Ep 158 – Rotator cuff tears

A rotator cuff injury is an event that causes pain in the shoulder. This can be due to a tear, inflammation or narrowing of the space within the shoulder joint. The rotator cuff muscles interlock to work as a unit. They help to stabilise the shoulder joint and also help with shoulder joint movement. In this episode, Dr Roger Henderson takes a specific look at tears to the rotator cuff – a problem often seen in primary care. The episode covers causes, diagnosis and treatment, including conservative approaches and surgical options.

Key take-home points

• The rotator cuff is a group of four muscles: subscapularis, supraspinatus, infraspinatus and teres minor. These originate from the scapula and inserting into the superior aspect of the humeral head.
• These muscles play a critical role in both movement and stabilisation of the glenohumeral joint.
• Rotator cuff tears have two main causes: injury and degeneration. Acute tears are usually due to injury. This type of tear can occur in isolation or with other shoulder injuries, such as a broken collarbone or dislocated shoulder. Degenerative tears are more common and are the result of wearing down of the tendon that occurs slowly over time.
• Rotator cuff tears are more common in the dominant arm.
• Risk factors include age, smoking, family history, poor posture, repetitive overuse and trauma.
• Tears may remain stable over time or progressively worsen. Factors influencing progression include the tear size, symptoms and location, with larger and anteriorly located tears more likely to worsen over time.
• Modern imaging techniques and arthroscopy have helped to replace the rather non-specific diagnosis of "impingement" with specific diagnoses of rotator cuff tendinosis, partial tear and complete tear. These refined terms better reflect the degree of damage to the rotator cuff.
• A decision to treat a rotator cuff tear surgically or conservatively should be based on several factors, including the size of any tear, the age of the patient and their expected normal level of activity, the degree of tendon retraction if present and whether rotator cuff muscle atrophy has occurred.
• Surgical treatment options include arthroscopic rotator cuff repair, open rotator cuff repair, tendon transfers and reverse shoulder arthroplasty.
• The long-term outcomes for rotator cuff tears depend on multiple factors including tear severity and chronicity, patient age and adherence to treatment protocols.
• With surgical repair, old age, chronicity and retraction of the tear, atrophy and fatty degeneration of the cuff muscle have all been associated with worse outcomes, regardless of the surgical approach.

Key references

1. Kulkarni R, et al. Shoulder Elbow. 2015;7(2):135-143. doi: 10.1177/1758573215576456.
2. OrthoInfo. 2025. https://orthoinfo.aaos.org/en/diseases--conditions/rotator-cuff-tears/.
3. Weber S, Chahal J. J Am Acad Orthop Surg. 2020;28(5):e193-e201. doi: 10.5435/JAAOS-D-19-00463.
4. Beaudreuil J, et al. Orthop Traumatol Surg Res. 2010;96(2):175-179. doi: 10.1016/j.otsr.2010.02.002.
5. MacDermid JC, et al. Am J Sports Med. 2021;49(12):3184-3195. doi: 10.1177/03635465211038233.
6. Longo UG, et al. BMC Musculoskelet Disord. 2021;22(1):749. doi: 10.1186/s12891-021-04634-6.