Rotator Cuff Tear

A degenerative partial-thickness tear developing over years in a shoulder that still works is a different situation from a full-thickness tear sustained in a fall. The first is common and often symptom-free; the second usually needs prompt surgical assessment.

Cuff tears are found on scans in a large proportion of people over 60 with no shoulder pain at all. Finding one does not establish that it is causing the symptoms.

For degenerative tears, structured exercise restores function in a substantial proportion of patients, and outcomes at one to two years are comparable to surgical repair in several trials 1. The tear does not heal; the shoulder learns to work around it.

The programme strengthens the remaining cuff and the scapular muscles, and takes sustained, consistent work before it can be fairly judged.

An acute traumatic full-thickness tear in a younger, active person. Progressive weakness rather than pain. Inability to lift the arm at all after an injury. A tear that has failed a properly delivered exercise programme.

Delay in acute traumatic tears matters — the tendon retracts and the muscle changes over months, and repair becomes harder. This is one of the situations where prompt referral is genuinely important.

Repair is followed by a protected period in a sling with the range dictated by the surgeon, then graded range, then strengthening. Full recovery is measured in months rather than weeks, and the early phase is slow by design — the repair has to hold.

We work to the operating surgeon's protocol and ask for it in writing, because it differs between surgeons and between repair techniques for the same tear.

Partial and even full-thickness rotator cuff tears are common findings in people who have no shoulder symptoms whatsoever, and they become steadily more common with age. A tear on a scan is therefore not automatically the explanation for the pain.

This changes the question from what the scan shows to what the shoulder can do. Two people with identical imaging can have completely different function, and it is function that the programme is aimed at.

The remaining cuff and the muscles around the shoulder blade, because a shoulder with a tear can still work well if the rest of the system compensates. Range is restored first where stiffness is limiting, then strength through that range, then control of the movements you actually need.

Progress is measured — degrees of elevation, external rotation strength, what you can lift and to what height — rather than judged by how the shoulder felt during the session.

Conservative treatment usually needs a sustained period before its effect can be fairly judged, and improvement often continues beyond that. Judging it too early and abandoning it is the most common reason people conclude rehabilitation does not work for them.

After surgical repair the timeline is longer and non-negotiable: a period of protection while the repair heals, then graded movement, then strengthening, with full return taking many months. Rushing this is how repairs fail.

Night pain is often the symptom that finally drives people to seek help, and it is the one that responds least predictably. Sleeping on the affected side compresses the shoulder; lying flat lets the arm drop into a provocative position.

Supporting the arm on a pillow, semi-reclined positioning and timing pain relief for the evening help most people. If night pain is severe and unrelenting despite these, that is worth reporting rather than enduring — it changes the plan.