Approximately 20% of people over the age of 65 have a rotator cuff tear, and this figure rises to 50% after the age of 80.

Here's the good news: most tears can be treated effectively without surgery. Research shows that conservative treatment produces results comparable to surgery for many types of tears. Your shoulder has a remarkable ability to adapt.

You will learn how to differentiate between different types of tears, when physical therapy is sufficient, and when to consult a specialist.

What is a rotator cuff tear?

A rotator cuff tear occurs when one or more tendons in the shoulder partially or completely detach from the arm bone (humerus).

The rotator cuff consists of four tendons that cover the head of the humerus like a cap: the supraspinatus, infraspinatus, teres minor, and subscapularis. These tendons connect the muscles to the bones and enable the arm to rotate and elevate.

The supraspinatus is the tendon most frequently torn, as it undergoes constant compression during overhead movements.

This injury affects both active and sedentary people. The intensity of the symptoms does not always reflect the severity of the tear.

Now that you understand the anatomy involved, let's look at how this injury manifests itself in different forms.

What are the different types of rotator cuff tears?

Tears are classified according to two criteria: their size and their cause.

Depending on size:

• Partial tear: The tendon is damaged but remains attached to the bone. The thickness of the tendon is affected, but continuity is maintained.
• Complete tear (transfixing): The tendon is completely detached from the bone, creating a hole in the rotator cuff.

Depending on the cause:

• Degenerative tear: The tendon gradually wears down over several years, usually after the age of 45. This natural wear and tear affects 40% of people over the age of 60.
• Traumatic tear: The tendon suddenly tears during a specific event (fall, lifting a heavy load, extreme movement).

An untreated partial tear can progress to a complete tear in 40% of cases after 4 years. This progression is not inevitable with appropriate treatment.

Understanding the type of tear guides the choice of treatment. Let's now explore how to recognize this injury.

What are the symptoms of a rotator cuff tear?

Here's a surprising fact: 50% of people aged 60 and over with a tear visible on MRI scans experience no pain. Similarly, 40% of professional baseball pitchers have partial or complete tears without symptoms.

The presence of a tear does not automatically mean pain or disability.

When symptoms appear, the most common ones are:

• Shoulder pain: Gradual onset (degenerative tear) or sudden onset after trauma. The pain often radiates to the arm or neck.
• Nighttime pain: Intensifies at rest, especially when lying on the affected shoulder.
• Muscle weakness: Significant difficulty raising the arm above the head or carrying loads.
• Reduced mobility: Limited range of motion when raising and rotating the arm.
• Cracking sensation: Joint noises during certain movements.

Traumatic tear specifically:

• Immediate intense pain after injury
• Sensation of popping or tearing in the shoulder
• Sudden and marked weakness in the arm

The severity of symptoms varies depending on the size of the tear, compensating muscles, and your activity level.

If you recognize several of these symptoms, you are probably wondering what is causing them. The answer depends on your situation.

What REALLY causes a rotator cuff tear?

Common misconception A tear occurs only as a result of a violent accident. Reality The majority of tears result from gradual and natural wear and tear of the tendons with age, even without trauma. Degenerative causes (the most common):

• Natural aging: The quality of tendons declines after age 45. Reduced vascularization slows down repair capacity.
• Repetitive movements: Professional or sporting activities involving repeated movements above the head (painting, tennis, swimming).
• Tendon compression: The space under the acromion (part of the shoulder blade) narrows with age, creating constant friction on the tendon.
• Decreased muscle strength: Progressive weakening increases the load on the tendons.

Traumatic causes (less common):

• Direct fall onto the shoulder
• Sudden lifting of an excessive load
• Violent pulling or twisting movement
• Direct impact during an accident

Liberating message If you have a degenerative tear, this reflects a natural aging process. not a personal weakness or vulnerabilityYour body retains its ability to adapt and heal itself.

