Rotator cuff tears

Rotator cuff tears

The rotator cuff is a group of four muscles and tendons — supraspinatus (most commonly torn), infraspinatus, teres minor, and subscapularis — that lift the arm, rotate the arm, and provide stability to the shoulder joint. A tear occurs when one or more tendons becomes damaged or pulls away from the bone, ranging from partial-thickness (damaged but not completely torn) to full-thickness (completely detached). Tears can involve one or multiple tendons and vary widely in size and severity.

What Is a Rotator Cuff Tear?

The rotator cuff is a group of four muscles and tendons — supraspinatus (most commonly torn), infraspinatus, teres minor, and subscapularis — that lift the arm, rotate the arm, and provide stability to the shoulder joint. A tear occurs when one or more tendons becomes damaged or pulls away from the bone.

Tears can be partial-thickness (damaged but not completely torn) or full-thickness (completely detached from the bone). They can involve one or multiple tendons and vary widely in size and severity. Some patients have a tear on imaging with few symptoms; others experience significant pain and dysfunction.

At Duke Health in Durham, NC, Dr. Jay Levin evaluates and treats the full spectrum of rotator cuff pathology — from minor tears that respond to conservative care to large or massive tears that require surgical reconstruction.

Causes

Rotator cuff tears generally fall into two categories:

Degenerative (wear-and-tear) — the most common cause — develops gradually over time. Contributing factors include aging, repetitive overhead activity, decreased blood supply to the tendons, and bone spurs.

Acute (traumatic) tears occur suddenly from a fall onto the arm, lifting a heavy object, or a sudden pulling injury. These are more common in younger, active individuals.

Symptoms

Shoulder pain, often worse with overhead activity
Pain at night or when lying on the affected side
Weakness with lifting or rotating the arm
Difficulty reaching behind the back
Decreased shoulder endurance

Diagnosis

Diagnosis is based on medical history, physical examination, and imaging. X-rays help evaluate bone spurs and arthritis. MRI is the best study for visualizing tendon tears. Ultrasound is sometimes used as well.

Treatment

Nonsurgical treatment is the starting point for many patients. Options include activity modification, anti-inflammatory medications, physical therapy, and corticosteroid injections. The focus is on reducing pain and improving function rather than healing the tear. Not all tears require surgery.

Surgical treatment is considered when:

Pain persists despite nonsurgical treatment
There is significant weakness
The tear is large or acute and traumatic
High functional demands require complete restoration

The decision is made collaboratively between you and your surgeon based on your symptoms, tear characteristics, and goals.

Dr. Levin performs arthroscopic rotator cuff repair — minimally invasive reattachment of the torn tendon using small anchors and sutures — as well as more advanced techniques for complex or irreparable tears when indicated.

Factors Affecting Outcomes

Outcomes are influenced by tear size and chronicity, muscle atrophy and fatty degeneration, age, smoking and nicotine use, diabetes, nutrition, and participation in rehabilitation.

When to Seek Evaluation

Schedule an evaluation with an orthopaedic shoulder specialist if you have:

Persistent pain lasting several weeks
Progressive weakness
Loss of function affecting daily activities
Pain following a traumatic injury
Night pain that disrupts sleep

Early diagnosis matters. Dr. Levin uses clinical examination, X-rays, and MRI to characterize the tear precisely and guide treatment recommendations at Duke Health in Durham, NC, serving patients from Cary, Chapel Hill, Raleigh, and throughout North Carolina.

Frequently Asked Questions

Can a rotator cuff tear heal without surgery?

Not all tears require surgery. Nonsurgical treatment — activity modification, anti-inflammatory medications, physical therapy, and corticosteroid injections — focuses on reducing pain and improving function rather than healing the tear. Surgery is considered when pain persists despite nonsurgical treatment, when there is significant weakness, or for large or acute traumatic tears. The decision is made collaboratively based on your symptoms, tear characteristics, and functional goals. Dr. Levin evaluates each case individually at Duke Health in Durham.

How long is recovery after rotator cuff surgery?

Recovery typically takes 4–6 months for most patients. The first 4–6 weeks involve protecting the repair in a sling, followed by gradual physical therapy to restore motion, strength, and function. Return to heavy lifting or overhead sports may take up to a year. Outcomes are influenced by tear size and chronicity, muscle quality, age, smoking, diabetes, nutrition, and participation in rehabilitation.

What happens if a rotator cuff tear goes untreated?

An untreated rotator cuff tear can progress in size over time, leading to worsening weakness, muscle atrophy, fatty degeneration, and eventually cuff tear arthropathy — irreversible arthritis of the shoulder. Early evaluation is important to preserve surgical options and optimize outcomes.

What causes rotator cuff tears?

Tears can be degenerative (wear-and-tear, most common) — from aging, repetitive overhead activity, decreased blood supply, or bone spurs — or acute (traumatic) — from a fall onto the arm, lifting a heavy object, or sudden pulling injury. Acute tears are more common in younger, active individuals.

Common Symptoms

Overview