04/29/2026
Mr. Patient: “My dear doctor, I find myself in a most troubling predicament, for I suspect that I have inadvertently torn the delicate fibers of my rotator cuff. Such an affliction is not merely a source of physical discomfort but a reminder of our fragile humanity, a whisper from the body that we are, after all, mortal beings subject to the trials of this earthly existence.”
This scenario occurs frequently during my clinical duties as a shoulder specialist. I walk into an exam room to hear a patient worried they may have sustained a rotator cuff injury to their shoulder. My previous post discusses rotator cuff tendonitis, so there are several overlapping details. Clinically, the symptoms can be very similar and difficult to determine solely on physical exam. The most common symptoms of rotator cuff tears include severe night pain, pain with arm elevation, weakness with arm rotation or elevation, and shoulder popping when moving.
Rotator cuff tears are the result of either acute traumatic injuries or degenerative tearing of the tendon. Acute traumatic injuries are typically the result of a fall, lifting a heavy object, or a traumatic accident such as an automobile accident. Degenerative tearing of the tendon is the most common cause of rotator cuff tearing, usually from repetitive push, pull, and lifting.
Clinically, the involved shoulder will exhibit pain with range of motion and will usually have weakness on rotator cuff testing. Radiographic images are performed to rule out arthritis of the glenohumeral joint and other causes of shoulder pain. After completing radiographs, Magnetic resonance imaging (MRI) will provide a comprehensive diagnostic workup. The MRI will provide several important factors for assessing rotator cuff pathology, such as tear size, retraction, and fatty atrophy.
Not all rotator cuffs require surgical repair; when indicated, I perform these repairs arthroscopically. The post-operative management consists of sling immobilization for 6 weeks and several weeks of physical therapy.