Medically Reviewed By:

Dr. Chaz Fausel, MD

Dr. Chaz Fausel is a Denver-based interventional orthopedics specialist and Regenexx educator, trained at Emory and the Centeno-Schultz Clinic.

Rotator cuff tears occur when shoulder tendons become damaged from overuse, acute injury, or age-related changes. These tears often result in pain, reduced strength, and difficulty with common movements like lifting or reaching.

While many individuals turn to medications for symptom relief, a 2024 study shows that shoulder injuries are frequently linked to increased opioid use. However, medication may only mask symptoms without addressing the underlying tendon damage and, in some cases, may contribute to the progression of the condition, ultimately increasing the likelihood of surgery.

At Active Life Physical Medicine & Pain Center in Phoenix, AZ, physicians in the licensed Regenexx network provide procedures using Regenexx injectates that utilize interventional orthobiologics to support the body’s natural healing response. These procedures offer a less invasive alternative to traditional shoulder surgery and may help reduce pain and limit long-term reliance on medications.

Understanding The Anatomy Of The Shoulder

The shoulder is a complex joint system that supports a wide range of arm movements necessary for daily tasks.

The shoulder is a highly flexible joint system composed of bones, joints, muscles, and connective tissues that work together to support a wide range of movement.

Bones:

Three major bones form the shoulder:

• Humerus – the bone of the upper arm
• Scapula – also known as the shoulder blade
• Clavicle – commonly referred to as the collarbone

Joints:

The shoulder includes four joints that enable its wide range of motion:

• Glenohumeral Joint – This ball-and-socket joint connects the humerus and scapula, allowing movements like arm rotation and overhead reaching.
• Acromioclavicular (AC) Joint – This joint links the clavicle with the scapula and helps stabilize the shoulder during movement.
• Scapulothoracic Joint – Located where the scapula glides over the rib cage, this joint plays a vital role in shoulder elevation and smooth motion.
• Sternoclavicular Joint – The connection between the clavicle and sternum supports upper body movement and shoulder stability.

Muscles and Tendons:

Tendons connect muscles to bones, helping stabilize the shoulder and facilitate motion. The shoulder’s flexibility depends on coordinated activity across these soft tissues.

What Is A Torn Rotator Cuff? 

The rotator cuff consists of four muscles and their tendons, working together to stabilize the shoulder’s ball-and-socket joint and enable controlled motion:

The rotator cuff is made up of four essential muscles and their tendons:

• Supraspinatus: Positioned at the top of the shoulder, it assists in raising the arm sideways (abduction).
• Infraspinatus: Located on the back of the shoulder, it plays a role in rotating the arm outward.
• Teres Minor: A small muscle beneath the infraspinatus that also contributes to external rotation of the arm.
• Subscapularis: Found on the front side of the shoulder, this muscle is responsible for rotating the arm inward.

Types of Rotator Cuff Tears

Rotator cuff tears occur when the tendons linking these muscles to the shoulder bones become damaged or worn down. This can be due to repetitive use, trauma, or aging, and it typically leads to reduced shoulder movement and strength.

Rotator cuff tears are classified based on the degree of tendon damage:

• Partial-thickness (incomplete) tear: This occurs when the tendon is partially torn but not completely severed. Only part of the tendon’s thickness is affected, and it remains attached to the bone. Individuals may experience pain and reduced shoulder mobility, although some normal function is still preserved.
  
• Full-thickness (complete) tear: The tendon is fully detached from the bone, typically causing significant pain and loss of mobility

Untreated full-thickness tears may lead to muscle atrophy and joint degeneration.

Who Is At Risk Of A Torn Rotator Cuff?

While rotator cuff tears can affect anyone, several risk factors increase the chances of developing one:

• Poor posture: Slouching or maintaining rounded shoulders places additional stress on the rotator cuff, potentially leading to muscle imbalances and uneven joint wear. According to a 2015 study, about 56% of individuals with poor posture experienced rotator cuff tears, compared to just 2.9% among those with proper posture.
  
