Introduction
Shoulder care · Tendon injuries
Rotator cuff tear
Dr Sean LeoOrthopaedic Surgeon, Singapore
Clinic enquiries · Not an emergency service
Illustrative image
A rotator cuff tear is a tear in the tendons that move the shoulder.
A rotator cuff tear is a tear in the tendons that move the shoulder.
A rotator cuff tear is a tear in the tendons that move the shoulder.
- A rotator cuff tear happens when one or more of the tendons of the rotator cuff is partly or completely torn away from the bone at the top of the upper arm.[1] It is a common cause of shoulder pain and weakness in adults.[1]
- A tear can be partial or full-thickness, and it can follow an injury or build up slowly with age.[1] Surgery is not automatic. Most people start with non-surgical care, and only a small number go on to need an operation.[1][6]
- Weakness or pain in the shoulder has more than one possible cause, so the answer comes from assessment, not from a webpage. Stiffness, shoulder pain in general, pinching pain and a shoulder that has come out of joint each have their own pages, linked below.
- OrthoKinetics is Dr Sean Leo’s professional brand. Clinical consultations and treatment are provided through OrthoSports Orthopaedic & Sports Surgery. Dr Sean Leo is a specialist orthopaedic surgeon who cares for shoulder problems.
What’s covered on this webpage
Follow the route in order, or jump to the stop you need. Stops you have read are marked.
The rotator cuff is four tendons that hold the shoulder and lift the arm.
The rotator cuff is four tendons that hold the shoulder and lift the arm.
The rotator cuff is four tendons that hold the shoulder and lift the arm.
The rotator cuff is a group of four muscles that come together as tendons to form a covering around the ball of the shoulder joint.[1] It attaches the upper arm bone to the shoulder blade and helps you lift and rotate your arm.[1]
Most tears occur in one of the four tendons, the supraspinatus, though the others can be involved too.[1] Not every shoulder problem is a supraspinatus tear.
A tear usually comes from an injury or from gradual wear over time.
A tear usually comes from an injury or from gradual wear over time.
A tear usually comes from an injury or from gradual wear over time.
There are two main causes of a rotator cuff tear: an injury and gradual wear.[1] A fall onto an outstretched arm, or lifting something too heavy with a jerking movement, can tear the cuff.[1]
Most tears, though, are the result of the tendon wearing down slowly over time. This wear comes with ageing and is usually relatively painless.[1] Because of this, people over 40 are at greater risk.[1] That is a statement about risk, not a rule about any one person, and a tear says nothing about how carefully you have used your shoulder.
Many people have a tear without knowing it, so a tear seen on a scan is not always the cause of a person’s pain.[4]
How common tears are with age
In one point-of-care review, about 30% of adults over 60 were reported to have a tear, and about 62% of adults over 80, whether or not they had symptoms.[4] These are approximate figures from international studies, not Singapore figures, and they describe groups of people, not you.
It often shows up as weakness and pain when you lift or reach.
It often shows up as weakness and pain when you lift or reach.
It often shows up as weakness and pain when you lift or reach.
The most common symptoms of a rotator cuff tear are:[1]
- pain at rest and at night, especially when lying on the affected shoulder
- pain when lifting and lowering the arm, or with specific movements
- weakness when lifting or rotating the arm
- a crackling sensation, called crepitus, when moving the shoulder in certain positions
A tear that happens suddenly, such as in a fall, usually causes intense pain. There may be a snapping sensation and immediate weakness in the upper arm.[1] Some tears are not painful at all, but they can still cause arm weakness and other symptoms.[1]
No symptom pattern confirms a tear, and symptoms alone do not show which structure is responsible. If stiffness stands out more than weakness, the frozen shoulder (adhesive capsulitis) page covers it. If the shoulder has come out of joint, see the shoulder dislocation page. If the pain is a pinching pain, see the shoulder impingement (bone spurs) page. For pain that is spread out and not clearly any of these, start with the shoulder pain page.
Tears are partial or full-thickness, and size matters.
Tears are partial or full-thickness, and size matters.
Tears are partial or full-thickness, and size matters.
