The rotator cuff tendon(s) may be torn as a result of injury, chronic tendinopathy, or a combination of both. Typically the injury is caused by a fall, direct blow, or a rapid use of force (pulling on a starter cable, for instance). Tears are uncommon in people under the age of 30; less than 1 percent of shoulder injuries in people under the age of 30 are complete rotator cuff tears, while up to 35 percent of people over age 45 with shoulder pain have a complete rotator cuff tear.
The goals of treatment for a torn rotator cuff are to recover lost strength, improve the function of the shoulder, and treat any underlying tendinitis. Conservative treatment is adequate in the vast majority of people, although younger people with a medium- to large-sized tear, particularly affecting the dominant arm, may be candidates for surgical repair. Surgery may also be recommended for older people who have significant pain related to a rotator cuff tear.
People with small- to medium-size tears usually improve with physical therapy exercises, stopping painful activities, and, in some cases, injection of a steroid. If shoulder strength and function do not improve after completing three to six months of physical therapy, surgical repair may be considered.