• Genetic predisposition: A family history of rotator cuff injuries may indicate a genetic tendency toward tendon weakness or degeneration. A 2017 systematic review found that roughly one-third of patients with rotator cuff tears had relatives with a similar history.
  
• Age over 40: As people age, shoulder tendons naturally lose strength and flexibility, making them more prone to tearing.
  
• Repetitive overhead activity: Athletes and workers who frequently use their arms in overhead motions, such as swimmers, baseball players, painters, or carpenters, are at higher risk due to ongoing strain.
  

Women may face a higher likelihood of rotator cuff injuries than men, possibly due to greater joint flexibility and a higher incidence of osteoarthritis. In a study of 1,003 women aged 64 to 87, 22% were found to have rotator cuff tears, with rates rising with age and more often affecting the dominant shoulder.

Rotator cuff tears are generally classified into two main types:

• Acute tears: Caused by sudden trauma, such as lifting something heavy or falling.
• Degenerative tears: These occur gradually over time as a result of ongoing wear and tear. They’re commonly associated with aging or repetitive motions that gradually weaken and fray the tendons.

Common Causes of Rotator Cuff Tears:

Repetitive overhead motion

Activities involving frequent overhead arm use, such as in sports like swimming or baseball, or jobs like painting, can place repeated stress on the shoulder. Over time, this strain can wear down the rotator cuff, especially in the dominant arm, leading to injury.

Trauma or sudden injury

An acute tear can result from sudden impact or overexertion, such as a fall or lifting a heavy object. These injuries are more common in individuals with existing tendon damage or those who participate in contact sports. Symptoms often include sudden, sharp pain and difficulty raising the arm.

Reduced blood flow

With age, the blood circulation to the rotator cuff tendons diminishes, reducing the body’s natural ability to heal minor damage. This decline in blood supply contributes to tendon degeneration and increases the likelihood of tears, particularly in individuals over 50.

Signs And Symptoms Of A Torn Rotator Cuff

A 2021 study suggests that around half of rotator cuff tears are asymptomatic. However, when symptoms are present, they can differ based on the extent of the damage and often worsen over time. Common symptoms include:

Pain And Swelling

Rotator cuff tear pain is most commonly felt at the front and side of the shoulder and may radiate down the arm toward the elbow. Discomfort often intensifies with certain actions like lifting, reaching overhead, or lying on the injured side.

In some cases, pain may also extend into the neck or upper back, especially when nearby muscles overcompensate for the shoulder’s reduced stability.

The nature and severity of the pain can differ depending on whether the tear is sudden (acute) or develops over time (degenerative). Swelling often accompanies the pain, caused by inflammation and fluid buildup around the shoulder joint.

Muscle Weakness

When the rotator cuff tendons are torn, they can no longer adequately support shoulder movement, resulting in decreased strength. This weakness may make it difficult to lift or carry objects and can impair daily arm function.

Limited Range Of Motion

Rotator cuff injuries often lead to reduced shoulder mobility. Inflammation and discomfort discourage movement, and over time, stiffness can set in. This can make actions like reaching overhead or behind the back more challenging or even impossible.

Diagnosis And Evaluation Procedure

A physician may use several tools to identify rotator cuff tears and rule out other conditions. These include:

• Medical history inquiry. A physician may assess past injuries, illnesses, and activity levels to determine the cause of shoulder pain. This information is crucial in identifying patterns, genetic factors, or pre-existing conditions that might contribute to a tear.
• Physical examination. Physical exams involve assessing shoulder strength and range of motion. Doctors check for pain points and perform specific movements to locate the tear. 
• X-ray. X-rays provide images of hard tissues like bones. They can detect bone spurs or other issues affecting the rotator cuff. Although X-rays can’t show soft-tissue damage directly, they may help rule out fractures and other bone problems.
• MRI. MRI scans offer detailed images of soft tissues, including muscles and tendons. They can show the extent of the rotator cuff tear, its location, and any associated inflammation or damage.
• Ultrasound. Physicians may use ultrasound to create real-time images of the shoulder’s soft tissues. This tool can help assess tendon movement to identify tears, inflammation, and other issues.

