Rotator Cuff Tears Explained: What You Need to Know

Rehabilitation Medicine Center of New Jersey often sees individuals with rotator cuff tears, a condition that occurs when shoulder tendons are affected by overuse, injury, or age-related degeneration. This can result in shoulder pain, weakness, and limited range of motion—often interfering with everyday tasks like lifting or reaching.

While many people turn to medication for symptom relief, a 2024 study notes a connection between shoulder injuries and increased opioid use. However, medications may only manage symptoms without addressing the underlying tissue damage, and over time, reliance on them may increase the likelihood of surgical intervention.

Procedures using Regenexx lab processes for rotator cuff tears apply interventional orthobiologics to help support the body’s natural healing response. This approach provides a less invasive alternative to shoulder surgery and may reduce the need for long-term prescription medication use.

Understanding The Anatomy Of The Shoulder

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

Key Structures of the Shoulder

The shoulder is made up of several interconnected components that allow for a wide range of motion while maintaining joint stability:

• Bones: The shoulder is supported by three primary bones:
  • Humerus: the upper arm bone
  • Scapula: the shoulder blade
  • Clavicle: the collarbone
• Joints: There are two main joints in the shoulder:
  • Glenohumeral joint: Connects the humerus to the scapula. This joint forms the ball-and-socket structure, enabling movements such as lifting and rotating the arm.
  • Acromioclavicular (AC) joint: Connects the clavicle to the scapula and helps stabilize the shoulder during arm motion.
  • Scapulothoracic articulation: This functional joint allows the shoulder blade to glide over the rib cage, supporting smooth shoulder elevation and coordinated movement.
• Muscles, Ligaments, and Tendons: The shoulder’s movement and stability rely on a network of muscles supported by ligaments and tendons. These soft tissues help maintain joint alignment and reduce the risk of injuries such as dislocations by enabling controlled, stable movement.

What Is A Torn Rotator Cuff? 

The rotator cuff is made up of four muscles and their associated tendons that work together to support the shoulder’s ball-and-socket joint. These structures help keep the upper arm bone (humerus) properly positioned within the glenoid cavity of the scapula, allowing for smooth and controlled arm movement.

Beyond stabilizing the joint, the rotator cuff plays an important role in:

• Assisting with arm elevation
• Enabling both internal and external arm rotation
• Supporting joint stability during active, repetitive motion

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

• Supraspinatus: Located on the top of the shoulder, this muscle plays a key role in lifting the arm out to the side (abduction).
• Infraspinatus: Found on the back of the shoulder, it supports the external rotation of the arm.
• Teres minor: A smaller muscle situated beneath the infraspinatus, also involved in rotating the arm outward.
• Subscapularis: Positioned at the front of the shoulder, this muscle is responsible for turning the arm inward (internal rotation).

Types Of Tears In The Rotator Cuff

Rotator cuff tears occur when the tendons that anchor the shoulder muscles to the bone become damaged or begin to wear down. These injuries may result from repetitive motion, acute trauma, or natural degeneration over time, leading to reduced shoulder function and limited range of motion.

Rotator cuff tears are identified by how much of the tendon is damaged:

• Partial-thickness (incomplete) tear: This type of tear affects only part of the tendon’s depth. Although the tendon is still attached, the damaged area may lead to pain and reduced range of motion. Some shoulder function typically remains intact.
• Full-thickness (complete) tear: A full-thickness tear involves a complete separation of the tendon from the bone. This often results in more pronounced pain, weakness, and difficulty using the shoulder for normal movements. Medical evaluation is often necessary to determine the most appropriate care.

If not addressed, full-thickness tears may result in progressive issues such as muscle wasting and degenerative joint changes over time.

Who Is At Risk Of A Torn Rotator Cuff?

Rotator cuff tears can affect anyone, but certain factors may raise the likelihood of developing one:

• Poor posture: Rounded shoulders or slouching can place added strain on the rotator cuff. Over time, this may result in muscle imbalances and uneven joint wear. A 2015 study showed that rotator cuff tears occurred in about 56% of individuals with poor posture, compared to 2.9% in those with proper alignment.
• Family history: Some individuals may inherit a predisposition to tendon weakness or degeneration, making them more likely to develop a rotator cuff tear. According to a 2017 systematic review, roughly one-third of patients with rotator cuff tears reported a family history of the condition.
• People aged 40 or older: As the body ages, shoulder tendons naturally lose strength and flexibility, increasing the chance of tears.
• Athletes or workers with repetitive shoulder movements: Individuals in roles or sports that involve repeated overhead motion, such as swimmers, baseball players, painters, or carpenters, face greater risk due to continuous strain on the shoulder joint.

Rotator cuff injuries may also occur more frequently in women than men, potentially due to greater joint mobility and a higher likelihood of osteoarthritis. In a study of 1,003 women aged 64–87, 22% had rotator cuff tears, with rates increasing with age and most commonly affecting the dominant arm.

