Rotator Cuff Tears: Causes, Symptoms & Diagnosis
Understanding why shoulder tendons break down - and how we protect long-term shoulder function. by Roger Sohn, MD
What Is a Rotator Cuff Tear?
The rotator cuff is a group of four tendons that stabilize your shoulder and guide controlled, powerful movement. These tendons help you lift your arm, reach overhead, rotate your shoulder, and perform everyday tasks. In many ways, the rotator cuff muscles and tendons are the unsung heroes of the shoulder. While the “show muscles” - the deltoid and pectorals - get most of the attention, the rotator cuff quietly keeps everything working smoothly, often going unnoticed until something goes wrong.
A rotator cuff tear happens when one or more of these tendons pull away from the bone. Although a single injury can cause a tear, most develop gradually. Years of minor wear, combined with repetitive motion, poor shoulder mechanics, and age-related tendon changes, weaken the tissue long before the painful event that finally brings a patient into the clinic.
Why Do Rotator Cuff Tears Happen?
Most tears don’t come from one dramatic accident. Instead, several factors work together:
1. Age-related tendon changes
As we age, the tendons naturally lose some of their blood supply, and the number of normal tendon-maintenance cells (tenocytes) decreases. With fewer repairs happening at the microscopic level, the tissue becomes thinner and more fragile.
2. Repetitive motion and overuse
Years of overhead activity, sports, heavy lifting, or even routine work can create small amounts of tendon wear that add up over time.
3. Poor shoulder mechanics
When the shoulder blade, rotator cuff, and larger shoulder muscles aren’t working together efficiently, the rotator cuff can become pinched or overloaded. A weakened tendon under abnormal stress is much more likely to tear.
In many patients, the moment they “felt it go” was simply the final straw - not the true start of the problem.
Common Symptoms of a Rotator Cuff Tear
Rotator cuff tears can cause:
- Pain on the front or side of the shoulder
- Pain when lifting or reaching overhead
- Weakness or reduced strength
- Night pain, especially when lying on the affected side
- Clicking, catching, or a “grinding” sensation
- Stiffness or reduced range of motion
Some patients recall a specific injury, while others notice symptoms that build slowly.
How Rotator Cuff Tears Are Diagnosed
Diagnosis begins with a focused physical exam to assess motion, strength, and tendon function.
Imaging helps confirm the tear and guide treatment:
- X-rays show bone alignment and rule out arthritis
- Ultrasound can show real time dynamic images of the tendons.
- MRI is the best tool for seeing the tendon, measuring the tear, and evaluating the quality of the tissue
MRI findings also help distinguish long-standing tendon degeneration from a more recent injury layered on top of it.
Our Approach: Preserving the Useful Life of Your Shoulder
Rotator cuff tears are common - and often part of the normal aging process - but that doesn’t mean you have to live with pain or declining function.
In my practice, we use the most up-to-date methods to:
- Identify the true cause of your shoulder pain
- Understand how aging, mechanics, and repetitive use contribute to the tear
- Protect the remaining tendon
- Extend the “useful life” of your shoulder
- Keep you active, strong, and doing what you love
For more information about non-surgical care and modern surgical options, visit the dedicated Rotator Cuff Treatment page.