Conventional Treatment Options Available

Treatment for rotator cuff tears varies based on the extent of the injury. Mild tears can often be managed with home-based care, whereas more severe cases may need advanced medical intervention. The primary objectives are to reduce pain, restore shoulder mobility and strength, and prevent additional injury.

Common treatments include:

• Medications: Medications may help manage pain temporarily. However, shoulder conditions like rotator cuff tears are often long-term. One study reports that over 40% of patients visiting a physician with shoulder pain were still experiencing symptoms 12 months later. Relying on medications for such extended periods can lead to severe side effects and let the underlying cause of pain go untreated. As damage to the rotator cuff and shoulder components progresses, the risk of requiring surgery increases. 

• Non-Steroidal and Inflammatory Drugs (NSAIDs): NSAIDs are commonly used to reduce inflammation and manage pain related to joint, muscle, or spine conditions, helping improve function. While they provide quick relief, NSAIDs do not treat the underlying issue causing the pain. Long-term use may lead to serious side effects, including heart and kidney issues. Read More About Non-Steroidal and Inflammatory Drugs (NSAIDs).

• Physical Therapy: Physical therapy involves exercises that strengthen shoulder muscles and improve flexibility. Therapists often use techniques like ultrasound or electrical stimulation to enhance treatment. This approach supports joint stability and function but requires consistent efforts over time. 

• Steroid injections:Steroid injections reduce inflammation and provide temporary pain relief for joint, muscle, and spine conditions. While they may help manage symptoms, repeated use can contribute to tissue damage, joint degeneration, and systemic side effects, requiring careful consideration. Read More About Steroid Injections.

• Surgery: Surgery is sometimes considered when non-invasive treatments fail to relieve symptoms or in cases of severe rotator cuff tears. The goal is to restore shoulder function and alleviate persistent pain. However, surgical procedures carry risks, and the results may vary depending on the patient’s condition. The 2021 study also found that even patients with full-thickness rotator cuff tears can achieve and maintain improved shoulder function and reduced pain without surgery. 
  • Arthroscopic Tendon Repair: This minimally invasive procedure uses small incisions to insert a tiny camera and specialized instruments to repair the torn tendon. Arthroscopic surgery generally results in quicker recovery and less tissue damage compared to traditional surgery. However, it is not without risks, such as infection, shoulder stiffness, and the possibility of incomplete tendon healing.
  • Open Tendon Repair: In this approach, a larger incision is made to directly visualize and repair the torn tendon. While it allows for more complex and extensive repairs, it typically involves a longer recovery time. Potential complications include a greater risk of infection, blood loss, and prolonged joint stiffness. Despite its effectiveness, a 2021 study reported re-tear rates ranging from 13.1% to 79%, influenced by factors like patient age, tear severity, and the quality of post-surgical rehabilitation.
  • Shoulder Replacement: This procedure replaces damaged parts of the shoulder with artificial implants and is typically reserved for severe cases involving large rotator cuff tears and coexisting arthritis. It is considered a major surgery and comes with risks such as infection, implant-related problems, and the need for extended rehabilitation. It is generally recommended when there is significant pain, loss of function, or disability that has not responded to other treatments.

Regenexx Non-surgical Treatment For Rotator Cuff Tears

At Active Life Physical Medicine & Pain Center, physicians in the licensed Regenexx network offer an evaluation to determine whether your tear may benefit from procedures using Regenexx injectates. These image-guided procedures aim to support the body’s repair mechanisms and may help reduce pain and restore function.

