Your Cart is Empty
Shoulder pain has a frustrating way of interfering with surprisingly ordinary things. Reaching into a cupboard hurts. Putting on a jacket becomes awkward. Washing your hair is uncomfortable. And perhaps most annoyingly, the shoulder that was manageable all day suddenly starts throbbing when you try to sleep.
For adults over 50, one possible culprit is the rotator cuff.
If you've been told you have a rotator cuff tear, the word "tear" can sound alarming. It seems logical to assume that something has ripped and therefore needs to be repaired.
But shoulders—and rotator cuffs in particular—aren't quite that simple.
What Exactly Is the Rotator Cuff?
The rotator cuff isn't one structure. It's a group of four muscles and their tendons that surround the shoulder joint.
These muscles help stabilize the ball of your upper arm bone within the relatively shallow socket of your shoulder. They also help you raise and rotate your arm, allowing you to perform everything from reaching for a seat belt to putting a dish on the top shelf.
Over time, however, the tendons can change.
Like many tissues in the body, tendons become less resilient with age. Years of repetitive movement, changes in blood supply and normal age-related degeneration can gradually weaken the rotator cuff. Sometimes a tendon becomes irritated or partially torn; in other cases, a complete tear develops.
And here's the surprising part: you can have a rotator cuff tear and not even know it.
Rotator Cuff Tears Become More Common with Age
Studies using ultrasound and MRI have found rotator cuff abnormalities in people who have no shoulder symptoms at all. These findings become increasingly common with age.
That's an important point.
An MRI showing a tear doesn't necessarily prove that the tear is responsible for someone's pain. Medical professionals must consider the imaging alongside symptoms, strength, mobility, physical examination and the circumstances in which the problem developed.
This also helps explain why two people with similar-looking scans can feel completely different. One may have considerable pain and difficulty using an arm, while another may happily play golf without realizing there's a tear at all.
What Does a Rotator Cuff Problem Feel Like?
Symptoms vary, but rotator cuff problems commonly cause pain around the outside or front of the shoulder.
You may notice pain when lifting your arm overhead, reaching behind your back, getting dressed or lifting something away from your body. The arm can also feel weak.
Nighttime pain is particularly common. Sleeping on the affected shoulder may be uncomfortable, and some people experience aching even when lying on the opposite side.
But shoulder pain doesn't automatically mean a torn rotator cuff. Arthritis, frozen shoulder, bursitis, neck problems and several other conditions can produce similar symptoms. That's why persistent shoulder pain is worth properly assessing rather than self-diagnosing.
Does a Tear Mean You Need Surgery?
Not necessarily.
Many rotator cuff problems can initially be treated without surgery, particularly when they have developed gradually rather than as the result of a major injury.
One of the most important treatments is exercise-based physiotherapy.
Strengthening the remaining rotator cuff muscles and the muscles surrounding the shoulder blade can improve how the shoulder functions. Gradually restoring mobility is also important because avoiding movement altogether can contribute to stiffness and weakness.
This can seem counterintuitive. If a tendon is damaged, shouldn't you rest it?
Some temporary modification of painful activities may certainly be appropriate, but prolonged avoidance of movement isn't usually the answer. Muscles become weaker when they aren't used, potentially making everyday activities even harder. It’s critical to build a plan with your health care provider.
The objective is generally to find an appropriate level of movement and progressively build strength rather than repeatedly aggravating the shoulder or protecting it indefinitely.
What About Cortisone Injections?
Corticosteroid injections can reduce shoulder pain for some people, particularly in the short term. That reduction in pain can sometimes make it easier to participate in physiotherapy.
But an injection doesn't repair a torn tendon.
Repeated steroid injections also aren't necessarily benign. There are concerns about their effects on tendon tissue, so the potential benefits and drawbacks should be discussed with a healthcare professional rather than treating injections as a routine long-term solution.
When Might Surgery Be Appropriate?
There are situations where surgery deserves serious consideration.
A significant rotator cuff tear caused by an acute injury—particularly when someone suddenly loses strength or the ability to raise an arm—is different from a small degenerative tear discovered after years of intermittent shoulder pain.
Surgery may also be considered when substantial pain and weakness persist despite an appropriate period of nonsurgical treatment, or when the nature and size of the tear make successful conservative treatment less likely.
Age, general health, activity level, severity of symptoms, type of tear and personal goals all matter. A very active 55-year-old with a sudden traumatic tear may face a different decision from an 80-year-old with a longstanding degenerative tear and relatively good shoulder function.
There simply isn't one answer that applies to everyone.
Can You Prevent Rotator Cuff Problems?
You can't completely prevent the changes that occur in tendons as we age, but maintaining strength and mobility can help keep shoulders functioning well.
Regular exercise that strengthens the shoulders, upper back and muscles surrounding the shoulder blades is useful. So is gradually increasing unfamiliar activities rather than suddenly asking your shoulders to perform hundreds of movements they aren't accustomed to.
That last point becomes particularly relevant with seasonal activities. Painting the house, pruning trees, shovelling snow or suddenly returning to tennis after a long break can place loads on the shoulder that it hasn't experienced for months.
Your shoulders generally appreciate preparation more than surprises.
A rotator cuff tear sounds like something that obviously needs to be fixed. But the reality is more nuanced.
Rotator cuff changes become increasingly common as we age, and some people have tears without experiencing any symptoms whatsoever. For many people who do develop pain, physiotherapy, appropriate exercise and changes in activity can substantially improve shoulder function without surgery.
That doesn't mean rotator cuff tears should be ignored. Sudden weakness following an injury, an inability to raise your arm, or persistent shoulder pain should be properly assessed.
But if an MRI report happens to contain the word "tear," don't assume that an operating room is your inevitable next destination.
When it comes to the aging shoulder, how well it works can be every bit as important as how it looks on a scan.