A partial tear goes only part-way through the thickness of the tendon. The tendon is still attached to the bone, but it is thinner than normal.[1]
A full-thickness tear detaches part of the tendon from the bone. When only a small part is detached, it is called a full-thickness incomplete tear. When the tendon is completely detached, it is a full-thickness complete tear, and there is essentially a hole in the tendon.[1]
You cannot tell your tear type from how it feels. The type is shown on imaging.[1] The size of the tear and the quality of the tissue around it are among the things weighed when care is chosen.[1]
How size enters the decision
The American Academy of Orthopaedic Surgeons (AAOS) lists a large tear, more than 3 cm, with good quality surrounding tissue as one of the signs that surgery may be a good option.[1] That figure is the AAOS patient reference’s own cut-off. It is not a universal threshold, and it is one of several things considered together.
When should I get this assessed?
When should I get this assessed?
When should I get this assessed?
A tear from a sudden injury usually causes intense pain, sometimes a snap, and immediate weakness.[1] Those are reasons to be assessed promptly rather than to wait and see. More generally, pain that persists, gets worse or limits your movement, work or sport, or simply not knowing what is causing it, is a reasonable reason to be assessed.
Some signs mean a shoulder should be seen urgently rather than at a routine appointment. Those signs are listed under Final next step at the end of this page.
Safety note: This webpage is not an emergency service. No list on this page can rule out a serious problem remotely.
Assessment looks at movement and strength, then uses imaging where it helps.
Assessment looks at movement and strength, then uses imaging where it helps.
Assessment looks at movement and strength, then uses imaging where it helps.
Assessment starts with the story of what happened and how the shoulder behaves. The examination then checks whether any area is tender, how far the arm moves in different directions, and how strong it is in different positions and movements.[1]
There is limited evidence that any single examination test is highly sensitive or specific for a cuff tear, so the diagnosis rests on the whole assessment rather than on one manoeuvre.[4]
Imaging is used where it helps. A plain X-ray does not show soft tissues such as the rotator cuff, so an X-ray of a shoulder with cuff pain is usually normal. A normal X-ray does not rule out a tear.[1] An MRI or an ultrasound can show the tendons, and will show the location and size of a tear.[1] Ultrasound can be quicker and easier to arrange than MRI, but how accurate it is depends on the quality of the person performing the scan.[1] A scan supports the assessment. It does not replace it, and it does not decide treatment by itself.
Most tears are treated without surgery first.
Most tears are treated without surgery first.
Most tears are treated without surgery first.
Non-surgical treatment is the usual starting point. The options include rest, changing your activities, anti-inflammatory medicines, and strengthening exercises with physiotherapy.[1] AAOS reports that in about 80 to 85% of patients, nonsurgical treatment relieves pain and improves function in the shoulder.[1] That is a patient-guidance figure from one source, so treat it as approximate, not as a promise.
For a newly diagnosed tear that causes symptoms, physiotherapy that strengthens the shoulder blade and core muscles is associated with similar clinical outcomes to surgical repair for small and medium-sized tears. It has also been an effective main treatment for most people even with a full-thickness tear, followed over two years.[4]
People who respond to non-surgical care typically do so within about 6 to 12 weeks.[4] More broadly, most people’s symptoms settle over time, and that can take several weeks or months.[6] A tear can also get larger over time, which is one reason to have it assessed rather than ignored.[3] Your clinician will tell you what to expect for your own shoulder.
An injection is one option some people are offered when rest, medicines and physiotherapy have not relieved the pain. It may help pain for some people, but it does not work for everyone, and sources differ on how much it helps.[1][4] It does not by itself change the tear.[4] Repeated, long-term injections carry potential risks, so the pros and cons are worth talking through with your doctor.[1]
When is repair considered?
When is repair considered?
When is repair considered?
Repair is considered for specific situations. It is not the default.
Your doctor may recommend surgery if your pain does not improve with non-surgical methods. Continued pain is the main reason for having surgery.[1] Surgery may also be suggested if you are very active or use your arms for overhead work or sport.[1] Other signs that surgery may be a good option include symptoms that have lasted 6 to 12 months, a large tear with good quality surrounding tissue, significant weakness and loss of function in the shoulder, or a tear caused by a recent, acute injury.[1]
How the tear happened and your age matter too. For complete tears in people under 40, which are usually from an injury, surgery is generally the recommended treatment, followed by rehabilitation, and these tears respond well to it. That advice rests on limited data, mostly from studies in older patients.[4] Tears from the natural wear that comes with ageing are normally treated without surgery first.[4] The overall evidence for surgery for full-thickness tears was graded weak in AAOS recommendations.[4]
Structure / Patient / Goal
Structure / Patient / Goal
Deciding together
Structure / Patient / Goal
S
Structure: what is affected?
