Rotator Cuff Tear Guide From Mountain View Headache and Spine Institute

Rotator cuff tears happen when the tendons in the shoulder are damaged from overuse, an acute event, or age-related changes. This results in pain, reduced strength, and limited shoulder movement, often making everyday tasks more challenging.

Although many people rely on medications for temporary relief, a 2024 study suggests a common link between shoulder injuries and increased opioid use. These drugs may only mask the symptoms without addressing the underlying damage to the tendon. In some situations, relying solely on medication may contribute to the condition’s progression.

Procedures using Regenexx processing utilize interventional orthopedics to enhance the body’s natural repair mechanisms. This approach presents a less invasive option than typical shoulder surgery, which may help manage discomfort and potentially minimize the need for long-term prescription medications.

Understanding The Anatomy Of The Shoulder

The shoulder is one of the body’s most complex and mobile joints, allowing a wide range of motion necessary for daily activities such as lifting, reaching, and pushing.

Key Structures

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: the Humerus (upper arm bone), the Scapula (shoulder blade), and the Clavicle (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 may help 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 may support upper body movement and shoulder stability.
• Muscles and Tendons: The shoulder’s range of motion and strength are supported by surrounding muscles, tendons, and ligaments. These soft tissues may help keep the shoulder joint stable, aligned, and protected from injury. Tendons connect muscles to bones, making them essential for shoulder function and control.

What Is A Torn Rotator Cuff?

The rotator cuff is a group of four muscles and their tendons that stabilize the shoulder’s ball-and-socket joint. These tissues help keep the humerus positioned within the glenoid cavity of the scapula, allowing smooth, coordinated arm movements.

Beyond stabilization, the rotator cuff supports:

• Raising the arm
• Internal and external rotation of the arm
• Shoulder stability during repetitive or dynamic movements

The four primary muscles and tendons of the rotator cuff include:

• Supraspinatus: Located at the top of the shoulder, assists with arm abduction.
• Infraspinatus: Positioned on the back of the shoulder, aids in external rotation.
• Teres Minor: A small muscle beneath the infraspinatus that also contributes to external rotation.
• Subscapularis: Situated at the front of the shoulder, responsible for internal rotation.

Types of Rotator Cuff Tears

Rotator cuff tears occur when the tendons connecting these muscles to the shoulder bones are damaged or weakened. Causes may include repetitive overhead activity, acute injuries, or age-related degeneration. These tears often reduce strength and limit the shoulder’s range of motion.

• Partial-thickness (incomplete) tear: The tendon is damaged but not fully separated from the bone. Only a portion of the tendon thickness is affected, which may cause pain and reduced mobility while preserving some shoulder function.
• Full-thickness (complete) tear: The tendon is completely torn and detached from the bone. This type of tear typically results in significant pain, weakness, and a major loss of shoulder function. Daily tasks may become challenging, and medical or surgical treatment is often required.

Untreated full-thickness tears can lead to long-term complications, including muscle atrophy and progressive shoulder joint degeneration.

Who Is At Risk Of A Torn Rotator Cuff?

While rotator cuff tears can affect anyone, several factors may increase the likelihood of this type of injury:

• Poor posture: Slouching or rounded shoulders increases strain on the shoulder tissues, which may contribute to uneven wear. A 2015 study noted that 56% of individuals with posture-related issues had rotator cuff tears, compared with 2.9% among those with neutral posture.
• Genetic predisposition: Tendon characteristics may run in families. A 2017 review found that about one-third of people with rotator cuff tears also had a family history.
• Age over 40: Tendons naturally lose elasticity and strength over time, increasing susceptibility to tearing.
• Repetitive overhead activity: Occupations or sports that require frequent overhead arm use—such as swimming, baseball, painting, or carpentry—place ongoing stress on the shoulder.

Some research suggests a higher prevalence of rotator cuff injuries in women, possibly linked to flexibility and degenerative changes. In one study involving 1,003 women aged 64 to 87, 22% had rotator cuff tears, with higher rates observed in older age groups and in the dominant shoulder.

Causes of a Torn Rotator Cuff

Rotator cuff tears are typically classified into two main types:

• Acute tears: These occur suddenly, often as a result of trauma such as a fall, a direct impact to the shoulder, or lifting an object that is too heavy.
• Degenerative tears: These develop gradually over time due to wear and tear. Age-related changes or repetitive movements that place stress on the shoulder tendons can weaken them, making them more prone to fraying or tearing.

Repetitive Overhead Motion

Frequent overhead activity—common in sports such as swimming or baseball, or in occupations involving lifting or painting—can strain the rotator cuff over time. This continuous stress, particularly on the dominant arm, may gradually weaken the tendons and increase the risk of injury.

Trauma or Sudden Injury

Acute tears can result from sudden force or overexertion, such as falling or lifting heavy objects. Individuals with pre-existing tendon damage or those engaged in contact sports may be more vulnerable. Symptoms often include sharp, immediate pain and difficulty raising the arm.

Reduced Blood Flow

Aging can decrease circulation to the rotator cuff tendons, limiting the body’s ability to repair minor injuries. Reduced blood supply contributes to tendon degeneration and increases the likelihood of tears, especially in adults over 50.

Signs and Symptoms of a Torn Rotator Cuff

Many rotator cuff tears may not produce noticeable symptoms. When symptoms do occur, they often vary based on tear severity and may worsen over time. Common indicators include:

Pain and Swelling

Pain typically occurs at the front or side of the shoulder and may radiate down the arm toward the elbow. Discomfort often intensifies during lifting, reaching overhead, or lying on the affected side. Compensatory use of surrounding muscles can sometimes cause pain in the neck or upper back.

