The most common symptoms which cause a patient to seek medical advice are:

• pain
• weakness and
• inability to raise the arm

In determining the diagnosis it is most important to take a thorough history from the patient and also to examine them to assess their range of motion and ability to use and raise their arm. After this, one or more of the following tests may be ordered – a plain xray, ultrasound or MRI in order to assess the condition of the bones, tendons and ligaments.

In patients who have an acute rupture of their rotator cuff after a fall, surgical management is generally indicated to restore function to the arm, however the majority of rotator cuff tears are degenerative in nature and occur over time. These ones rarely require surgery and are best managed with non-operative management.

• Physiotherapy, including exercises of stretching and strengthening
• Anti-inflammatory medication
• Activity modification
• Cortisone (steroid) injections

If this does not help in reducing the pain or if there is poor shoulder function then surgery maybe recommended. For those patients with a rotator cuff tear, a rotator cuff repair is performed. If a patient with a rotator cuff tear does not have surgery, then the tendon tear may, in some cases, increase in size. For others the shoulder may continue to function reasonably for many years.

When rotator cuff tears are relatively recent and when a significant force was required to tear the tendon, the chances of regaining shoulder strength by rotator cuff surgery are good. Conversely, when the defect is longstanding and occurred without a major injury, the quality and quantity of tissue available for repair may not be sufficient for the restoration of good shoulder function.