A rotator cuff tear is a partial or complete severing of the rotator cuff tendons in the shoulder, usually due to injury. A strain is different, as it involves an overstretch of the tendons.

The rotator cuff consists of four muscles that help keep shoulder movement stable. They support the glenohumeral joint, where the ball-shaped top of the humerus (the upper arm bone) meets the socket joint of the glenoid (shoulder). These muscles can overstretch or separate from the bone due to overuse, trauma, or wear and tear.

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The rotator cuff is a set of four muscles in the shoulder that work together to control arm movement and rotation and keep the shoulder in place.

Due to its anatomy, the rotator cuff can be prone to certain injuries. Strains and tears can both affect this group of muscles, but these injuries differ in important ways.

Rotator cuff strain

This is a soft tissue injury that involves placing extreme tension on the shoulder tendons and ligaments. It usually occurs due to overstretching the joint but does not always cause a tear.

These types of rotator cuff injuries may occur due to a single trauma or gradual wear and tear. They are a normal part of aging. Strains of the rotator cuff are not as common as those in the back or leg.

Rotator cuff tear

A rotator cuff tear occurs when the tendons of the rotator cuff separate from the bone they support. These tears can be full or partial.

Full tear

A full-thickness rotator cuff tear means the tendon completely detaches from the top of the arm bone after an injury.

If a small part detaches, doctors refer to this as a full-thickness incomplete tear. A full-thickness complete tear occurs when there is a hole in the tendon, and it has completely detached.

Partial tear

A partial tear means the separation has not completely detached the tendon from the bone. This may occur due to lifting a heavy object or falling on a fully extended arm.

Overuse of overhead motions can also cause tears. For example, repeated overhead serves in tennis — which make up 45% to 60% of all strokes in a tennis match, according to a 2020 review — can lead to both types of tears in regular tennis players.

Learn more about the shoulder bones.

Rotator cuff injury is the most common injury in adults, with around 30% of those over 60 years old and 62% of those over 80 years old receiving treatment for it.

Several factors can make soft tissue injuries more likely in the rotator cuff, including:

  • age, as wear and tear can affect tendon health over time
  • smoking, which can make tears both more frequent and more severe
  • a family history of rotator cuff disease in people under 40 years of age
  • a slouched or unstable posture
  • recent physical injury or trauma
  • jobs or regular activities that involve a lot of overhead arm movement
  • a history of partial tears, which may develop into full tears

Rotator cuff strains and tears from an injury can cause immediate pain, while those that involve wear and tear may cause no pain. However, they may still cause:

Rotator cuff strain symptoms

Additionally, a rotator cuff strain may cause:

Rotator cuff tears

The following symptoms may develop due to rotator cuff tears:

  • pain during bed rest, especially when lying on the affected shoulder
  • pain when lifting and lowering the arm
  • a snapping sensation during acute injuries or immediate tears, such as a fall
  • instability of the joint

The pain of a rotator cuff tear may be immediate and severe. However, pain due to tears from overuse may develop more gradually.

A doctor will ask the individual about symptoms and any regular overhead activities, such as sports or job-related tasks.

They will also test the person’s arm-lifting and rotating movements to check strength and mobility.

They may request various types of imaging scans, such as:

These can help the doctor check whether there is a tear, measure the thickness of the tear if one is present, and assess any more gradual issues with the rotator cuff tendons.

Treatment for rotator cuff injuries depends on:

  • a person’s age
  • how much pain the injury is causing
  • whether the injury occurred due to a specific trauma or event or developed over time due to wear and tear

Nonsurgical treatment

Around 80% to 85% of people find that nonsurgical treatment helps relieve symptoms, according to the AAOS.

The following measures may help the tendons recover from strains, relieve pain, and restore full movement:

If these measures do not relieve pain, a doctor may recommend a corticosteroid injection into the shoulder.

Doctors may also recommend heat therapy to reduce shoulder soreness for rotator cuff tears or prescribe a method called transcutaneous electrical nerve stimulation (TENS), in which a person uses a machine to stimulate the shoulder and repair tears over time.


A doctor may recommend surgery under the following conditions:

  • symptoms last 6 to 12 months or longer
  • a tear is particularly large
  • a tear significantly affects a person’s ability to use their shoulder or causes severe pain

Rotator cuff tears due to recent injuries may also warrant surgery.

Surgery can involve repairing the tendon or performing a reverse total shoulder replacement. The doctor will decide on the most appropriate surgery based on the person’s age, the extent of the tear, and whether osteoarthritis is present.

Read on to learn more about rotator cuff surgery.

People who respond well to nonsurgical care usually recover within 6 to 12 weeks.

Adhering to a rehabilitation exercise plan and giving the joint adequate rest is essential for a full recovery.

Those who need surgery will often have the following recovery timeline:

Up to 4 to 6 weeks after surgery

An individual typically wears their arm in a sling to keep it still while the tendon heals. This may vary depending on the surgical procedure and the severity of the tear.

Toward the end of this period, a surgeon may recommend passive exercise to start restoring the muscles around the rotator cuff that support the arm during these motions.

After 4 to 6 weeks

Around 8 to 12 weeks after surgery, an individual can start exercising their arm independently under a physical therapist’s guidance.

Complete recovery may take several months, with full motion and strength likely to return around 4 to 6 months after surgery.

Learn more about rotator cuff stretches and exercises.

A rotator cuff strain occurs when a person overstretches the tendons supporting the glenohumeral joint.

A strain that stretches the tendons too far can partially or completely separate the tendon and the bone, leading to a tear. Some tears cause immediate pain and weakness, but others do not cause symptoms for some time.

Aging, smoking, and frequent overhead lifting or motion can increase a person’s risk of rotator cuff injury. Most people manage these through nonsurgical measures, such as rest, ice, and physical therapy. Some may need surgery to reattach the tendon.