Structure is what is affected: which tendon is torn, where, what type and size the tear is, and how the rest of the shoulder around it is doing.
P
Patient: how does it affect you?
Patient means you as a whole person. Your symptoms, how active you are, your general health, your preferences and your circumstances all shape which options are reasonable.
G
Goal: what are you hoping to return to?
Goal is what matters to you, whether that is everyday tasks, work or sport. A useful plan starts from a clear purpose.
Your plan
No single factor decides treatment alone, and one scan or one symptom does not determine the plan.
Does this tear need surgery?
Does this tear need surgery?
Does this tear need surgery?
For most tears the answer starts with non-surgical care, and a clinician then weighs what is specific to your shoulder.
The things weighed include how the tear happened (a recent injury or gradual wear), your age and how much you use the arm, the size of the tear and the quality of the tissue around it, and how long the symptoms have lasted.[1][4] Continued pain despite non-surgical care is the main reason surgery is considered.[1]
Non-surgical care is associated with similar outcomes to surgery for small and medium-sized tears.[4] Across trials of full-thickness tears, both groups improved most in the first 12 months, and there was no clear advantage of surgery overall.[4] That is a finding about groups of people. It does not mean surgery is never right for a particular tear, and some situations more clearly favour repair.[1][4]
That judgement is made with your treating clinician, from the examination and the imaging. It is not something to work out from a tear size on a report or from a webpage.
Repair reattaches the torn tendon to the bone.
Repair reattaches the torn tendon to the bone.
Repair reattaches the torn tendon to the bone.
Rotator cuff repair is an operation that reattaches the torn tendon to the bone.[2] The technique depends on the tear and the tissue.
Repair reattaches the tendon. It does not guarantee a pain-free or tear-free result, and the risks section below explains why.[2][5]
Recovery is staged over months, not a fixed date.
Recovery is staged over months, not a fixed date.
Recovery
Recovery is staged over months, not a fixed date.
After a repair, recovery moves through stages, and it is judged by how the shoulder is doing at each stage, not by the calendar. The stages below are AAOS ranges. They vary with the tear and the repair.[2]
- Protected phase. You will most likely use a sling and avoid using the arm for the first 4 to 6 weeks.[2]
- Passive movement. In most cases, passive exercise begins within the first 4 to 6 weeks after surgery.[2]
- Active movement. After 4 to 6 weeks, you progress to active exercises.[2]
- Strengthening. At 8 to 12 weeks, your physiotherapist starts to introduce strengthening exercises.[2]
- Function. Most people have a functional range of motion and adequate strength by 4 to 6 months after surgery, and a complete recovery takes several months.[2]
How long you need a sling depends on the severity of the injury, the quality of the tissue and the type of repair.[2]
If you are treated without surgery, recovery is also a matter of weeks to months. Those who respond typically do so within about 6 to 12 weeks, and symptoms settle gradually over several weeks or months.[4][6]
Risks and complications
Risks and complications
Risks and complications
A repair can re-tear, and it is better to know that before you decide than to find out afterwards.
Re-tear. Surgical repair can improve function and ease pain, but failure rates remain substantial. Across the published literature, reported rates range widely, from about 7% to 69%.[5] The range is wide because the studies differ. It is not a figure for any one person. Higher re-tear rates are associated with advanced age, larger tears, poor tissue quality, greater tendon retraction, longer symptom duration, diabetes, and other factors.[5] There is a chance of re-tear after every type of repair, and the larger the tear, the higher the risk.[2]
What a re-tear means. People who re-tear the tendon usually do not have greater pain or decreased shoulder function. Repeat surgery is needed only if there is severe pain or loss of function.[2] That does not make a re-tear harmless or inevitable, and it is one of the things to weigh with your surgeon.
Before you decide. Your surgeon can go through the risks that apply to your shoulder and your health.
Does repair give a better result than non-surgical care
Does repair give a better result than non-surgical care
Does repair give a better result than non-surgical care?
