Shoulder pain from a rotator cuff tear can significantly disrupt your daily activities and participation in your favorite sports. This common condition, especially among athletes and older adults, can cause significant discomfort and limit mobility. This article will answer 10 frequently asked questions about rotator cuff injuries, exploring everything from causes and diagnosis to treatment options and recovery tips. The bottom line: You can conquer shoulder pain and return to living an active life.

The rotator cuff is a group of four tendons that attach to the humerus bone and provide shoulder movement and stability. A “torn rotator cuff” is a tear in one or more of those tendons. Typically, this type of shoulder injury occurs due to wear and tear. However, it can also be from a traumatic injury that ruptures a tendon.

Shoulder pain and weakness are typical symptoms of a rotator cuff tear. Depending on the tendons involved, a clinician can perform specific physical examination tests to detect a rotator cuff tear. However, not all such tears cause pain or weakness. For example, in one study evaluating people who have never experienced shoulder pain, half the patients over 60 had rotator cuff tearing and no symptoms!

Other shoulder injuries include shoulder impingement, which can cause pain and limited motion. It can be challenging to differentiate from a torn rotator cuff, although people with rotator cuff tears sometimes will develop more weakness than those with impingement. Frozen shoulder (also known as adhesive capsulitis) causes stiffness from an inflamed joint capsule. People with frozen shoulder will generally have stiffness and pain but won’t have weakness within their range of motion. Patients with shoulder arthritis will also experience stiffness like a frozen shoulder but caused by degeneration of the cartilage in the joint.

In addition to a detailed physical examination, magnetic resonance imaging (MRI) is the most common way to diagnose a rotator cuff tear. Unlike an X-ray, which doesn’t show soft tissue, an MRI allows a provider to assess a tear while also aiding in examining the health of the muscles and implications for treatment options. Ultrasound and computed tomography (CT) scans also can be used.

Physical therapy/rehabilitative exercises can relieve pain and improve function in some patients. Cortisone injections can ease pain and make it easier to perform exercises to build strength.  More recently, clinicians have utilized platelet-rich plasma (PRP) and bone marrow aspirate (BMA) injections to treat rotator cuff tears. Surgical treatment of a torn rotator cuff can involve repair of the tear using sutures to tie the tendon back to the bone or other reconstructive options such as tendon transfers or shoulder replacement for large, otherwise irreparable tears.

Yes, when a patient expresses an interest in natural healing, I discuss options such as physical therapy and PRP/BMA injections. However, these two nonsurgical treatment options won’t result in the reattachment of a fully torn, retracted rotator cuff tendon. I always take the time to discuss with patients the potential consequences of leaving a tendon torn. Over time, large tears can become irreparable due to tear enlargement, scarring and muscle atrophy.

During a rotator cuff repair, a surgeon reattaches the tendon to the bone using sutures. While technology has advanced to include arthroscopic techniques and maximizing biologic factors to promote healing, not all tendons heal after surgery. Surgeons continue to perform extensive research in identifying risk factors for patients who don’t heal after surgical rotator cuff repair. The good news is that when a repair surgery is successful, the chance of re-tearing a healed rotator cuff repair is extremely low.

Read: Athletes Who Throw Deal With Shoulder Injury Risks

Nonsurgical healing time for a torn rotator cuff is highly variable, depending on a patient’s activity level, age, tear size and multiple other factors. In general, the average patient with the average rotator cuff tear may begin returning to normal activities 6-8 weeks post-injury and initiating rehabilitation exercises. However, not all patients have adequate results without surgery.

If we define "healing" as a fully torn tendon becoming reattached, physical therapy cannot heal a torn rotator cuff. However, suppose we classify "healing" as a patient who no longer has pain or functional limitations. In that case, physical therapy can aid patients in regaining motion and strength, particularly by strengthening the other shoulder muscles that are still intact.

Because the rotator cuff is vital to shoulder motion, we have not found specific nutritional supplements or activity avoidance to prevent rotator cuff injury. However, if performing specific activities causes shoulder pain and weakness, I recommend consulting a specialist to make sure a tear hasn’t developed.

As an orthopedic surgeon specializing in the diagnosis and treatment of shoulder injuries, I’ve witnessed exciting advancements in the surgical treatment for rotator cuff tears. If you suspect a shoulder injury, it’s crucial to consult a shoulder specialist to ensure you receive the best care possible. While cortisone injections are commonly performed, they can potentially worsen a rotator cuff tear in the long run.

Specialized training and practice are even more critical when considering surgical treatment. For example, if a tear is not reparable, a specialist can typically decide during surgery to perform an alternate reconstructive procedure—such as a tendon transfer or capsular reconstruction—a decision that would have been discussed with you ahead of time.

If you suspect a rotator cuff tear, don’t hesitate to consult a healthcare professional for a proper diagnosis and to discuss the best course of action for regaining shoulder strength and function. Remember, knowledge is power, and with the correct information and approach, you can conquer shoulder pain and get back to enjoying the activities you love.