Neck & Shoulder

What It Is

A rotator cuff tear is a common cause of shoulder pain and disability among adults. Each year, almost two million people in the United States see their doctor because of a rotator cuff tear (AAOS, n.d.a). A torn rotator cuff can weaken the shoulder, so daily activities such as combing your hair or getting dressed can become painful and difficult to do.

Rotator Cuff Tear Anatomy

The rotator cuff is made up of four muscles that join together as tendons and form a covering around the head of the humerus (the upper arm bone). The rotator cuff connects the humerus to the shoulder blade and helps you to rotate and lift your arm. While all four rotator cuff tendons can tear, the one most commonly torn by far is the supraspinatus (AAOS, n.d.a).

The supraspinatus sits above the spine of the shoulder blade, and attaches to the top of the arm bone (humerus) via a tendon. A rotator cuff tear most commonly relates to a tear of this tendon.

Tears Are Usually Classified Into the Following

Fraying of the supraspinatus tendon (usually along the top of the tendon).
Partial thickness tear (the tear goes partway through the thickness of the tendon).
Full thickness tear (the tear goes all the way through the tendon).
Rupture (the tendon is completely torn into two parts).
Retraction (the tendon has torn into two parts, and one part has pulled back towards the shoulder blade).

There is a lubricating sac known as the bursa that lies between the rotator cuff and the bone on the top of the shoulder (the acromion). The bursa allows the rotator cuff tendons to glide freely whenever you move your arm. When the tendons are damaged or injured, the bursa can also become painful and inflamed (AAOS, n.d.a). So it is not uncommon to have "subacromial bursitis" (inflammation of this bursa) with a rotator cuff tear.

The problem sits under the acromion, the bony point at the top of the shoulder blade. The acromion is joined to the collarbone at the AC joint (acromioclavicular joint), which sits next to the main ball and socket shoulder joint (AAOS, n.d.c).

How Do Rotator Cuff Tears Occur?

Rotator cuff tears usually occur in one of two ways: degeneration (wear) and trauma (injury) (AAOS, n.d.a).

Degeneration: most tears are the result of the tendon slowly wearing down over time, which happens naturally as we age. Repeating the same shoulder movements again and again, and a reduced blood supply to the tendon as we get older, both contribute (AAOS, n.d.a). Bone spurs on the underside of the acromion can also rub on the tendon when you lift your arm (AAOS, n.d.c).
Trauma: falling and landing on your shoulder or an outstretched arm, or lifting something too heavy with a jerking motion, can tear the rotator cuff. This type of tear can happen alongside other injuries, such as a broken collarbone or a dislocated shoulder (AAOS, n.d.a). Sports injuries can cause it too.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat a Rotator Cuff Tear

Specific exercises to restore movement and strengthen the muscles that support the shoulder can relieve pain and help prevent further injury (AAOS, n.d.a). If your tear is small, I can start this rehabilitation with you, with exercise and hands-on care; if it is larger or caused by an injury, I support the plan your medical team sets. See the My Approach tab for how I work.

1. Assessment

It's important to see a physical therapist or doctor to assess the damage. If the tear is likely to be significant, you may be referred for an ultrasound scan or MRI scan, which can confirm the diagnosis and help plan treatment (UHCW, 2020). As a general guide, when the tendon has torn because of a recent injury such as a fall, early surgical repair is normally recommended for people under 70; when it has torn through wear and tear, non-surgical treatment is normally tried first (UHCW, 2020).

2. Modification of Activities

Avoid any activities that cause pain in the shoulder (AAOS, n.d.a), especially sleeping on the affected side, and lifting your arm to the side or above your head.

3. Anti-Inflammatory Medication

AAOS OrthoInfo lists anti-inflammatory medicines, such as ibuprofen and naproxen, as a non-surgical treatment that can reduce the pain and swelling of a rotator cuff tear (AAOS, n.d.a). (This medicine information comes from AAOS OrthoInfo, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Rotator cuff repair surgery: an operation, usually done by keyhole (arthroscopic) surgery, to reattach the torn tendon to the arm bone (UHCW, 2020). It may be considered for large tears, pain that does not improve, significant weakness, or a tear caused by a recent injury (AAOS, n.d.a). Recovery takes several months, and stiffness is a recognised complication afterwards (AAOS, n.d.b).
Steroid injection: an injection of a local anaesthetic and a steroid (cortisone) to ease pain and inflammation. It does not work for everyone (AAOS, n.d.a), and it does not repair the torn tendon.

How I can help (see the My Approach tab)

Exercises to restore shoulder movement and strength

Hands-on work for the shoulder, neck and upper back

Support after surgery, within your surgeon's limits

Tips

Try to avoid falling on an outstretched arm or lifting an object that is too heavy using a jerking motion. Doing so could tear your rotator cuff (AAOS, n.d.a).
Repeating the same activity and motion over and over puts stress on the tendons and muscles of the rotator cuff. Tennis, baseball, weightlifting and rowing are all examples of activities that can put you at risk of tearing the tendon (AAOS, n.d.a).
As you age, the blood supply to the tendon lessens. Without a good blood supply, the body's ability to repair damage to the tendon is reduced (AAOS, n.d.a).
Bone spurs can develop on the underside of the acromion (the bony point of the shoulder). When the arm is lifted, a spur can rub on the rotator cuff tendons and bursa, causing irritation and pain (AAOS, n.d.c).
Carpenters, painters and others who do a great deal of overhead work have a greater chance of tears (AAOS, n.d.a).

