Degenerative rotator cuff tear

What it is

Rotator cuff tendons degenerate with age, and partial and full-thickness tears become progressively more common - present in a large proportion of people over sixty who have no shoulder symptoms at all. Finding one on a scan therefore does not establish it as the cause of someone's pain.

What correlates with symptoms and function is the strength and coordination of the remaining cuff and of the scapular muscles. Many people with substantial tears function well because the rest compensates, and exercise therapy produces outcomes comparable to surgical repair in trials of degenerative tears.

What it feels like

• Aching in the outer upper arm, worse at night and lying on that side
• Weakness lifting the arm out to the side or overhead
• Difficulty reaching behind the back or into a back pocket
• Gradual onset over months, without a specific injury
• Function often better than the scan would suggest, or worse - the two correlate poorly

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Age-related tendon degeneration

Cuff tendons lose cellularity, blood supply and collagen organisation over decades. Tears then occur under ordinary loads rather than requiring an injury, which is why so many people cannot identify a moment.

Reduced blood supply

The supraspinatus tendon has a relatively poorly supplied zone near its insertion, which is where most degenerative tears begin.

Cumulative overhead load

Decades of overhead work or overhead sport increases the risk. It is a contributor rather than the whole story, since tears are common in people who have done neither.

Weakness of the remaining cuff and scapular muscles

This is what determines symptoms and function. A tear in a shoulder with a strong, well-coordinated girdle behaves very differently from the same tear in a weak one.

Scapular dyskinesis

A shoulder blade that does not rotate properly reduces the space available and increases the load on the remaining cuff.

Smoking

Consistently associated with cuff tears and with worse healing after repair, through effects on tendon blood supply.

Diabetes and high cholesterol

Both are associated with tendon degeneration generally and with cuff tears specifically.

Genetics

Cuff tears cluster in families to a degree that suggests an inherited component in tendon quality.

A tear extending over time

Degenerative tears can enlarge, particularly full-thickness ones in younger patients. This is one argument for repairing some tears rather than all of them.

Being told the shoulder is torn

Not a biological cause, but the finding frequently produces avoidance and fear that costs more function than the tear does.

Who tends to get it

• Adults over sixty, in whom tears are extremely common
• Anyone with decades of overhead work or overhead sport
• Smokers
• People with diabetes or high cholesterol
• Anyone with a family history of cuff problems

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineShoulder Relief & Overhead Range

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Acute traumatic tear in a younger person with sudden weakness - surgical referral within weeks; a dropped arm sign needs urgent review

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Exercise therapy produces good outcomes for degenerative cuff tears and matches surgical repair in trials at one and two years for many patients, which makes it a reasonable first choice. Acute traumatic tears in younger people, and large tears with genuine functional loss, are a different situation where surgical opinion is worth seeking. A tear found incidentally on a scan of a shoulder that works well needs no treatment at all.

Prevalence basis: Shoulder imaging cohorts

Others the same routine covers

These share the Shoulder Relief & Overhead Range routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.