji, Orthopaedic Surgeon (AIIMS)
Last Updated: February 2026
This educational content is intended for informational purposes and should not replace professional medical consultation. Always consult an orthopaedic specialist for diagnosis and treatment.