Treatment

My Approach

How I help with a rotator cuff tear depends on how big it is and how it happened.

If it's a small or wear-related tear and you can still lift your arm, I can usually treat it directly, with exercise and hands-on care.
If it's a large tear, it came from a fall or injury, or you suddenly can't lift your arm or have marked weakness, please see a doctor first, as earlier surgery may give a better result for tears caused by an injury. I then work alongside your medical team, and after surgery I need your surgeon's okay before any hands-on treatment.

I start by assessing how your shoulder, shoulder blade, neck and upper back move and testing your strength. A scan may be needed to show how large the tear is.

If It's a Small Tear

Cutting back what provokes it, such as reaching overhead, sleeping on that side and heavy carrying, rather than stopping everything
Hands-on work for the shoulder, neck and upper back muscles that tighten up or work overtime; chest wall work needs your informed consent and a written consent form
Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
Gentle holds, then shoulder blade control and rotator cuff strengthening, building to overhead and gym-based work, with a home programme between visits
Taping to support the shoulder blade in the short term, and I'll show you how to tape it yourself

If It's a Large Tear or You've Had Surgery

Working within your surgeon's protocol for the sling, allowed movements and strengthening
Easing the neck, upper back and other arm, and keeping the elbow, wrist and hand moving
Gentle lymphatic drainage for swelling, and scar work once the incisions have healed
Assisted movement, then gentle strengthening, with firm stretching waiting until your surgeon says the repair is ready

What to Expect

Typical Course

Typical course: For a small tear, most people come once or twice a week at first, then weekly, with a reassessment at about 4 to 6 weeks, then less often as the home programme takes over; improvement usually builds over about 6 to 12 weeks. For a large tear, visits follow your medical team's plan, and recovery after a repair takes several months.

What I Focus On

Assessment

Shoulder & Neck Release

Shoulder Blade Control

Progressive Cuff Strength

Working With Your Surgeon

Please read

When to See a Doctor First

When to Get Urgent Help

Get urgent medical help if you have sudden or very bad shoulder pain, you cannot move your arm, the pain started after a fall or injury, or you feel feverish or unwell (NHS, 2023).

Call 911 or go to the emergency room at your nearest hospital if your arm or shoulder has changed shape or is badly swollen after an injury, there is no feeling in your arm, or your arm is cold to the touch. These can be signs of a broken or dislocated bone or a ruptured tendon (NHS, 2023).

If you suddenly cannot lift your arm after a fall, see a doctor promptly: for tears caused by an injury, earlier surgical treatment may give a better result (UHCW, 2020).

Sources

References

American Academy of Orthopaedic Surgeons (n.d.a) Rotator cuff tears. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/rotator-cuff-tears/ (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.b) Rotator cuff tears: surgical treatment options. OrthoInfo. Available at: https://www.orthoinfo.org/en/treatment/rotator-cuff-tears-surgical-treatment-options/ (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.c) Shoulder impingement/rotator cuff tendinitis. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/shoulder-impingementrotator-cuff-tendinitis/ (Accessed: 7 October 2026).
NHS (2023) Shoulder pain. Available at: https://www.nhs.uk/conditions/shoulder-pain/ (Accessed: 8 October 2026).
University Hospitals Coventry and Warwickshire NHS Trust (2020) Rotator cuff tear. Patient information leaflet. Available at: https://www.uhcw.nhs.uk/download/clientfiles/files/Patient%20Information%20Leaflets/Trauma%20and%20Neuro%20services/Trauma%20and%20Orthopaedics/Rotator%20cuff%20tear.pdf (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooRotator Cuff Tear

What It Is

Rotator Cuff Tear Anatomy

Tears Are Usually Classified Into the Following

How Do Rotator Cuff Tears Occur?

Self-Care & Treatment

How to Treat a Rotator Cuff Tear

1. Assessment

2. Modification of Activities

3. Anti-Inflammatory Medication

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

If It's a Small Tear

If It's a Large Tear or You've Had Surgery

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooRotator Cuff Tear

What It Is

Rotator Cuff Tear Anatomy

Tears Are Usually Classified Into the Following

How Do Rotator Cuff Tears Occur?

Self-Care & Treatment

How to Treat a Rotator Cuff Tear

1. Assessment

2. Modification of Activities

3. Anti-Inflammatory Medication

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

If It's a Small Tear

If It's a Large Tear or You've Had Surgery

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Acromioclavicular Joint Sprain

Biceps Brachii Tendinopathy

Biceps Tendonitis of the Shoulder

Calcific Tendinopathy of the Shoulder

Book a session