Rotator Cuff Tear
Rotator Cuff Tear: A Houston Specialist's Guide
The rotator cuff is the group of four tendons—supraspinatus, infraspinatus, teres minor, and subscapularis—that surrounds the head of the humerus and gives the shoulder both stability and the ability to lift and rotate the arm. Rotator cuff tears are one of the most common shoulder problems treated by Houston orthopaedic surgeons, affecting an estimated 20 to 30 percent of adults over age 60. Many tears cause no symptoms at all; others cause significant pain, weakness, and loss of function.
How Rotator Cuff Tears Happen
Rotator cuff tears generally fall into two categories:
- Acute (traumatic) tears occur after a discrete event—a fall on an outstretched arm, a sudden lift of a heavy object, or a forceful pull. Patients often remember the exact moment the injury occurred and notice immediate pain or weakness.
- Degenerative (chronic) tears develop gradually over years from normal tendon wear. There is often no specific injury; the patient simply notices increasing pain, particularly at night, and difficulty with overhead activities. Many degenerative tears are partial-thickness initially and may progress to full-thickness over time.
Some patients have both: a degenerative tear that has been silently present for years until a minor injury extends it and triggers symptoms.
Symptoms
The most common symptoms of a rotator cuff tear include:
- Pain with overhead activities such as reaching into a cabinet, throwing, or washing hair
- Pain at night, particularly when lying on the affected shoulder
- Weakness when lifting or rotating the arm
- Difficulty using the arm for daily tasks
- A crackling sensation (crepitus) with movement
- In larger tears, the inability to lift the arm overhead at all
Pain is often felt in the upper arm rather than directly on top of the shoulder.
Diagnosis
Diagnosis begins with a careful history and physical examination. Specific tests (such as the empty-can test for the supraspinatus or external rotation strength for the infraspinatus) can identify which tendons are involved and how severe the tear is.
- X-rays evaluate for arthritis, calcium deposits, bone spurs, and—in chronic tears—upward migration of the humeral head, which suggests a large tear.
- MRI is the most accurate non-invasive test for confirming a tear, measuring its size, identifying tendon retraction, and assessing muscle quality (atrophy and fatty infiltration). MRI is ordered when results will influence the treatment plan.
- Ultrasound is an alternative for evaluating cuff integrity and can be useful for dynamic assessment or for patients unable to have an MRI.
Non-Surgical Treatment
A large fraction of rotator cuff tears improve with non-operative care, particularly small partial tears, degenerative tears in older or lower-demand patients, and many tears not associated with significant weakness. Non-surgical options include:
- Activity modification to avoid aggravating motions while the tendon is irritated
- Physical therapy focused on restoring range of motion, strengthening the surrounding rotator cuff and scapular stabilizers, and improving posture
- Anti-inflammatory medication (NSAIDs) for pain control
- Corticosteroid injections in the subacromial space for short-term symptom relief
Most patients are given a structured trial of non-operative care for several weeks to several months before surgery is considered, unless the tear is acute and traumatic in a younger, active patient.
Arthroscopic Rotator Cuff Repair
When surgery is indicated, arthroscopic rotator cuff repair is the standard approach. The procedure is performed through three to four small incisions—each under a quarter-inch—using a camera (arthroscope) and specialized instruments. Suture anchors are placed into the bone of the greater tuberosity, and sutures are passed through the torn tendon and tied down to reattach the tendon firmly to its anatomic position. The number and configuration of anchors depends on the tear size and pattern.
Rotator cuff repair is performed as an outpatient surgery in Houston, with patients going home the same day.
Recovery After Rotator Cuff Surgery
Recovery is a staged process:
- Weeks 0–6: Sling immobilization to protect the repair while the tendon heals to bone. Gentle pendulum exercises are typically allowed; active motion is restricted.
- Weeks 6–12: Passive and active range-of-motion exercises with a physical therapist. Strengthening is not yet started.
- Months 3–6: Progressive strengthening of the rotator cuff and surrounding muscles. Return to most non-strenuous activities.
- Months 4–9: Return to heavier work, sports, and overhead activities. Heavy laborers and overhead athletes may take longer.
Healing rates after arthroscopic rotator cuff repair depend on multiple factors, including tear size, tendon quality, patient age, smoking status, and adherence to the rehabilitation protocol. Smaller tears in younger patients heal more reliably than larger or older tears.
Further patient education is available in this handout.
Irreparable Rotator Cuff Tears
In some cases—usually large, chronic tears that have been present for years—the tendon has retracted and the muscle has degenerated to the point that repair is not possible or unlikely to heal. These "irreparable" tears require a different strategy. Options depend on the patient's age, symptoms, and presence of arthritis:
- Debridement and biceps tenotomy for pain relief in lower-demand patients
- Superior capsular reconstruction or balloon spacer procedures in selected cases
- Tendon transfer (such as lower trapezius transfer) to restore active motion
- Reverse shoulder replacement for patients with associated arthritis (rotator cuff tear arthropathy) or significant functional loss
Scheduling Your Visit
Appointments for rotator cuff evaluation are scheduled through UTHealth Houston at 713-486-1700. The practice has offices in Memorial Villages and the Texas Medical Center.
Frequently asked questions
What are the most common symptoms of a rotator cuff tear?
Shoulder pain with overhead activity, pain at night that disturbs sleep (especially when lying on the affected side), weakness when lifting or rotating the arm, and sometimes a popping or catching sensation. Pain is often felt in the upper arm rather than directly on top of the shoulder.
What causes a rotator cuff tear?
Tears either occur acutely from an injury such as a fall or heavy lift, or develop gradually from tendon wear over years of normal use. Degenerative tears are common after age 50 and are not always painful—many people have small tears without symptoms.
Can a rotator cuff tear heal without surgery?
Torn tendon fibers themselves do not heal back together without surgical repair, but many tears (especially small or partial tears) become asymptomatic with physical therapy, anti-inflammatory medication, and selective corticosteroid injections. Whether surgery is needed depends on the size of the tear, your age, activity level, and how much the symptoms affect daily life.
How is a rotator cuff tear diagnosed?
Diagnosis combines history, physical examination, and imaging. X-rays evaluate for arthritis or bone changes; MRI is the most accurate test for confirming a tear and measuring its size, location, and tendon quality. Ultrasound is sometimes used as well.
When is rotator cuff surgery recommended?
Surgery is generally recommended for full-thickness tears in active patients, for tears that have failed several months of appropriate non-operative care, for acute traumatic tears in younger patients, and for tears causing significant weakness or functional loss.
How long does recovery take after rotator cuff repair?
Most patients wear a sling for about six weeks, work on regaining motion through three months, and progress to strengthening from three to six months. Return to desk work is typical within a few weeks; return to heavy lifting and overhead work generally takes four to six months.
What are the success rates of rotator cuff surgery?
Most patients achieve significant pain relief and functional improvement after arthroscopic rotator cuff repair. Healing rates depend on tear size, tendon quality, patient age, and adherence to rehabilitation. Smaller tears in younger patients heal more reliably than large or chronic tears.
What if my rotator cuff tear is too large to repair?
For large, chronic, or irreparable tears, several options exist depending on your symptoms and age. These include superior capsular reconstruction, tendon transfers, debridement procedures, and reverse shoulder replacement when the tear has led to arthritis (cuff tear arthropathy).