Causes Of A Torn Rotator Cuff

There are two types of rotator cuff tears:

• Acute tears: These happen suddenly and are typically caused by a specific incident, such as a fall, a strong impact, or lifting an object that is too heavy.
• Degenerative tears: These form gradually over time, often due to age-related changes or repeated use of the shoulder that leads to tendon weakening and fraying.

Common causes for rotator cuff tears include:

Repetitive Overhead Activities

Activities that involve frequent overhead motion, like swimming, baseball, or painting, can place continuous stress on the rotator cuff. Over time, this repetitive strain may lead to tendon breakdown, particularly in the dominant arm.

Trauma And Injury

An acute tear may result from a sudden injury, such as a fall or lifting something heavy. This is more likely to occur in individuals who already have weakened tendons or participate in contact sports. The result may include sharp pain and limited ability to raise the arm.

Lack Of Blood Supply

As people grow older, blood flow to the rotator cuff tendons tends to decline. This reduced circulation limits the body’s ability to heal small tendon damage, which can lead to gradual weakening and increase the chance of degenerative tears, especially in those over age 50.

Signs And Symptoms Of A Torn Rotator Cuff

A 2021 study shows that nearly 50% of rotator cuff tears do not cause noticeable symptoms. However, when symptoms are present, they often depend on how severe the tear is and may worsen gradually. These can include:

Pain And Swelling

Pain is commonly felt in the front and side of the shoulder and may travel down toward the elbow. Discomfort often increases during certain movements, such as lifting, reaching overhead, or lying on the affected side

In some cases, the discomfort may also reach the neck or upper back, especially when nearby muscles compensate for weakened shoulder function.

The severity and location of pain can vary based on whether the tear is traumatic or age-related. Inflammation in the joint may also cause swelling and fluid buildup, which contributes to shoulder stiffness and tenderness.

Muscle Weakness

Damage to the rotator cuff tendons can reduce shoulder muscle support, resulting in decreased strength. This may make it harder to lift or carry objects and affect everyday arm function.

Limited Range Of Motion

Rotator cuff injuries can lead to a reduced ability to move the shoulder freely. Pain and swelling may limit certain motions, and over time, continued restriction can make it more difficult to perform activities like reaching overhead or behind the back.

Diagnosis And Evaluation Procedure

A physician may use a variety of methods to evaluate a rotator cuff tear and eliminate other possible causes of shoulder pain. These may include:

• Medical history inquiry. To understand the source of discomfort, the physician may review past injuries, medical conditions, and physical activities. This background helps identify contributing factors such as genetics, previous trauma, or repetitive use that may be linked to tendon damage.
• Physical examination. A hands-on assessment may be performed to evaluate shoulder mobility and muscle strength. The physician will identify areas of tenderness and guide the shoulder through specific motions to pinpoint potential signs of a tear.
• X-ray.  X-rays capture images of bones and may reveal structural concerns such as bone spurs. Although they do not show tendons or muscles directly, they can help rule out fractures or other bone-related causes of shoulder pain.
• MRI. Magnetic resonance imaging (MRI) provides detailed views of soft tissues, including the tendons and muscles in the shoulder. This imaging can show the location and size of a tear, along with any surrounding inflammation or tissue changes.
• Ultrasound. Ultrasound technology allows physicians to view real-time images of the soft tissues around the shoulder. It is useful in evaluating tendon motion, detecting tears, and identifying inflammation or other abnormalities.

Conventional Treatment Options Available

The approach to treating a rotator cuff tear depends on how severe the injury is. For minor tears, self-care at home may be effective, while more advanced cases might require medical intervention. The main goals are to relieve pain, enhance shoulder function, and prevent the condition from worsening.

Typical treatment options include:

• Medications: Medications may provide temporary relief from shoulder pain, but rotator cuff tears are often chronic in nature. Research has shown that more than 40% of individuals who sought care for shoulder pain continued to experience symptoms a year later. Prolonged reliance on pain medications can lead to significant side effects and may delay addressing the root cause of the problem. As shoulder tissue damage progresses, the likelihood of requiring surgical intervention may increase.
• 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 focuses on targeted exercises that build strength in the shoulder and improve mobility. Treatment may also include techniques like ultrasound or electrical stimulation to support recovery. While this method promotes joint stability and improved function, it typically requires consistent participation 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: Surgical procedures may be considered if non-invasive treatments are unsuccessful or when the rotator cuff tear is severe. Surgery aims to restore function and reduce ongoing pain, but it carries inherent risks, and outcomes can vary based on individual factors. A 2021 study also found that even individuals with full-thickness rotator cuff tears may achieve significant improvements in pain and function without undergoing surgery.
  • Arthroscopic Tendon Repair: This procedure uses small incisions to insert a camera and surgical tools to access and repair the torn tendon. Compared to traditional surgical approaches, it is less invasive and often allows for a shorter recovery period. However, it still carries risks such as infection, joint stiffness, or incomplete healing.
  • Open Tendon Repair: In this procedure, a larger incision is made to directly access the damaged tendon for repair. While it allows for more complex reconstructions, it also involves a longer recovery time and carries higher risks, including infection, greater blood loss, and ongoing shoulder stiffness. A 2021 study reported re-tear rates ranging from 13.1% to 79%, depending on factors like age, tear severity, and post-operative care.
  • Shoulder Replacement: Shoulder replacement surgery involves removing and replacing damaged joint components with artificial implants. This option is typically reserved for individuals with severe rotator cuff damage, advanced arthritis, or significant loss of joint function. It is a major procedure that comes with potential risks, including infection, implant complications, and the need for extended rehabilitation.