The type of pain can differ between sudden (acute) tears and gradually developing (degenerative) tears. Swelling may accompany pain due to inflammation and fluid buildup around the shoulder joint.

Muscle Weakness

Damaged rotator cuff tendons cannot fully support shoulder movement, which can reduce strength. This may make lifting, carrying, or performing routine arm tasks difficult.

Limited Range of Motion

Rotator cuff injuries can restrict shoulder mobility. Pain and inflammation may discourage movement, leading to stiffness over time. Activities such as reaching overhead or behind the back can become challenging.

Diagnosis and Evaluation

Evaluating a rotator cuff tear typically involves a combination of methods to determine the severity of the injury and rule out other conditions:

• Medical History: Physicians review past injuries, illnesses, and activity levels to identify contributing factors or predispositions.
• Physical Examination: Strength, range of motion, and pain points are assessed through targeted shoulder movements to locate the tear.
• X-ray: X-rays reveal bone structure and can detect fractures, bone spurs, or other structural issues, although soft tissue damage cannot be seen.
• MRI: MRI scans provide detailed images of tendons and muscles, showing the tear’s location, extent, and any associated inflammation.
• Ultrasound: Ultrasound imaging allows real-time observation of tendon movement, helping identify tears, inflammation, or other soft tissue abnormalities.

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 may help reduce pain, restore shoulder mobility and strength, and prevent additional injury.

Treatment options include:

• Medications: Medications may help manage pain temporarily. However, shoulder conditions like rotator cuff tears are often long-term.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs (NSAIDs) help reduce pain and inflammation in conditions affecting joints, muscles, and the spine. While they provide temporary relief, prolonged use may increase heart, kidney, and gastrointestinal risks, requiring careful management. Read More About 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 may be considered when conservative treatments fail to provide relief or in cases of extensive rotator cuff damage. The aim is to restore shoulder function and reduce ongoing pain. Surgical outcomes can vary based on the patient’s overall health, the severity of the tear, and other individual factors.

Surgical options include:

• Arthroscopic Tendon Repair: Arthroscopic repair is a minimally invasive technique that uses small incisions to insert a camera and specialized instruments to repair the torn tendon. This approach generally allows for faster recovery and less disruption to surrounding tissues compared with open surgery. However, potential risks include infection, stiffness, and incomplete tendon healing.
• Open Tendon Repair: Open tendon repair involves a larger incision to allow direct visualization of the damaged tendon. This method is often chosen for more complex or extensive tears. Recovery may take longer, and there is a higher risk of complications such as infection, increased blood loss, and prolonged shoulder stiffness.
• Shoulder Replacement: In severe cases—such as large rotator cuff tears combined with arthritis—shoulder replacement may be performed. This procedure involves replacing damaged joint components with artificial implants to restore function and reduce pain.

The Regenexx Approach At Mountain View Headache and Spine Institute

In certain cases, rotator cuff tears can be managed by supporting the body’s natural healing abilities. Physicians in the licensed Regenexx network at Mountain View Headache and Spine Institute provide a non-surgical treatment option that utilizes interventional orthobiologics as an alternative to typical methods, such as medication or surgery.

Determining the suitability of this treatment depends on the classification and severity of the rotator cuff tear. The first step is a thorough evaluation by a physician within the licensed Regenexx network in Phoenix, Arizona.

Customized 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 intellectual property involving Bone Marrow Concentrate (BMC), which contains a patient’s own healing agents. Regenexx SD injectate is processed to achieve a significantly higher concentration of cells compared to typical techniques, which may enhance the body’s repair response.

• Regenexx SCP Injectate: This advanced Platelet-Rich Plasma (PRP) treatment involves drawing a small amount of 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 typical PRP methods.

• Regenexx PL Injectate: Derived from PRP, this specialized formulation offers a rapid and enhanced release of growth factors. Regenexx PL injectate is often used alongside other orthobiologics, such as PRP and bone marrow concentrate, to support natural healing.

Supporting Healing with the Regenexx Approach

Physicians in the licensed Regenexx network at Mountain View Headache and Spine Institute in Phoenix, AZ, 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, physicians in the licensed Regenexx network gain a more thorough understanding of the cause of pain, how joint function is impaired, and the underlying source of symptoms.

With this insight, they develop customized treatment plans specific to the patient’s injury. Procedures using Regenexx proprietary lab techniques work to support the body’s natural healing processes. Through the use of interventional orthopedics , this approach offers a non-surgical alternative that may also help reduce the reliance on prescription medications.

What Happens When A Rotator Cuff Tear Is Left Untreated

When rotator cuff tears are left unaddressed, the damage can worsen, potentially leading to chronic discomfort, 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. As the damage progresses, the likelihood of recommended treatment can increase. This may affect activity levels and overall well-being.

Learn how a physician in the licensed Regenexx network at Mountain View Headache and Spine Institute may be able to help treat a rotator cuff tear without the need for surgery.

Regenexx for Rotator Cuff Tears: Patients’ Results

Take a look below at the outcomes of two of our patients who chose to have a Regenexx procedure for rotator cuff tear repair instead of surgery.

Scroll the arrow to the right to see the MRI of the rotator cuff before the treatment and to the left to see the outcome. The BEFORE shows a torn rotator cuff. The arrow points at a gap where the tendon should be. Once treated, the area will look like a dark band going diagonally, as seen on the AFTER.

Frequently Asked Questions About Rotator Cuff Tears

Learn More About Rotator Cuff Tears

• Shoulder Replacement Recovery: Rotator Cuff Damage
• Acromioplasty: Why This Frequent Addition to Rotator Cuff Surgery Is Usually a Bad Idea
• Is Nonsurgical Treatment for Rotator Cuff Tears a Long-Term Solution?
• Can a Torn Rotator Cuff Heal on Its Own Without Surgery?