Rotator Cuff Tear – A common cause of shoulderpain in older adults

By Erik Versluis, physiotherapist / Musculoskeletal sonographer
Published: July 17, 2025 
⏳ Reading time: 8 minutes

Have you been struggling with shoulder pain, weakness, or limited mobility? One possible explanation could be a tear in one of your shoulder tendons — a condition known as a rotator cuff tear.

While some tears are caused by accidents, such as a fall, most develop gradually over time. In fact, studies show that from the age of 60 onward, the likelihood of a tendon tear increases by 15% every ten years.

In this article, I explain what a rotator cuff tear is, how it can be diagnosed, and what treatment options — surgical or not — are available. I also share insights from my own physiotherapy practice and experience with diagnostic ultrasound imaging.

Understanding the Rotator Cuff

The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint. Their main job is to stabilize the shoulder and control movement.

These tendons work together like the fingers of a hand that suspend and guide the head of the upper arm bone (the humeral head) within the shoulder socket (see the image of the ‘hand metaphor’ below)

If one of these tendons tears, the balance is disturbed. The muscle can no longer pull effectively on the tendon, which often leads to weakness, pain, and difficulty lifting or rotating the arm. In some cases, the tear spreads to nearby tendons — much like a small rip in a sheet of paper that worsens as you pull on it.

When the shoulder fails to cooperate

Most patients with a rotator cuff tear come to the clinic complaining of persistent shoulder pain, often worse at night or when performing overhead movements. Some can still use their arm fairly well, especially with smaller tears. But in more severe cases, strength loss is noticeable.

I recall one patient who had difficulty lifting his right arm after a long-standing tear. He compensated by lifting his shoulder blade in an attempt to raise his arm — a clear sign of muscle dysfunction and imbalance.

Diagnosing a tendon tear

A thorough physical examination may raise suspicion, especially in the case of larger tears. One example is the ‘external rotation lag sign”: the therapist lifts the arm of the patient and makes an external rotation. The patient is unable to keep the arm in that specific position, and the arm drops.

To get a more accurate picture, we often use ultrasound imaging, which is quick, non-invasive, and increasingly used in physiotherapy. At Fysiotherapie Middenweg, we use ultrasound to identify tendon damage such as partial or complete tears.

In many cases, the supraspinatus tendon — located at the top of the shoulder — is involved. This tendon plays a key role in lifting the arm.

In complex cases, an MRI scan is recommended to assess the size and location of the tear. MRI can also reveal another complication: muscle fatty infiltration. This happens when the muscle tissue breaks down and is gradually replaced by fat, making it impossible for the muscle to recover full function — and sometimes making surgical repair no longer viable.

Treatment: When to operate and when not to

Not every rotator cuff tear needs surgery. In fact, many patients recover well with physiotherapy alone, especially when the tear is small or has developed gradually.

However, in younger individuals with a sudden traumatic tear, surgical repair may be advised to prevent further damage. The torn tendon is then stitched and reattached to the bone using anchors. This procedure requires a long period of recovery and structured rehabilitation.

Older patients are less likely to undergo surgery, especially if the tear has been present for some time or if muscle degeneration is visible. In such cases, if the loss of function is severe, a reverse shoulder prosthesis may be considered. This type of prosthesis is specifically designed for shoulders where the rotator cuff no longer functions.

Does it heal on its own?

Unfortunately, tendon tissue does not regenerate naturally. However, this is not always as problematic as it sounds. Many people with rotator cuff tears — even large ones — learn to function well with the remaining musculature. The impact of a tear depends on its size, location, and whether it affects essential movement patterns.

The road to recovery

Rehabilitation after a tendon tear is essential and often lengthy. Whether surgery was performed or not, it typically takes 6 to 9 months to restore mobility and function.

In the early weeks, the focus is on protecting the healing tendon. Gradually, we begin to work on restoring shoulder mobility and rebuilding strength. Around 3 months into rehab, most patients can resume activities such as cycling, driving, or desk work.

Returning to overhead sports can take 9 to 12 months, especially for athletes. In these cases, the final rehab phase focuses on regaining sports-specific strength and control.

Even without surgery, structured physiotherapy plays a vital role. Without the need for surgical healing, we can usually progress faster in training, allowing earlier functional recovery.

Still, it’s important to acknowledge that not every patient achieves full recovery. Mild to moderate weakness or stiffness may persist — particularly in older adults with chronic tears.

Final thoughts

Rotator cuff tears are more common than people think, particularly as we age. While a tear can’t heal by itself, the good news is that with the right diagnosis and a tailored rehab plan, many patients regain comfort and function in daily life — even without surgery.

Curious whether your shoulder pain could be related to a tendon injury? Feel free to get in touch or book an ultrasound consultation.