What Are Rotator Cuff Tears?

Rotator cuff tears are one of the most common causes of shoulder pain in older people.

The rotator cuff is made up of four muscles and their tendons that surround the shoulder joint. These muscles are important because they:

• Help lift and rotate the arm.
• Keep the ball of the shoulder joint stable in its socket.

As we age, these tendons can wear down, weaken, and tear, which often leads to shoulder pain, stiffness, and reduced strength.

Why Do Rotator Cuff Tears Happen in Older Adults?

There are two main reasons:

• Degeneration over time: With age, tendons naturally lose some of their strength and elasticity, making them more prone to tearing.
• Repetitive use or strain: Years of overhead activities (such as gardening, lifting, or certain sports) put stress on the tendons.
• Reduced blood supply with age: Tendons heal more slowly and are less able to repair small injuries.

In some cases, tears can also happen suddenly after a fall or injury, but in older people they are usually the result of gradual wear and tear.

Symptoms of a Rotator Cuff Tear

• Pain in the shoulder, especially at night or when lying on the affected side.
• Pain when lifting or rotating the arm.
• Weakness in the shoulder.
• A limited range of motion — difficulty reaching overhead, behind the back, or lifting objects.

Treatment Options

Non-Surgical Treatments

For many older adults, non-surgical treatment is effective and improves symptoms significantly. Options include:

• Steroid injections into the shoulder to reduce inflammation and pain.
• Physiotherapy to strengthen surrounding muscles, restore mobility, and improve shoulder function.
• Activity modification (avoiding heavy lifting or painful movements).
• Pain relief medication (anti-inflammatories or simple analgesics).

Most patients notice significant improvement after 1–2 months of physiotherapy, especially when combined with an injection.

Surgical Treatments

If pain remains severe or function is limited despite non-surgical care, surgery can be considered.

• The main procedure is a rotator cuff repair, where the torn tendon is reattached to the bone.
• Surgery may improve pain and strength, but outcomes can be less predictable in older patients, especially if the tear is large or the tendon quality is poor.
• Recovery from surgery requires several months of physiotherapy to regain strength and mobility.

In some severe cases where the tendon cannot be repaired, other surgical options — such as reverse shoulder replacement — may be discussed, particularly if there is advanced arthritis.

Can Rotator Cuff Tears Be Prevented?

While not all tears can be avoided, you can lower your risk by:

• Maintaining good shoulder strength and flexibility with regular exercise.
• Avoiding repetitive overhead lifting.
• Keeping a healthy lifestyle to slow age-related wear and tear (diet, exercise, no smoking).

Key Takeaway

• Rotator cuff tears are a very common cause of shoulder pain in older adults.
• Most patients do well with non-surgical treatment such as steroid injections and physiotherapy.
• Surgery is an option for those with persistent pain and loss of function, but it is not always necessary.

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