The shoulder is one of the most mobile joints in the human body, designed to allow movement in almost every direction. This flexibility is made possible by a complex relationship between muscles, tendons, and bones — particularly the rotator cuff, which plays a crucial role in keeping the joint stable and functional during everyday activity.
Bones of the Shoulder
Before focusing specifically on the rotator cuff, it helps to understand the bones that form the foundation of the joint. The shoulder is a ball-and-socket joint made up of three bones: the scapula (shoulder blade), clavicle (collarbone), and humerus (upper arm bone). The scapula provides a shallow socket (the glenoid), into which the rounded head of the humerus fits. If you'd like to explore this in more depth, you can visit the full shoulder anatomy guide for a broader overview.
Muscles of the Rotator Cuff
The rotator cuff is a group of four deep muscles and their tendons that surround the shoulder joint. Working together, they play a vital role in stabilising the ball of the humerus within the shallow socket of the scapula. While larger muscles like the deltoid generate power, the rotator cuff provides the fine control and joint security needed for smooth, pain-free movement — especially during lifting, rotation, or reaching overhead. Each muscle has a distinct function, which becomes especially important when understanding shoulder injuries or planning rehabilitation
The Supraspinatus
The supraspinatus is the most commonly injured of the four rotator cuff muscles. It sits at the top of the shoulder, originating from the supraspinous fossa (the concave surface above the spine of the scapula) and passing under the acromion before attaching to the superior facet of the greater tubercle of the humerus. Its unique path through the narrow subacromial space makes it particularly vulnerable to overload and compression.
Primary Function:
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The supraspinatus is responsible for initiating abduction of the shoulder, lifting the arm away from the body for the first 15–20 degrees of movement.
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Beyond this initial phase, the deltoid muscle becomes the primary abductor in a graduated fashion until about 90 degrees, where the supraspinatus is no longer really active.
Additional Roles:
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It plays a crucial role in stabilising the humeral head within the glenoid socket during all shoulder movements.
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Works in coordination with the other rotator cuff muscles to provide dynamic control (movement through a certain range, not stationary) of the joint and prevent excessive translation of the humerus.
Clinical Relevance:
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The supraspinatus tendon is the most frequently injured structure in rotator cuff pathology — commonly affected by tendinopathy, partial-thickness tears, or full-thickness tears.
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It is particularly susceptible to impingement beneath the acromion, especially in individuals with altered shoulder mechanics or structural narrowing of the subacromial space.
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Weakness or dysfunction of the supraspinatus can cause difficulty initiating abduction, a “painful arc” (typically between 60–120° of elevation), and a sense of instability or weakness during overhead activity.
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Imaging (e.g. ultrasound or MRI) often focuses on this tendon when assessing rotator cuff injuries, as it is a common site of degeneration with age or repetitive use.
The Subscapularis
The subscapularis is the largest and strongest of the four rotator cuff muscles. It originates from the subscapular fossa on the front surface of the scapula (shoulder blade) and travels across the front of the shoulder joint to insert onto the lesser tubercle of the humerus. Its position at the front of the joint allows it to play a unique role in both shoulder movement and anterior joint stability.
Primary Function:
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The subscapularis is the main internal rotator of the shoulder. It allows you to rotate your arm inwards — a movement used for actions like placing your hand on your stomach, reaching across your body, or tucking in your shirt.
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It also assists with adduction of the arm, particularly when the arm is elevated.
Additional Roles:
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This muscle acts as a dynamic stabiliser of the shoulder joint, helping to keep the humeral head securely positioned in the glenoid socket during arm movements.
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Because of its location, it also resists anterior translation of the humeral head, helping to prevent the shoulder from slipping forward — particularly important in positions of external rotation or elevation.
Clinical Relevance:
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Subscapularis injuries are less common than supraspinatus tears but still significant. Damage to this muscle can cause weakness in internal rotation, anterior (front) shoulder pain, and difficulty with functional tasks like reaching behind your back or fastening clothing.
