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 functions through an interconnected system of bones, joints, muscles, and soft tissues that support stability and flexibility.

• Bones: The shoulder is formed by three primary bones—the humerus (upper arm), scapula (shoulder blade), and clavicle (collarbone).
• Joints: Four joints contribute to the shoulder’s wide mobility:
  • Glenohumeral Joint: A ball-and-socket connection between the humerus and scapula that enables rotation and overhead movement.
  • Acromioclavicular (AC) Joint: The junction of the clavicle and scapula that may assist with structural support during motion.
  • Scapulothoracic Joint: The surface where the scapula moves along the rib cage, allowing elevation and smooth shoulder motion.
  • Sternoclavicular Joint: The articulation between the clavicle and sternum that plays a role in upper body movement and overall shoulder stability.
• Muscles and Tendons: These tissues surround the shoulder to help maintain alignment, provide strength, and enable a wide range of controlled motion. Tendons attach muscles to bone, making them essential for coordinated shoulder activity.

What Is A Torn Rotator Cuff?

The rotator cuff consists of four muscles and their tendons that help stabilize the shoulder’s ball-and-socket joint. This soft-tissue group keeps the humerus centered within the glenoid cavity of the scapula to support smooth, controlled arm movement.

In addition to providing stability, the rotator cuff plays a central role in:

• Lifting the arm
• Rotating the arm inward and outward
• Maintaining shoulder control during repetitive or dynamic motion

The four rotator cuff muscles and their tendons include:

• Supraspinatus: Positioned at the top of the shoulder and helps raise the arm outward.
• Infraspinatus: Located at the back of the shoulder and assists with external rotation.
• Teres Minor: A small muscle beneath the infraspinatus that also supports outward rotation.
• Subscapularis: Found at the front of the shoulder and responsible for inward rotation.

Types of Rotator Cuff Tears

Rotator cuff tears occur when the tendons attaching these muscles to bone become weakened or damaged. This may develop due to aging, repetitive movement, or sudden injury and can affect shoulder motion and strength.

These injuries are generally grouped into:

• Partial-thickness (incomplete) tear: Only a portion of the tendon is damaged, and the tendon stays attached to the bone. Individuals may notice discomfort and limited mobility, while some function remains intact.
• Full-thickness (complete) tear: The tendon is fully torn, separating it from its attachment. This often results in marked pain, weakness, and reduced shoulder function, sometimes requiring medical or surgical management.

If untreated, full-thickness tears may contribute to long-term changes such as muscle atrophy and joint degeneration.

Who Is At Risk Of A Torn Rotator Cuff?

Although rotator cuff injuries can occur in anyone, some factors may increase the likelihood of developing them:

• 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 generally categorized into:

• Acute tears: These occur suddenly from events such as falling, direct impact, or lifting something too heavy.
• Degenerative tears: These develop slowly due to age-related changes or repetitive strain that gradually wears down the tendon.

Repetitive Overhead Motion

Regular overhead activity in sports or work settings places ongoing pressure on the rotator cuff, especially in the dominant arm, which may gradually weaken the tendons.

Trauma or Sudden Injury

A tear may result from a sudden incident such as a fall or forceful lifting. These injuries may be more likely when underlying tendon changes are already present and may produce sharp pain and difficulty lifting the arm.

Reduced Blood Flow

Blood supply to rotator cuff tendons decreases with age, limiting the ability to repair small injuries. This reduced circulation may contribute to tendon degeneration and a higher risk of tearing, especially in individuals over 50.

Signs and Symptoms of a Torn Rotator Cuff

A 2021 study indicated that up to half of rotator cuff tears do not cause noticeable symptoms. When symptoms do occur, they vary depending on the severity and may become more noticeable over time. Common symptoms include:

Pain and Swelling

Pain is often felt at the front or side of the shoulder and may extend down the arm. Movements such as lifting, reaching overhead, or lying on the affected side may increase discomfort.

Some individuals may also feel pain in the neck or upper back when surrounding muscles compensate for reduced shoulder stability. Pain may differ between sudden and degenerative tears, and swelling may appear as inflammation and fluid build up around the joint.

Muscle Weakness

Tears reduce the tendons’ ability to support shoulder movement, which may cause noticeable weakness when lifting or carrying objects.

Limited Range of Motion

Reduced mobility may occur due to pain, inflammation, or stiffness. Tasks such as reaching upward or behind the body may become difficult or restricted.

Diagnosis and Evaluation

A physician may combine several methods to assess a suspected rotator cuff tear:

• Medical history: Reviewing past injuries, activity levels, and symptoms helps identify contributing factors.
• Physical examination: Shoulder strength, motion, and pain points are evaluated using specific maneuvers.
• X-ray: While X-rays do not show tendons directly, they can reveal bone-related issues such as spurs or fractures.
• MRI: MRI imaging provides detailed views of soft tissues and can show the tear’s location and severity.
• Ultrasound: Ultrasound allows real-time visualization of tendon movement and may help detect tears or inflammation.

Conventional Treatment Options Available

Treatment varies according to the severity of the tear. Mild cases may respond to conservative care, while more advanced tears might require additional intervention. The primary goals are to help manage discomfort, improve mobility and strength, and reduce the risk of further injury.

Treatment options include:

• Medications: These may offer temporary relief but do not address long-term tendon changes.
• 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: Structured exercises may help strengthen supporting muscles and improve flexibility. Therapists may also use tools such as electrical stimulation or ultrasound to support progress.
• 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: When conservative options do not improve symptoms or in cases of significant tears, surgery may be considered. Common procedures include:
  • Arthroscopic Tendon Repair: A minimally invasive technique using small incisions and instruments to repair the tendon, typically associated with quicker recovery but still involving potential risks.
  • Open Tendon Repair: A larger incision allows direct access to the tendon and may be used for extensive repairs, though recovery time is generally longer.
  • Shoulder Replacement: Usually reserved for severe cases involving major tendon damage combined with arthritis, this procedure replaces damaged structures with artificial components.

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?