Rotator Cuff Tear: Symptoms, Types and Why Not All Tears Need Surgery

The rotator cuff is a group of four small muscles and their tendons. Together they wrap around the top of the upper arm bone and keep the ball of the shoulder centred in its socket. A tendon is the cord that joins muscle to bone.

A tear is a break in one of these tendons. Tears are described in a few ways:

• Partial tear: the split goes partway through the tendon.
• Full-thickness tear: the split goes all the way through.
• Sudden or gradual: some tears follow an injury, such as a fall or a hard lift. Others develop slowly over time.

Some tears cause little trouble. Others cause real pain or weakness.

Symptoms that can go with a rotator cuff problem include:

• pain when reaching overhead, lifting or reaching behind you
• weakness when lifting or rotating the arm
• aching that wakes you at night
• trouble with everyday tasks, like dressing or reaching a shelf

Studies have found that people with one-sided shoulder pain often prefer sleeping on the painful side, but the cause of that link is not known [R29]. Experiment gently, and tell your clinician about it.

These symptoms are not specific to a tear. Other shoulder problems can feel similar. An assessment is the only way to find out what is going on.

A doctor, physiotherapist or specialist diagnoses a rotator cuff tear. They usually do this with a physical exam, and sometimes with imaging. NHS England advises against routine ultrasound or MRI unless there is a treatment pathway that will use the result [R30].

• Exercise-based care is the usual first step. Most shoulder pain in primary care is managed with advice and exercise. This includes rotator-cuff-related pain, which covers symptomatic tears [R30][R03].
• Progressive, resisted exercise probably helps. Gentle movement without load alone probably does not move pain much [R01].
• Exercise helps middle-aged and older adults. A 2026 review found exercise reduces pain and improves function and range of motion in people with this kind of pain [R04].
• The choice between surgery and exercise is not settled by this research. The evidence varies for each person, so ask your clinician to explain the options for your tear.

1. Get it assessed. A clinician can tell you what is happening and what is safe. Do this before you start a new routine. Seated option: You can book the appointment from a chair, and bring a list of what makes the shoulder better or worse.
2. Move within comfort. Using your other arm to support the sore one, lift it gently in front of you as far as is comfortable. Hold briefly, then lower slowly. Seated option: Do this with your back supported in a chair.
3. Progress gradually, once cleared. If a clinician agrees, add light, resisted movement and increase slowly [R01].
4. Protect the shoulder during heavy tasks. Avoid heavy overhead lifting until you have been checked. Ask for help with snow, luggage or shelves when you need it. Seated option: Keep objects at waist height and within easy reach from a chair.
5. Watch the night. If pain wakes you, try a supportive pillow under the arm and see what changes. Mention persistent night pain to your clinician.