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Tears are often associated with trauma, degenerative changes, or as part of massive rotator cuff tears.
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It’s also a key structure to assess following shoulder dislocations, particularly in older adults.
The Infraspinatus
The infraspinatus is a thick, triangular muscle that lies on the back of the scapula, just below the spine of the shoulder blade. It originates from the infraspinous fossa and attaches to the middle facet of the greater tubercle of the humerus. Alongside the teres minor, it plays a vital role in external (lateral) rotation of the shoulder and contributes significantly to joint stability during movement.
Primary Function:
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The infraspinatus is one of the primary external rotators of the shoulder. It allows you to rotate your arm outward, such as when reaching to put on a jacket, throwing, or preparing for a tennis backhand.
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Also assists with horizontal abduction when the arm is lifted to shoulder height.
Additional Roles:
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Like all rotator cuff muscles, the infraspinatus helps to compress the humeral head into the glenoid cavity, ensuring the joint remains centred during movement.
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It is particularly important during overhead or high-velocity activities, where it provides fine-tuned control and dynamic joint stability.
Clinical Relevance:
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The infraspinatus is often affected in overhead athletes (e.g. tennis players, cricketers, swimmers) due to repetitive external rotation demands.
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It may become strained, overloaded, or affected by tendinopathy, especially in conjunction with supraspinatus pathology.
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Tears of the infraspinatus can lead to weakness in external rotation, posterior (back)shoulder pain, and sometimes a loss of control or power when reaching outward or backward.
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Chronic (>12 weeks) injuries can contribute to posterior shoulder tightness, altered scapular mechanics, and symptoms commonly referred to as posterior impingement.
Teres Minor
The teres minor is the smallest of the four rotator cuff muscles, but it plays an important role in shoulder stability and control. It originates from the upper two-thirds of the lateral border of the scapula and inserts onto the inferior facet of the greater tubercle of the humerus, just below the insertion of the infraspinatus.
Primary Function:
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Like the infraspinatus, the teres minor contributes to external rotation of the shoulder, particularly when the arm is abducted.
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It plays a supportive role during activities that involve rotation, deceleration, or controlled lowering of the arm.
Additional Roles:
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Teres minor is involved in stabilising the humeral head within the glenoid socket, especially during rotational movements and overhead activity.
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Often functions as part of a unit with the infraspinatus, but may contribute more during late-phase abduction and fine-tuned rotational control.
Clinical Relevance:
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Isolated injuries to the teres minor are uncommon, but it may be affected in larger posterior cuff tears or in chronic degenerative rotator cuff pathology.
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In some cases of massive cuff tears (involving supraspinatus and infraspinatus), the teres minor may be the only remaining external rotator — making it crucial for maintaining some degree of shoulder function.
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This muscle is also assessed in relation to quadrilateral space syndrome, where it may become compressed along with the axillary nerve, leading to weakness or atrophy.
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Weakness in the teres minor can reduce external rotation strength and cause difficulty with controlled arm positioning.
What is a Rotator Cuff Tear?
A rotator cuff tear occurs when one or more of the tendons in the rotator cuff become damaged or torn. This can happen suddenly due to trauma (such as a fall or heavy lift) or develop gradually over time as a result of wear and tear, age-related degeneration, or repetitive overuse. Tears are a common cause of shoulder pain and weakness, particularly in middle-aged and older adults, though they can affect individuals of any age.
Pain ≠ Tear (Especially As We Age)
As with many musculoskeletal conditions, rotator cuff tears come with a level of clinical uncertainty — and by that, I mean that a tear doesn’t always equal pain. This is especially true as we get older.
Research suggests that:
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Around 15–20% of people aged 60–69 have a full-thickness rotator cuff tear without any symptoms.
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This figure increases to 31% in people over 70, and more than 50% of those aged 80+ show tears on imaging despite having no shoulder pain or dysfunction.
