What is a rotator cuff tear?

The rotator cuff is a group of four tendons and muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that wrap the top of the arm bone and hold it centered in the shoulder socket while you raise and rotate the arm. A tear means one or more of these tendons is partially frayed or fully detached from the bone. Tears happen suddenly from trauma, such as a fall onto an outstretched arm, a hard pull on the steering wheel during a collision, or lifting a heavy load at work, and they can also build up gradually from repeated overhead motion. The supraspinatus tendon is the most commonly torn.

Rotator cuff tear symptoms

Rotator cuff symptoms center on weakness and pain with arm elevation rather than a single sharp catch. A tear from acute trauma often causes immediate weakness, while a fraying tendon may ache for weeks before it is recognized.

• Deep, dull ache in the outer shoulder, often worse at night and when lying on that side
• Weakness lifting the arm out to the side or overhead, sometimes unable to raise it at all
• Pain reaching behind the back, into a coat sleeve, or up to a shelf
• A sense that the arm is giving out or cannot hold a weight
• Crackling or clicking (crepitus) when moving the shoulder

How a rotator cuff tear is diagnosed

A clinician reviews how the injury happened and examines the shoulder with strength and motion tests that isolate each cuff tendon, such as the empty-can, drop-arm, and lift-off maneuvers. X-rays do not show tendons but rule out fracture and reveal bone spurs that can rub the cuff. When weakness or pain points to a tear, an MRI or ultrasound is used to confirm whether the tear is partial or full thickness and to measure its size, which guides whether a non-surgical or surgical path is appropriate.

Rotator cuff tear treatment

Many partial tears and small full-thickness tears improve with structured non-surgical care, which is the starting point for most patients. The goal is to calm inflammation, then rebuild the strength and coordination of the cuff and surrounding shoulder-blade muscles. Surgical evaluation is considered for large or complete tears, tears that fail to improve after a fair trial of rehab, or significant ongoing weakness that limits work or daily function.

• Physical therapy emphasizing scapular control, cuff strengthening, and restoring pain-free range of motion
• Activity modification and short-term relative rest from overhead and lifting tasks
• Anti-inflammatory measures and image-guided injections from pain-management specialists when appropriate
• Chiropractic and manual therapy to address compensating neck and upper-back stiffness
• Referral for orthopedic surgical evaluation when imaging and exam indicate a repair may be warranted

Recovery & when to see a doctor

Recovery varies with tear size, the demands of your job, and how consistently you complete rehab; progress is gradual and individual, and no specific timeline can be promised. See a doctor promptly if you cannot raise your arm after an injury, if shoulder weakness is worsening, or if night pain is disrupting sleep. Early evaluation after an accident also documents the injury while findings are fresh. Our Long Island team coordinates orthopedic, physical therapy, chiropractic, and pain-management care under one roof so your treatment plan stays connected.

Related care at Injury Recovery MD

• shoulder pain
• workers’ comp injury care
• physical therapy

Long Island offices & service areas

We treat patients across Nassau and Suffolk County from offices including Medford, Islandia, East Islip, Mineola, Bohemia, Smithtown and Stony Brook. Find your nearest office →

Not near one of our offices? We can help arrange transportation to your appointment, or coordinate your care with providers in our Long Island network — call (631) 560-8357 to ask.

Rotator cuff tear FAQ

Will my rotator cuff treatment be covered by No-Fault or Workers’ Comp?

If your shoulder injury came from a car accident, treatment is generally billed to New York No-Fault auto coverage; if it happened at work, it is billed to Workers’ Comp. Eligible patients typically pay $0 out of pocket for covered visits. Our team verifies your coverage before care begins.

Can a rotator cuff tear heal without surgery?

Many partial and smaller full-thickness tears improve with physical therapy and other non-surgical care. Larger or complete tears, or tears that do not respond to rehab, may warrant orthopedic surgical evaluation.

Why does my shoulder hurt more at night?

Lying down shifts pressure onto the inflamed cuff tendons and removes the daytime support of your arm, which commonly increases the ache. Night pain that disrupts sleep is a reason to be evaluated.

Can I still lift my arm if the cuff is torn?

Sometimes, yes. Other muscles can partly compensate, so some people with a tear can raise the arm while others cannot lift it at all — which is why the size and location of the tear matter more than any single movement. Weakness that is getting worse, or an arm that cannot be raised after an injury, should be evaluated promptly.

What can I do about the night pain?

Sleeping propped up, keeping a pillow under the arm so it does not drop backward, and staying off the injured side often reduce pressure on the inflamed tendons. Those are stopgaps — the ache generally settles as the cuff and shoulder-blade muscles are rehabilitated and the inflammation is treated. Night pain that disrupts sleep is itself a reason to be seen.