A degenerative tear often coexists with shoulder tendinopathy, as both conditions share similar mechanisms.

Now that you understand the causes, let's find out how to make an accurate diagnosis.

How is a rotator cuff tear diagnosed?

The diagnosis combinesyour symptom history andthe clinical examination performed by your physical therapist or doctor.

The clinical evaluation includes:

• Questions about your symptoms: When did the pain start, circumstances surrounding its onset, aggravating factors, and relief.
• Mobility tests: Range of motion in all directions.
• Strength tests: Resistance against manual pressure for each muscle of the rotator cuff.
• Specific tests: Clinical maneuvers that reproduce or reduce pain (Jobe test, Neer test, Hawkins test).

Medical imaging (MRI or ultrasound):

Imaging is not always necessary to begin treatment. Your physical therapist can develop an effective treatment plan based on clinical examination.

Imaging becomes relevant in these situations:

• No improvement after 3 to 6 months of physical therapy
• Suspected complete tear in an active person
• Pre-surgical assessment to determine the size and precise location
• Marked muscle weakness suggesting a massive tear

Important : MRI frequently reveals tears in people who are not experiencing pain. The presence of a tear on imaging does not automatically dictate treatment.

Now that the diagnosis has been made, let's explore the treatment options available to you.

What are some effective treatments that do not involve surgery?

Reassuring fact Recent meta-analyses show that there is no no clinically significant difference between surgery and active physical therapy after one year for complete tears.

Conservative treatment is the first-line approach for most tears.

Physical therapy as the primary treatment:

Your physical therapist will evaluate these elements:

• Joint mobility: Passive and active range of motion in the shoulder
• Nerve slippage: Mobility of the nerves in the arm
• Quality of movement: Coordination and motor control
• Strength and stability: Capacity of the rotator cuff muscles and shoulder blade

The treatment plan includes:

• Manual mobilizations: Techniques to reduce pain and restore movement
• Progressive exercises: Personalized program to strengthen the rotator cuff muscles and improve scapular control
• Modifying activities: Strategies for balancing your daily activities and sports
• Postural education: Corrections to reduce compression on tendons

Improvement period Symptoms generally improve within 4 to 12 weeks. Complete healing of the tendons requires at least 6 months. Other conservative interventions:

• Anti-inflammatory medication: Temporary pain relief (prescribed by your doctor)
• Cortisone injection: Reduction of inflammation in acute cases (maximum 3 per year)

Physical therapy remains safer and less expensive than surgery, with a complication rate of virtually zero.

For partial tears and multiple complete tears, this treatment is sufficient. But when should surgery be considered?

When does surgery become necessary?

Surgery is not automatic for a complete tear. It becomes an option in these specific situations:

Surgical indications:

• Failure of conservative treatment after 4 to 6 months of supervised exercises
• Acute traumatic tear in an active person (under 50 years of age)
• Massive tear affecting several tendons with significant weakness
• Recent complete tear with significant functional loss in a manual laborer
• Documented progression of the tear despite treatment

Factors influencing the decision:

• Age: Younger, active individuals benefit more from surgical repair.
• Activity level: High functional demands sometimes justify intervention.
• Size of the tear: Large tears (more than 5 cm) have limited potential for spontaneous healing.
• Tendon quality: Fatty degeneration (replacement of muscle with fat) reduces the chances of surgical success.

Types of surgery:

• Arthroscopic repair: Minimally invasive procedure to suture the tendon to the bone (duration: 45-90 minutes)
• Capsular reconstruction: If the tendons are irreparable but without osteoarthritis
• Reverse prosthesis: For massive tears that cannot be repaired with osteoarthritis

Surgical recovery:

• Immobilization: 4 to 6 weeks in a splint
• Physical therapy: Began immediately after surgery
• Return to activities: 6 to 12 months depending on complexity

Success rate : 90% of repairs heal without major complications. However, the re-tear rate varies between 10% and 40% depending on the initial size. Crucial point : To undergo physical therapy before Surgery significantly improves post-operative outcomes.

