Rotator Cuff Tear Types, Symptoms & Treatment Options

Understanding Rotator Cuff Tears

The rotator cuff is made up of four muscles and their tendons — the supraspinatus, infraspinatus, teres minor, and subscapularis — that work together to stabilize the shoulder joint and power arm movement. A tear in any one or more of these tendons disrupts that balance, causing pain, weakness, and reduced range of motion. Left untreated, rotator cuff tears can grow larger over time and, in severe cases, progress to rotator cuff arthropathy.

Types of Rotator Cuff Tears

Rotator cuff tears are classified in two key ways: by depth and by cause.

By depth:

• Partial-thickness tears involve damage to part of the tendon without a complete separation; these are often managed conservatively, though larger partial tears may require surgery
• Full-thickness tears involve a complete rupture of the tendon from its attachment; these are more likely to require surgical repair, particularly in active patients

By cause:

• Acute tears result from a sudden injury such as a fall on an outstretched arm, a direct blow to the shoulder, or a forceful lifting or pulling movement
• Degenerative tears develop gradually over time due to repetitive stress, reduced blood supply to the tendon, and age-related tendon weakening; these are the most common type and are frequently seen in patients over 40

Rotator Cuff Tear Symptoms

Common rotator cuff tear symptoms include:

• A dull ache deep in the shoulder, often worse at night
• Pain that intensifies with overhead activity, reaching behind the back, or lifting
• Weakness in the shoulder and arm, particularly when lifting or rotating
• A crackling or grinding sensation during shoulder movement
• Difficulty with everyday tasks such as combing hair, reaching overhead, or carrying objects
• In acute tears, sudden sharp pain and immediate weakness at the time of injury

Because these symptoms can overlap with other shoulder conditions such as shoulder bursitis and tendinitis and biceps tendinitis, an accurate diagnosis from an experienced rotator cuff surgeon is essential before beginning treatment.

Rotator Cuff Tear Treatment Options

Treatment is determined by the size and type of the tear, the patient's age and activity level, and how long the injury has been present.

Conservative treatment is appropriate for many partial tears and may include:

• Anti-inflammatory medications to manage rotator cuff tear pain and swelling
• Corticosteroid injections for targeted relief that supports participation in physical therapy
• Physical therapy to strengthen the muscles surrounding the shoulder, improve mechanics, and compensate for the damaged tendon
• Activity modification to reduce ongoing stress on the injured tissue
• Platelet-rich plasma (PRP) therapy as a supportive orthobiologic option to promote tendon healing and reduce inflammation

Surgical treatment is recommended when conservative care has not provided adequate relief, when the tear is large or complete, when there is significant weakness compromising daily function, or when an acute tear occurs in an otherwise healthy, active patient. Dr. Duany performs arthroscopic rotator cuff repair, which allows her to reattach the torn tendon to the bone through small incisions. Key advantages of the arthroscopic approach include:

• Minimal disruption to surrounding tissue
• Reduced post-operative pain compared to open surgery
• Lower risk of infection and complication
• A more efficient recovery with a faster return to activity

For patients with a medium- to large rotator cuff tear involving significant tendon loss or retraction, a graft augmentation procedure using the Zuri patch may be considered to reinforce the repair and improve outcomes, sometimes decreasing the sling wear. The patch adds mechanical strength on day one. Dr. Duany will evaluate the extent of your tear and determine whether augmentation is appropriate for your case.