These are significant numbers — and they remind us that the human body can be remarkably adaptable. As we age, our activity levels often change, and so do our expectations of movement and comfort. Many people naturally accommodate to changes in their shoulder without realising a tear has occurred. Not all findings on a scan are problems that cause pain, symptoms, or need fixing - this is a vital message for the whole body, not just the shoulder.
Causes of Rotator Cuff Tears
Several factors can lead to a rotator cuff tear:
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Trauma: Sudden injuries, such as falling onto an outstretched arm or lifting a heavy object, can cause a tear.
There are almost always more benefits than drawbacks to staying fit and active, and as more people take this advice on board, we’re seeing new sports and activities gain popularity.
In my own practice, I’ve noticed a marked increase in walking football–related injuries over the last five years. It reminds me a bit of netball — arguably the most contact “non-contact” sport out there!
The combination of natural age-related changes — such as reduced balance, slower reflexes, and stiffer joints — with a renewed outlet for competitiveness often leads to falls onto an outstretched arm. Unsurprisingly, this is a common mechanism for shoulder injuries, including rotator cuff tears.
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Degeneration: As we get older, the tendons in our shoulder naturally weaken — just like the tread on a tyre gradually wears down. This kind of age-related degeneration is the most common reason for a rotator cuff tear, especially in people over 60. An example of this may be that you haven’t had a fall or injury, but over the years you’ve developed a dull ache in your shoulder, especially at night. You might even have a tear and not know it, because the body has slowly adapted over time.
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Repetitive Actions: Doing the same shoulder motion repeatedly — particularly overhead — can gradually irritate or damage the rotator cuff. This is common in both sports and everyday tasks. A relatable example could be that you play tennis a few times a week, swim regularly, or work as a decorator or hairdresser. Even reaching up to hang washing, paint a ceiling, or lift boxes onto high shelves can eventually strain the tendon enough to cause a tear.
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Bone Spurs: In some people, small bony overgrowths (called spurs) develop around the shoulder joint. These can rub against the tendon every time you move your arm, gradually wearing it down — like a frayed rope over a sharp edge. We see patients that deny ever injuring their shoulder, but they’ve had years of limited movement and now their arm feels weak or painful when reaching overhead — particularly when putting things in cupboards or lifting something to an overhead locker.
Symptoms of Rotator Cuff Tears
If you’ve ever found yourself wondering, "Why does my shoulder hurt when I lift my arm?" or "Why can’t I sleep on my side anymore?" — you’re not alone. These are some of the most common early signs of a rotator cuff issue but remember, not all mean a tear, it is more likely to be a lesser inflammatory or mechanical irritation but is worth gettgin checked out by a professional. As always, when it comes to the body in this type of context, there are very few absolute answers:
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Trauma: This is perhaps the most obvious cause. If your tear happened after a fall or sudden movement, you may have felt sharp, intense pain straight away, followed by a deep, aching soreness that lingers. The body’s natural pain protection system kicks in quickly, which can be overwhelming at first — but over time, symptoms often evolve into ongoing aches at rest, with sharper pain during movement. In some cases, particularly with shoulder dislocations, the force of the humerus being pulled out of — and sometimes slammed back into — the joint can stretch or tear the rotator cuff. Not every dislocation causes a tear, but it’s a common mechanism, especially in older adults or traumatic falls.
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Pain in the shoulder: This often starts as a dull, deep ache in the upper arm or outer shoulder. It may not be constant, but it’s usually worse at night — especially when lying on the affected side. Simple tasks like putting on a jacket or reaching into the back seat can become surprisingly uncomfortable.
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Weakness: You might find yourself struggling to lift a kettle, hold a hairdryer, or put dishes away in high cupboards. Movements that used to feel easy now take effort — or just don’t feel possible.
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Altered range of motion: It’s not just pain — the shoulder may feel stiff or stuck, especially when reaching overhead or behind your back. People often say they feel like something is “catching” or “just not working right.”