For recent traumatic injuries, certain immediate measures accelerate healing.

What should you do at home for a recent traumatic tear?

For a traumatic tear (less than 72 hours), follow the PEACE and LOVE principles:

PEACE (acute phase, first 72 hours): P = Protection : Support your arm with a triangular bandage for 24 to 48 hours if the pain is severe. Avoid prolonged immobilization. E = Elevation Keep your arm slightly elevated with a pillow under your armpit when sitting. A = Avoid anti-inflammatory drugs Anti-inflammatory drugs can interfere with long-term healing. Use acetaminophen for pain relief. C = Compression : Not applicable for the shoulder. E = Education Understand that initial pain does not predict recovery time. Avoid excessive passive treatments. LOVE (recovery phase, after 72 hours): L = Load (progressive load) Gradually resume your daily activities without significantly increasing the pain. Use the injured arm for light tasks (washing dishes, brushing your teeth). O = Optimism : Maintain a positive attitude. Research shows that many tears heal without surgery. V = Vascularisation Engage in light to moderate cardiovascular activity without straining the shoulder: walking, stationary cycling with arm support, aqua jogging. E = Exercise Start gentle mobility exercises as soon as tolerated, then progress to strengthening under professional supervision. Additional tips:

• Sleeping position: Sleep on the uninjured side. Place a pillow between your arm and your body to support your shoulder. Avoid sleeping with your arm behind your head.
• Neck support: Use a pillow that fills the hollow of your neck to reduce tension.
• Pain management: Apply ice for 15 minutes every 2-3 hours for the first 48 hours.

Consult a physical therapist promptly after an injury to establish an appropriate treatment plan.

You now have the essential information, but certain questions come up frequently.

When should you seek medical attention for a rotator cuff tear?

Consult a physical therapist if:

• You have been experiencing shoulder pain for more than two weeks.
• You feel a marked weakness in your arm.
• Pain regularly disrupts your sleep
• You have recently suffered a shoulder injury.
• Your daily or professional activities are limited

You do not need a doctor's referral. to consult a physical therapist in Quebec. The physical therapist will assess your condition and refer you to a doctor if necessary. Consult your doctor promptly if:

• Complete loss of arm mobility after trauma
• Severe pain not relieved by painkillers
• Significant swelling or visible deformation of the shoulder
• Persistent numbness or tingling in the arm

For people awaiting surgery : Doing physical therapy before surgery significantly improves post-operative recovery. Don't remain inactive while you wait.

To optimize your recovery, also explore our resources on shoulder pain and physical therapy for the shoulder.

Frequently asked questions about rotator cuff tears

Can a tear heal without surgery?

Yes. Studies show that conservative treatment produces results comparable to surgery for many types of complete tears. Partial tears are treated almost exclusively without surgery.

How long does recovery take?

With physical therapy, symptoms improve within 4 to 12 weeks. Complete healing of the tendons requires at least 6 months. After surgery, it takes 6 to 12 months to fully resume activities.

Can I continue to exercise with a tear?

It depends on the size of the tear and your symptoms. Many professional athletes perform with asymptomatic tears. Your physical therapist will gradually adapt your sports program.

Will the tear get worse if I don't have surgery?

Not necessarily. Approximately 40% of complete tears progress after 4 years without treatment. However, an active physical therapy program can prevent this progression by strengthening compensatory muscles.

Can physical therapy repair a torn tendon?

Physical therapy does not "reattach" the tendon, but it strengthens the surrounding muscles and improves shoulder mechanics. This compensation restores function and eliminates pain in most cases, even if the tear persists on imaging.

What is the difference between a tear and tendinopathy?

Tendinopathy refers to degeneration of the tendon without complete tearing. A tear involves partial or complete rupture of the tendon fibers. The two conditions frequently coexist and share similar treatments.

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