A rotator cuff tear is a disruption of one or more of the four tendons that attach the rotator cuff muscles to the humeral head. Most tears occur at the tendon-bone insertion, where the tissue is repeatedly loaded by every overhead and reaching motion. Untreated, tears enlarge, retract, and can become irreparable.
What Is a Rotator Cuff Tear?
The rotator cuff is a group of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that run along the shoulder blade and wrap around the humeral head to stabilize it in the glenoid socket. The cuff keeps the humeral head centered during arm movement, so the larger muscles of the arm and chest can generate force without destabilizing the joint. Even a simple reach away from your body requires the rotator cuff to generate forces approaching 80 percent of body weight to keep the humeral head centered in the socket.
A tear occurs when one of the cuff tendons fails, either acutely from a fall or lifting injury, or gradually from repetitive loading. Most tears involve the supraspinatus, which has the most vulnerable blood supply and bears the highest load in overhead motion. Partial-thickness tears affect only part of the tendon’s depth. Full-thickness tears extend completely through the tendon and often retract away from the bone, which makes repair more complex the longer they go untreated.
Causes and Risk Factors
Rotator cuff tears fall into two mechanistic categories. Acute tears result from a fall on an outstretched arm, a forceful lift, or a shoulder dislocation that damages the cuff as the humeral head displaces. Degenerative tears result from repetitive overhead loading that gradually thins and fails the tendon, common in overhead athletes, tradespeople, and patients over 50.
Risk increases with age, repetitive overhead work, smoking, prior shoulder injury, and shoulder impingement that creates repetitive friction on the cuff.
Symptoms
- Pain on the outside of the shoulder or upper arm, often worse at night and with overhead activity
- Weakness lifting the arm, reaching overhead, or rotating the arm outward
- Difficulty sleeping on the affected side
- Loss of active range of motion without loss of passive motion (you cannot lift your arm, but an examiner can move it through full range)
Diagnosis
Dr. Chudik’s evaluation begins with a history focused on mechanism, duration, and functional limitations, then a physical examination that tests each rotator cuff tendon individually. Specific maneuvers (empty can, lift-off, belly-press, external rotation lag sign) isolate the supraspinatus, subscapularis, and infraspinatus and help localize the tear. X-rays evaluate bone anatomy and any arthritic changes. MRI confirms the diagnosis, characterizes the tear’s size and retraction, and assesses tissue quality. The Westmont office has on-site high-field MRI, so imaging is often completed the same day as the consultation.
Treatment
Non-surgical management is the first line for partial tears and lower-demand patients. It includes activity modification, a targeted physical therapy program for the scapular stabilizers and posterior cuff, and corticosteroid injection for pain control. Many partial tears and some full-thickness tears in older, lower-demand patients improve with this approach.
Surgery is indicated when non-surgical treatment fails, when the tear is acute in a younger active patient, or when the tear is large and at risk of progression. Dr. Chudik performs arthroscopic rotator cuff repair through small incisions, reattaching the torn tendon to its bone insertion with suture anchors. For massive, retracted, or irreparable tears, he performs superior capsular reconstruction, tendon transfers, or graft augmentation depending on the specific tear pattern.
Recovery and Outcomes
Recovery depends on tear size, tissue quality, and the specific repair performed. A typical timeline after arthroscopic repair includes four to six weeks of sling protection with passive range-of-motion exercises, active motion at two to three months, and strengthening at three to four months. Return to heavy overhead work or sport is typically six to nine months. Outcomes are best when tears are repaired before they enlarge and while the tendon tissue is still healthy, which is why early evaluation matters.
When to See Dr. Chudik
Schedule an evaluation if shoulder pain, weakness, or loss of motion has persisted beyond a week or two, if an acute injury was followed by difficulty lifting the arm, or if prior treatment has failed. Call 630-324-0402 or request an appointment online.