Diagnosis of Rotator Cuff Tears
Getting to the bottom of a shoulder problem starts with asking the right questions and looking at how your shoulder actually moves — not just what shows up on a scan. A working diagnosis always begins with a detailed look at your symptoms, history of your injury, lifestyle, and full medical history, followed by a hands-on physical assessment to test your shoulder’s movement, strength, and stability. Taking you time to get it right at this stage is vital to under pin any future advice and or treatmnet. Health porfessionals are still human so there will alwasy be soe cases that catch us out, but on the whole, as long as as a good, non rushed assessment is made, a reliable picture can be made without imaging.
When Is Imaging Needed?
Sometimes, things aren’t completely clear-cut — especially if:
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Your symptoms are complex or long-standing,
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Conservative treatment hasn’t provided the expected improvement, or
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Surgery is being considered as a next step.
In these cases, we may recommend imaging such as X-rays, ultrasound, or an MRI scan to gather more information.
Each type of scan has its strengths:
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X-rays are the most commonly used in primary care (e.g. via your GP), but they’re mainly useful for ruling out bone-related problems such as arthritis or fractures. They don’t show soft tissues, so they’re limited when it comes to assessing tendons or muscles.
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Ultrasound and MRI are usually more appropriate for suspected rotator cuff tears, tendon inflammation, or bursitis.
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Ultrasound is quick (in terms of being done but the NHS wait is long!), cost-effective, and excellent for seeing tendon movement in real time. Great for suspected impingement syndromes that occur only when you move.
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MRI provides a more detailed view of the soft tissues, including the depth and extent of any tear, and surrounding joint structures.
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In some cases, a more advanced scan called an MRI arthrogram may be recommended. This involves injecting a special dye into the shoulder joint before the scan to give a clearer picture of the cartilage and joint lining — often useful when investigating labral tears or subtle joint injuries.
Treatment Options for Rotator Cuff Tears
The goal of treatment is simple: to reduce pain, restore movement, and help you get back to doing the things you enjoy — whether that’s walking football, reaching into a cupboard, or sleeping comfortably on your side again.
There are two main types of treatment: conservative (non-surgical) and surgical. Most people start with the conservative route.
Conservative (Non-Surgical) Options
These are the first steps we usually explore — especially for small or partial tears, or if symptoms are manageable.
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Activity modification: You don’t need to stop moving, but we may recommend avoiding certain actions that are clearly aggravating your symptoms (like repetitive lifting or overhead reaching).
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Pain relief: Over-the-counter anti-inflammatories or painkillers can help settle symptoms in the early stages.However, it’s essential to speak to your doctor, pharmacist, or another healthcare professional before taking any anti-inflammatory medication. These drugs, while commonly used, can carry significant risks — particularly if you’re over 55, have existing health conditions (such as stomach, kidney, or heart issues), or are taking other medications.
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Physiotherapy: This is where people like me come in. At Chris Heywood Physio, your rehab plan is tailored to you — focusing on improving shoulder mobility, strengthening the right muscles, and restoring joint control so you can move with confidence again.
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Steroid injections: In some cases, a guided steroid injection can help ease inflammation and pain, particularly if things are very flared up. But it’s not a standalone fix — it’s crucial to have a rehab plan in place during the recovery window, as steroids can temporarily weaken tendons if not managed carefully.
Surgical Options
Surgery is usually only considered if:
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Conservative treatment hasn’t helped after 6–12 months,
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The tear is large or clearly limiting function,
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There’s significant loss of strength or mobility, or
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The injury is traumatic and clearly full-thickness from the outset.
Rotator Cuff Repair
This involves reattaching the torn tendon back to the bone (humerus). There are two common surgical methods:
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Arthroscopic (keyhole) surgery:
A modern technique using small instruments and a camera, inserted through tiny incisions. This generally means less tissue trauma, smaller scars, faster recovery, lower infection risk and earlier rehab and movement.
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Open surgery: Used in more complex cases. This involves a larger incision over the shoulder and is sometimes necessary for bigger or older tears.