Rehab Medicine Center Offers Non-Surgical Shoulder Treatment

Rehabilitation Medicine Center of New Jersey, NY, provides access to procedures using the Regenexx approach, which may help support the body’s natural healing response for certain rotator cuff tears. This non-surgical option utilizes interventional orthobiologics as an alternative to more conventional approaches like medication or surgery.

The type and severity of the tear help the physician determine whether this approach may be appropriate. An evaluation by a physician in the licensed Regenexx network is the first step in making that determination.

Based on the findings, your physician may recommend a customized treatment plan that could include one or more of the Regenexx orthobiologic procedures listed below.

Regenexx SD Injectate
Procedures that use Regenexx SD injectate follow a patented protocol involving bone marrow concentrate (BMC), which contains the individual’s own mesenchymal stem cells. The Regenexx lab process consistently yields a BMC concentration up to 20 times higher than what is typically achieved through non-Regenexx methods.

Regenexx SCP Injectate
Regenexx SCP injectate is a highly refined form of platelet-rich plasma (PRP). Blood is collected and processed to separate platelets and growth factors, which are then further purified and concentrated. These growth factors are reintroduced into the shoulder area using image-guided injection techniques to support precision. Regenexx SCP delivers a higher concentration of growth factors compared to standard PRP procedures.

Regenexx PL Injectate
Regenexx PL injectate is a specialized formulation derived from platelet-rich plasma, designed to release growth factors more rapidly and in greater concentration than conventional PRP. This injectate is often used in combination with other Regenexx orthobiologics, such as PRP and bone marrow concentrate, to enhance overall treatment outcomes.

The Benefits Of The Regenexx Approach

Using the industry-leading SANS evaluation method, physicians at Rehabilitation Medicine Center of New Jersey can assess the body in motion, including the shoulder, neck, and surrounding nerves, and review existing imaging such as MRI or X-ray. Ultrasound is also commonly used to observe the joint in real time.

Together, these tools allow physicians at the Rehabilitation Medicine Center of New Jersey to gain a clearer understanding of what is contributing to symptoms, how movement is affected, and the likely source of pain.

This insight helps inform personalized treatment plans based on the individual’s specific injury. Procedures using Regenexx lab processes aim to support the body’s natural healing response. With the use of interventional orthobiologics, the Regenexx approach may offer an alternative to surgery and reduce reliance on prescription medications, including opioids.

What Happens When A Rotator Cuff Tear Is Left Untreated

When rotator cuff tears are not addressed, they may result in long-term complications such as ongoing pain, reduced mobility, joint damage, loss of function, and muscle weakness. Over time, untreated tears can contribute to the development of arthritis or other joint-related conditions, and the likelihood of needing surgery may increase as the damage progresses.

Learn how a physician at the Rehabilitation Medicine Center of New Jersey, NY, may be able to help manage your rotator cuff tear using non-surgical options.

Regenexx’s outpatient procedures use custom concentrations of your body’s natural healing agents to treat rotator cuff tears without surgery. Treatments use only your own blood to make super-concentrated platelet-rich plasma (PRP) or your own bone marrow concentrate (BMC), which contains stem cells.

Downtime is a fraction of what it is with surgery and generally requires little or no need for opioid pain medications or time off of work.

Regenexx Alternative to Shoulder Surgery

Can A Rotator Cuff Heal Without Surgery?

In many cases, the answer is yes.

Physical therapy can promote improved blood supply and strengthen the muscles of the rotator cuff. A 2014 study determined that, upon one year of follow-up, physical therapy was equally effective to rotator cuff surgery in terms of regaining physical strength and range of motion in study participants (55 years of age or older).

Regenexx procedures can be a better alternative for people looking to avoid surgery, lengthy recovery, and overuse of prescription pain medication.

How Long Does It Take For A Torn Rotator Cuff To Heal Without Surgery?

Patients treated without surgery with Regenexx procedures usually return to their daily activities within two to five days. In comparison, rotator cuff surgery recovery time is extensive and can take anywhere from six months to a year to completely heal.

*Bone marrow concentrate which contains stem cells.

Webinar: Treating Shoulder Pain Without Surgery

Join Chris Centeno, MD, founder of Regenexx, to learn how Regenexx procedures can help treat your rotator cuff without surgery and lead to a faster recovery.

During this free webinar you’ll learn:

• How procedures using bone marrow concentrate (BMC) and platelet-rich plasma (PRP) compare to surgery and other shoulder pain treatment options
• Procedure expectations
• Answers to the most common questions about regenerative medicine treatments