Rotator Cuff Tear

These three get used interchangeably. They're related but distinct ¹, and they don't respond to the same plan.

A rotator cuff tear shows up as weakness, not just pain. Pain sits in the shoulder and the upper arm, it's worse lying on that side at night, and it bites during anything overhead: washing or brushing your hair ¹. Which direction is weak points to which part is torn: inwards suggests the front of the cuff, outwards the back ².

Shoulder impingement feels more like a pinch or catch through one arc as the arm goes up, often easing once you're past it, with strength largely intact.

Frozen shoulder is stiff in every direction, including when somebody else moves the arm for you. That's the giveaway: a torn cuff usually lets someone lift your arm passively; a frozen shoulder won't.

Often there's no scan involved at all ¹. You'll be asked what the pain is like, what eases it or sets it off, and how active you are ¹. Then the shoulder gets examined: where it's tender, how far it moves in each direction, and how strong the arm is in different positions ⁶. Your neck may be checked too, in case a pinched nerve there is behind the pain ⁶.

If imaging is needed, an X-ray usually comes first. It can't show the cuff. Its job is to rule out other causes of shoulder pain, such as arthritis ^{1 6}. An ultrasound or MRI can show where a tear is and how big it is ⁶.

The first job is working out what's torn and how much, usually physically rather than with a scan: in many cases further tests aren't needed ¹. We test strength direction by direction, because which movement is weak tells us which part of the cuff is involved ². From there:

Being straight about the research: in a trial of 708 patients, a supervised progressive exercise program was not superior at 12 months to a single best-practice advice session plus self-management ⁴. Worth saying out loud on a physiotherapy website. The value is in the right plan (the right movements, loaded properly, for your particular tear), not the number of appointments. That trial did exclude full-thickness tears requiring surgery and significant shoulder trauma ⁴.

Corticosteroid injection. Commonly offered, and worth understanding before you accept one. It's prescribed and administered by a doctor, not by physiotherapists. The largest relevant trial found it provided no long-term benefit at 12 months ⁴. It may still have a place for short-term symptom control; it isn't a repair, and it isn't a plan.

Anti-inflammatory medication. A recognised part of standard care ¹, and it can make the early weeks more bearable. Also outside physiotherapy scope: a conversation with your GP, not with us.

Surgery. For mostly small degenerative tears of the supraspinatus tendon, a Cochrane review of nine trials found repair probably provides little or no improvement in pain at 12 months versus exercise-based care, improving function by around six points on a 0 to 100 scale; the authors were uncertain whether that is clinically meaningful ³. Check the scope before applying it to yourself: it may not hold for traumatic tears, large tears involving the front of the cuff, or younger people ³. Surgery is a real option for some tears, just not the default the word "tear" makes it sound.

The current clinical practice guideline on rotator cuff assessment and rehabilitation covers tendinopathy and partial-thickness tears, not full-thickness tears ⁵. That gap is why individualised assessment matters more here than a protocol copied off a website.

A torn cuff is treated along The Well Motion Recovery Path™. What your shoulder can do decides when you move up a phase, not the calendar.

• Reset: the first weeks, and where we start depends on your pain. Above 6 out of 10, we use isometric holds, where the muscle works without the joint moving, to settle the irritated tissue. At 6 or below, we start movement inside what you can tolerate: 0 to 3 out of 10 is fine, and at 4 or more you ease off. Then come muscle activation exercises, to win back control and stop the rest of the shoulder compensating, which is what breaks the chain of pain. Cold packs ¹ and manual therapy sit alongside. Expect night pain to ease last. We move you on once the shoulder takes light loading without the pain building. After surgery, this phase is a sling, usually for 4 to 6 weeks ¹⁰.
• Rebuild: the longest phase. Exercise prescription and conditioning in the directions you have lost. Expect strength to come back before overhead control does. We move you on when the arm does what your daily tasks ask of it without stalling. Reaching overhead often comes back even with a massive tear: in one small study of 17 older people, an exercise program took forward elevation from an average of 40 degrees to 160 ¹². Lifting load overhead is a different matter, and we set that goal with you. After a repair, strengthening usually starts at 8 to 12 weeks ¹⁰.
• Return: overhead work, lifting and sport. We test the tasks your job or game demands. You leave with a strengthening program ⁶ and one rule: new pain in a settled shoulder gets rechecked ⁷.

How long it usually takes. In a study of 452 people with full-thickness tears not caused by an injury, shoulder scores improved by 6 and 12 weeks of physiotherapy ¹¹. After a repair, most people have functional movement and adequate strength by 4 to 6 months ¹⁰. Treat both as guides: after a repair, your surgeon sets the timeline.

Across 21 studies, about a quarter of partial tears and just over half of full-thickness tears grew over two to three years ⁷, and nothing has yet been proven to stop that, so these go after the known risks:

• New pain in a shoulder that had settled. In people followed with painless tears, those whose shoulder started to hurt were more likely to have a tear that had grown ⁷. Get it looked at again, and don't push on through pain that's building ⁶.
• Overhead work. Repetitive overhead activity and heavy lifting above shoulder height are the two things to cut back ¹. Working with the arm above shoulder height is linked with rotator cuff tendon problems ⁸, and a high work level was among the factors tied to tears enlarging ⁷.
• Strength around the shoulder. Strengthening the muscles that support it can ease pain and prevent further injury ⁶. Which exercises are safe depends on your shoulder, so have them checked first ⁶.
• The other shoulder. With a wear-related tear on one side, a tear on the other is more likely, even if it doesn't hurt ⁶.