Personalized Treatment Plans Using Regenexx Orthobiologics

Each patient receives a customized plan that may include one or more of the following regenerative procedures:

Regenexx SD Injectate

This procedure uses a patented protocol involving Bone Marrow Concentrate (BMC), which contains your mesenchymal stem cells. Regenexx SD injectate is processed to achieve up to 20 times the stem cell concentration compared to standard techniques, enhancing the body’s repair response.

Regenexx SCP Injectate

This advanced platelet-rich plasma (PRP) treatment involves drawing a small amount of your blood, isolating the platelets and growth factors, and precisely injecting them into the shoulder using imaging guidance. The SCP injectate delivers a significantly higher concentration of growth factors than conventional PRP methods.

Regenexx PL Injectate

Derived from PRP, this specialized formulation offers a faster and more potent release of growth factors. Regenexx PL injectate is often used alongside other orthobiologics, such as PRP and bone marrow concentrate, to enhance healing.

The Benefits Of The Regenexx Approach At Active Life

At Active Life Physical Medicine & Pain Center Phoenix, AZ, physicians in the licensed Regenexx® network use the advanced SANS evaluation method to assess the body in motion, focusing on the shoulder, neck, and surrounding nerves. This comprehensive assessment includes a review of existing imaging (MRI and/or X-rays) and frequently incorporates real-time ultrasound to visualize joint function and tissue health.

By combining these diagnostic tools, Regenexx physicians gain a more detailed understanding of what’s driving the patient’s symptoms, how joint function is impaired, and the underlying source of pain.

With this insight, they develop personalized treatment plans tailored to the patient’s specific injury. Regenexx procedures, using proprietary lab techniques, work to stimulate the body’s natural healing processes. Through the use of interventional orthobiologics, this approach offers a non-surgical alternative that may also reduce the reliance on prescription medications like opioids.

What Happens When A Rotator Cuff Tear Is Left Untreated

When rotator cuff tears are left untreated, they can lead to serious complications, such as chronic pain, joint deterioration, reduced range of motion, loss of strength, and decreased overall function. Over time, untreated tears may contribute to arthritis or other degenerative joint conditions, and the likelihood of requiring surgery increases as the damage progresses.

Learn how a physician at Active Life Physical Medicine & Pain Center in Phoenix, AZ, licensed to provide Regenexx procedures, may help address your rotator cuff tear without surgery.

Doctors

Wendi Lundquist, DO, FAAPMR

Active Life Physical Medicine & Pain Center

As the medical director and founder of Active Life Physical Medicine and Pain Center, Innovative Surgery Center, and Regena Spa, Dr. Lundquist has great enthusiasm toward regenerative medicines and a special interest in sports medicine and pain. She loves her work and feels blessed to be entrusted to help patients by alleviating painful ailments.

Her desire is to uncover methods that are more healing and less of a “band aid,” which has led her to become a leader in regenerative medicine technologies. She feels strongly about the importance of seeking methods to help alleviate pain on every level – holistically.

Originally a massage therapist and, later, an osteopath, she has a strong foundation to alleviate patient’s pain. She is a “hands on” physician who implements osteopathic techniques when appropriate with other tools.

She is dual board certified in physical medicine and rehabilitation along with pain management, as well as a diplomat with the American Board of Pain Medicine.

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Areas treated: Cervical Spine (Not Upper Cervical or CCI)*, Elbow, Foot & Ankle, Hand & Wrist, Hip, Knee, Lumbar Spine, Shoulder, Thoracic Spine

Website

activelifepaincenter.com

Areas Treated

Cervical Spine (Not Upper Cervical or CCI)*, Elbow, Foot & Ankle, Hand & Wrist, Hip, Knee, Lumbar Spine, Shoulder, Thoracic Spine

^*This provider is NOT authorized by Regenexx to treat the C0-C1 or C1-C2 levels of the neck or CCI (craniocervical instability).

Medically Reviewed By:

Dr. Chaz Fausel, MD

Dr. Chaz Fausel is a Denver-based interventional orthopedics specialist and Regenexx educator, trained at Emory and the Centeno-Schultz Clinic.