ROTATOR CUFF STRAIN VS TEAR: YOUR COMPLETE GUIDE

Typical rotator cuff strain symptoms can include:

• Dull, aching pain around the top or side of the shoulder, often after activity.
• Pain with lifting, reaching overhead, or rotating the arm, but usually manageable.​
• Mild weakness or fatigue in the shoulder muscles.
• Stiffness, especially after rest or first thing in the morning.​
• Pain that generally improves with rest and activity modification over days to weeks.

Typical rotator cuff tear symptoms can include:

• Sharp or more intense pain at the time of injury, sometimes with a popping or tearing sensation.
• Persistent pain that worsens with lifting or lowering the arm and when lying on the affected side at night.
• Noticeable weakness. Difficulty raising the arm overhead, reaching behind your back, or lifting everyday objects.
• Crackling, grinding or clicking (crepitus) with shoulder movement.
• In full‑thickness tears, it may be impossible to lift the arm above shoulder height or away from the body.

Some rotator cuff tears cause little or no pain, especially degenerative tears in older adults, and may be found incidentally on MRI. Pain intensity alone does not reliably indicate how bad the structural damage is.​

Both rotator cuff strains and tears can result from:

• Repetitive overhead movements (painting, manual trades, racquet sports, swimming).
• Sudden overload, such as lifting something heavy or awkward, or a fall onto an outstretched arm.
• Poor shoulder posture and mechanics, especially slouched posture and impingement.​

• Ageing: tendon quality declines with age; degenerative tears are very common after 50.
• Smoking: linked to more frequent and more severe rotator cuff tears.​
• Long history of overhead sport or labour, especially without adequate conditioning.
• Previous partial tears or long‑standing impingement syndrome.

You cannot be 100% sure without an assessment, but these patterns help guide suspicion.

• Gradual onset of pain after increasing training, DIY or workload.
• Discomfort rather than severe pain at rest; movement is sore but still possible.​
• Weakness is mild, more like “tiredness” than sa udden loss of strength.
• Symptoms start to ease with a few days of rest and simple home care.

• Sudden, sharp pain at the moment of injury, often with a “snap” or “pop”.
• Immediate or rapid loss of strength. Struggling to lift the arm or hold objects.
• Night pain that keeps you awake, especially lying on that shoulder.
• Symptoms that persist or worsen beyond one to two weeks despite rest.

Because shoulder sprains (ligaments) can mimic rotator cuff tears, and both can coexist, a thorough clinical exam is essential rather than relying purely on self‑diagnosis.​

A good assessment usually combines history, physical tests, and sometimes imaging.

Your clinician will ask about:

• How the pain started (sudden trauma vs gradual overload).
• Exact location of pain (top of shoulder, outer arm, front of shoulder).
• Activities or positions that aggravate or ease pain.
• Night pain, weakness, clicking and any sense of instability.

They will then test shoulder range of motion, strength of individual cuff muscles, and perform special tests that tension specific tendons and look for impingement.

Your clinician will ask about:

• How the pain started (sudden trauma vs gradual overload).
• Exact location of pain (top of shoulder, outer arm, front of shoulder).
• Activities or positions that aggravate or ease pain.
• Night pain, weakness, clicking and any sense of instability.

They will then test shoulder range of motion, strength of individual cuff muscles, and perform special tests that tension specific tendons and look for impingement.

Treatment overlaps significantly, especially early on, but severity and goals drive the plan.

Around 80–85% of people with rotator cuff injuries improve with non‑surgical treatment. This typically includes:​

• Relative rest and activity modification: avoiding or reducing overhead and heavy lifting while staying generally active.
• PEACE & LOVE protocol.
• Structured physiotherapy and exercise physiology: targeted strengthening of rotator cuff and scapular stabilisers, mobility work and gradual load progression.
• Posture and movement re‑education to reduce impingement and mechanical overload.
• Corticosteroid injection: sometimes used for persistent pain to calm inflammation and allow rehab to progress.

Physiotherapy is central for both strains and many tears and often allows patients to avoid or delay surgery.

Surgery is usually reserved for:

• Large or full‑thickness tears with significant functional loss.
• Acute traumatic tears in younger or highly active patients.
• Symptoms persisting 6-12 months despite high‑quality non‑surgical care.​

Common surgical options include arthroscopic tendon repair, open repair for complex or massive tears, tendon transfer, or reverse total shoulder replacement in severe, irreparable cases with arthritis. Surgical recovery involves a period in a sling (often 4-6 weeks) followed by months of progressive physiotherapy, with many people regaining good function by about 4-6 months.

Recovery time depends on injury grade, your age, general health and how well you follow rehab.

• Mild strain (Grade 1): often improves over 2-4 weeks with appropriate rest and exercises.​
• Moderate strain/partial‑thickness tear: commonly requires 8-12 weeks or more of structured rehab to restore strength and function.
• Full‑thickness tear managed conservatively: may improve symptomatically over months but residual weakness can remain.
• Post‑surgical repair: sling for up to 4-6 weeks, then progressive rehab over several months; full strength and range can take 4-6 months or longer.​

Tendon healing is slow because of relatively poor blood supply, so even with ideal management, you should expect “good days and bad days” rather than linear improvement.​

If your symptoms sound more like a mild to moderate strain and there are no red flags (see below), simple measures can help.

• Reduce overhead and heavy lifting for a few weeks rather than complete rest.
• Start gentle pain‑free range‑of‑motion exercises (pendulums, supported forward reach) and progress to light strengthening when pain allows.
• Prioritise posture – avoid prolonged slumping at a desk and adjust workstations where possible.​

If pain is not clearly improving after 1–2 weeks, or if you rely on pain medication to cope with everyday tasks, you should seek professional assessment.

Seek prompt medical or physiotherapy review if:

• You had a fall or sudden injury with immediate sharp pain and loss of strength.
• You cannot lift or rotate your arm as you normally would.
• You notice visible deformity, significant swelling or bruising around the shoulder.
• Night pain is severe or worsening and interrupts sleep regularly.
• Symptoms have not improved after 1–2 weeks of rest and simple care.

Early assessment and targeted treatment help prevent minor strains from progressing and improve outcomes for more significant tears.

In summary, rotator cuff strain vs tear differs mainly in severity. Strains involve overstretching with milder pain and quicker recovery (2–12 weeks), while tears cause significant weakness, night pain, and may need surgery after failed physio. We’ve covered symptoms, causes, diagnosis (exam/ultrasound/MRI), treatments, and red flags like the inability to lift your arm. For accurate assessment and tailored physiotherapy in Sydney’s Burwood, Top Ryde, Newington, or East Gardens clinics, book today to prevent progression and restore shoulder function.