What is a Rotator Cuff Tear — and Do You Really Need Surgery?

What is a Rotator Cuff Tear — and Do You Really Need Surgery?

The rotator cuff is a group of four muscles that connect your shoulder blade (scapula) to your upper arm bone (humerus). These muscles are:

• Subscapularis – located on the front of the shoulder blade

• Supraspinatus – sits on top of the shoulder blade

• Infraspinatus – found on the back of the shoulder blade

• Teres minor – also on the back of the shoulder blade

While each muscle helps with specific movements like lifting your arm, rotating it inwards or outwards, their most important role is dynamic stability—keeping the shoulder joint controlled and supported during all movements.

Common Causes of a Weak or Painful Shoulder

Shoulder pain generally falls into three broad categories:

1. Stiff Shoulder – for example, frozen shoulder (adhesive capsulitis)

2. Unstable Shoulder – usually following dislocations or subluxations

3. Weak & Painful Shoulder – including conditions such as:

   • Shoulder impingement

   • Subacromial pain syndrome

   • Rotator cuff tendinitis, tendinosis, or tendinopathy

   • Rotator cuff tears

Many people assume that imaging, injections, or surgery are required to treat these issues. In reality, exercise therapy is usually the first-line treatment. Shoulder pain often relates more to current tissue sensitivity from activity changes or overall health factors than to structural damage like a new tear or severe inflammation.

For instance, rotator cuff tears are surprisingly common in people without any symptoms, and their prevalence increases with age. Research shows that these tears don’t always affect function or cause pain:

Surgery is not always necessary. Evidence suggests that non-operative management is as effective as surgery for many rotator cuff tears, including both partial and full-thickness tears. In fact, nearly half of full-thickness tears can be asymptomatic.

Understanding Pain and Recovery

Rotator cuff tears are often thought to be like a rope that’s been cut, but a better analogy is a small hole in a piece of cloth—the cloth (aka the shoulder) can still function well despite the tear.

This means that experiencing some discomfort during rehab is normal and safe, as long as it’s manageable and progressively improves over time. Symptoms are usually linked to the shoulder being sensitive to certain positions or movements, not irreparable damage.

The goals of rehab are straightforward:

• Temporarily modify activities that aggravate the shoulder

• Improve overall health through lifestyle and exercise

• Address deficits in strength, range of motion, and confidence with a manageable and progressive exercise program

With the right approach, most people can safely return to their normal activities, improve function, and reduce pain—all without immediately resorting to surgery.

If you have been told you have a rotator cuff tear and would like to know what you can do to help, book in for an appointment at Realign Physio & Co. Our team can guide you through tailored exercises, pain management strategies, and support your recovery.