Condition
Understanding a rotator cuff tear in the shoulder
‘A tendon has torn’ may at first seem to have an obvious consequence: it needs stitching back together. Yet you may still be able to move your arm surprisingly well, or have pain mainly at night. Someone else may suddenly lose considerable strength after a fall. These situations call for different decisions.
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Do not simply wait after an injury
If you suddenly find it very difficult to lift your arm after a fall or sudden strain, seek prompt medical assessment. An acute tendon injury may require timely assessment by a shoulder surgeon. Spending weeks treating only the pain before the diagnosis is clear would be unhelpful.
A visible deformity, new paralysis or impaired circulation after an accident requires urgent help. If shoulder or arm pain occurs with chest pressure, breathlessness or circulatory problems, call 112 immediately.
Understanding
A closer look
With a rotator cuff tear, we therefore look beyond the tear itself. We want to understand how it developed, which function is limited and what you would like to be able to do with your shoulder again.
What the rotator cuff does
The rotator cuff consists of several muscles and their tendons. It guides and stabilises the head of the upper arm bone and helps lift and rotate the arm. A tear can affect part of the tendon’s thickness or its full thickness. Tears also vary in size, location and whether several tendons are involved.
Some tears happen in an accident; others develop in tendon tissue that has already changed. As we get older, tendon tissue can change and become less able to tolerate strain. Symptoms may become apparent gradually or suddenly. A tear seen on MRI can be relevant but does not necessarily explain all the pain. Conversely, new, marked weakness should be taken seriously even if pain is not particularly severe.
Further information
How we assess the tear and shoulder function together
The examination shows which movements are possible and where strength is lacking. As far as possible, we distinguish between movement avoided mainly because of pain and a substantial loss of tendon function. Joint mobility and possible additional causes are also considered.
Ultrasound can show tendon damage. MRI can answer further questions about the extent of the tear, tendon retraction and the condition of the muscles. This is particularly relevant when surgery is being considered. We review existing images together with you and the written report. Treatment should not be based solely on one sentence in a report.
When non-surgical treatment may be appropriate
For certain tears, particularly those that developed gradually, non-surgical treatment may be a useful first approach. Tailored exercises and physiotherapy aim to improve usable shoulder function. Pain relief can help you begin moving again. Whether this approach is suitable depends on factors including the tear pattern, strength, associated findings and your needs.
Having less pain and being able to use your arm in daily life is an important success. It does not automatically mean that the tear has healed anatomically. We therefore want to assess together whether function is actually improving and whether new weakness develops. Even when treatment starts without surgery, the question of an operation can be reviewed later.
Reasons to consider a surgical assessment
A recent injury-related tear, marked loss of function or persistent limitations despite appropriate non-surgical treatment may justify a surgical assessment. The decision also considers whether the tissue can be repaired, other health conditions and the demands of a longer recovery period.
Age alone does not determine the approach. An active older person may have different needs from someone whose shoulder faces fewer demands in daily life. Equally, a sporting goal does not guarantee a successful outcome. A consultation with a specialist surgeon should clarify what the operation can specifically improve, which risks are involved and what rehabilitation afterwards will entail.
Injections and exercise need a clear goal
An injection cannot reliably join a torn tendon back together. Whether an injection is appropriate for pain relief at all must be considered alongside the ongoing treatment plan, especially if surgery is being considered. Repeated cortisone injections around tendon tissue require very careful consideration. Treatment using PRP/ACP from your own blood has different benefits and risks from a cortisone injection. It can also cause discomfort after injection, bleeding or infection. A blanket assurance of significantly fewer side effects cannot be made for a tendon tear. Whether PRP/ACP is suitable for you depends on the specific findings. It is not a proven substitute for necessary surgery.
For exercise, what matters is which activities are currently suitable for your shoulder. Tell us whether your concern is carrying things at home, physical work or a particular sport. Existing reports and images, together with a description of your treatment so far, help us address these questions. In the absence of a new injury, neither blanket immobilisation nor undertaking maximum-intensity strength training on your own is an appropriate standard approach.
Frequently asked questions
Does every full-thickness tendon tear need surgery?
No. The tear pattern, how it occurred, function and personal goals are considered together. Prompt specialist assessment is particularly important after a recent accident with marked loss of strength.
Can physiotherapy help even though the tendon is torn?
In suitable cases, it can improve movement and tolerance of activity by making targeted use of existing function. This is different from anatomically repairing the torn tendon.
Why is aftercare so important in the decision?
Tendon repair needs protection and a coordinated, gradual return to activity. Daily life, support at home and work demands therefore need to be planned before surgery.
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