Recovery and Prognosis
Understandably, one of the first questions people ask is "How long will this take to get better?"
The honest answer? It depends — and that’s not just a cop-out. Asking about recovery time for a rotator cuff tear is a bit like asking, “How long is a piece of string?” There are many variables involved, and they all matter.
These include:
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Whether the tear is partial or complete
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Your age, general health, and activity level
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How long you’ve had symptoms before starting treatment
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Whether the issue is linked to trauma or degeneration
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How consistently you can follow a rehab or recovery plan
Recovery times can vary enormously. In a young, healthy individual with a minor tear, full recovery might take as little as 2–6 weeks. At the other end of the spectrum, complex surgical repairs or severely degenerated shoulders may require 12–18 months or more — and even then, a full return to pre-injury function may not always be realistic.
It’s important to be honest about this. For more severe cases, a complete recovery isn’t always possible, no matter how long the rehab lasts. One of the key responsibilities of any healthcare professional is to give patients a clear, realistic picture from the outset. False promises or overly optimistic timelines serve no one — and can undermine trust when recovery doesn’t follow a perfect script.
Summary - Key Takeaways
Rotator cuff tears are a very common cause of shoulder pain and weakness, especially as we get older or stay active into later life. These injuries can happen suddenly — like falling onto an outstretched arm — or develop slowly over time through everyday wear and tear.
Symptoms can range from a deep aching pain and weakness when lifting to difficulty sleeping or even sudden loss of movement after trauma. But not every tear causes pain, and not every scan tells the full story — that’s why getting a proper diagnosis is so important.
At Chris Heywood Physio, we focus on combining clinical expertise with real-world context. We'll help you understand not just what's wrong, but what to do next. Most people improve with targeted physiotherapy, but in more complex cases, imaging or surgery may be part of the plan. Either way, recovery is about building strength, control, and confidence over time — not chasing perfection.
If your shoulder has been holding you back, it's worth finding out why — and what can be done to get you moving again.
If you want to be able to read about specific post operative rotator cuff protocols etc, I can highly recommend visiting the website of Manchester based Professor Leonard Funk and his team, who have spent decades building very specific content for patients and professionals alike - https://shoulderdoc.co.uk/
A Quick Note From Chris
It won’t surprise many of you to know that I don’t get any financial reward for writing and sharing these pages. I do it because I genuinely want to help people better understand their conditions and feel more in control of their recovery.
All I ask is that you don’t plagiarise or claim this work as your own — and if you’ve found it helpful, please consider sharing it with friends, family, or anyone else who might benefit from it. Follow my blog for regular updates on new topics, pages and future projects.
Thanks for reading — and for taking your health seriously.
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Rotator Cuff Tear FAQ's
Why You Should Choose Chris Heywood Physio
The most important thing when seeking help is finding a practitioner you trust—someone who is honest, responsible, and clear about your diagnosis, the treatment you really need, and whether any follow-up appointments are necessary.
I’m not here to poach you from another therapist, but if you’re looking for a new physiotherapist in Northamptonshire or simply want a second opinion, here’s why many people choose to work with me (read my reviews):
Over 25 Years of Experience & Proven Expertise
With 25+ years of hands-on physiotherapy experience, I’ve built a trusted reputation for clinical excellence and evidence-based care. My approach combines proven techniques with the latest research, so you can feel confident you’re in safe, skilled hands.
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No two people—or injuries—are the same. That’s why I offer 60-minute one-to-one sessions, giving us time to:
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Thoroughly assess your condition
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Provide focused, effective treatment
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Explain what’s really going on in a clear, simple way
Your treatment plan is tailored specifically to you, aiming for long-term results, not just temporary relief.
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I believe the best outcomes happen when you understand your body. I’ll explain your condition clearly, give you practical tools for self-management, and step in with expert hands-on treatment when it’s genuinely needed.
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Book an appointment today and take the first step towards feeling better.
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