For many full-thickness tears, the research so far does not show a clear winner.
A 2019 meta-analysis of randomised trials in full-thickness tears, as summarised by StatPearls, found that both the surgical and non-surgical groups had their largest improvement by 12 months, after which improvement levelled out. There was no clear advantage of surgery over non-surgical treatment.[4]
This is a finding about groups of people. It does not predict what will happen to you, and it does not remove the specific situations in which surgery is recommended.[1][4] The choice is individual. It is not a contest with one winner.
OrthoKinetics Recovery Reflection
Recovery reflection
If a tear can sit on a scan without causing any trouble, what is the picture really telling you?
A scan shows the structure. It does not show how the shoulder works or how it feels to live with. Many people have a tear without knowing it,[4] so a tear on an image is not, by itself, a description of a problem. In the other direction, people whose repaired tendon has re-torn usually do not have greater pain or less function.[2] The picture and the person do not always match.
What would it mean to judge your shoulder by what it does, rather than by what the image shows?
It might mean noticing whether the reach you avoided last month comes more easily now, whether nights are quieter, whether the arm holds up when you carry something. Those are things you can observe, and they belong to you. The image is one useful piece of information alongside them. It is not the whole account of your shoulder.
A scan describes the tendon. Your shoulder is described by how it moves, how strong it feels and how comfortable it is, and the picture and the person are both worth attending to.
Illustrative image
With you through the seasonsMeet Dr Sean Leo
Meet Dr Sean Leo
A consultant orthopaedic surgeon whose clinical focus is the knee, sports injuries and the lower limb.
- Dr Sean Leo is a consultant orthopaedic surgeon. OrthoKinetics is his professional brand; clinical services are provided through OrthoSports Orthopaedic & Sports Surgery at Mount Elizabeth Novena Specialist Centre and Connexion, Farrer Park Hospital.
- His clinical interests include sports injuries, including those in adolescent athletes; ligament reconstruction; realignment surgery; cartilage repair and joint-preservation approaches; knee replacement; and technology-assisted hip and knee surgery.
- The consistent aim is to return people to meaningful function and activity while avoiding unnecessary downtime.
- Qualifications: MBBS, MRCS (Ed), MMed (Ortho), FRCSEd (Ortho).
More detail: Meet Dr Sean Leo
- Training and career: Dr Leo trained in medicine at the National University of Singapore and served in the Singapore Armed Forces Medical Corps from 2000 to 2012, where his work included the care of soldiers in physically demanding roles. He completed postgraduate orthopaedic training in 2009 and a one-year clinical fellowship at Royal North Shore Hospital in Sydney, Australia, before joining Changi General Hospital as an orthopaedic consultant in 2012, where he later held the positions of Senior Consultant and Director of the Hip and Knee Service. With seniority, his educational contribution has evolved towards mentorship and support for junior doctors.
Questions people often ask
Common rotator cuff tear questions
Common rotator cuff tear questions
What is a rotator cuff tear?
A rotator cuff tear is a tear in one or more of the four tendons that hold the ball of the shoulder and help lift and rotate the arm. The tendon is partly or completely detached from the bone. It can follow an injury or build up with age, and it is common in adults.[1]
Why does my shoulder hurt when I lift my arm, especially at night?
Pain at rest and at night, especially when lying on the affected shoulder, and pain when lifting or lowering the arm, are common symptoms of a rotator cuff tear. Symptoms alone do not confirm a tear, and other shoulder problems can feel similar, so an assessment is what tells them apart.[1]
How do I know if my shoulder problem is a rotator cuff tear?
You cannot tell from symptoms alone. Weakness and pain on lifting or rotating the arm are typical of a tear, but they do not confirm one. Assessment looks at tenderness, movement and strength, and imaging such as MRI or ultrasound shows a tear and its size.[1][4]
What is the difference between a partial and a full-thickness tear?
A partial tear goes only part-way through the tendon, so the tendon stays attached to the bone but is thinner than normal. A full-thickness tear detaches part or all of the tendon from the bone. The type is shown on imaging, not felt from symptoms.[1]
Can a rotator cuff tear heal without surgery?
Most people’s symptoms settle over several weeks or months with non-surgical care such as strengthening exercises and physiotherapy.[1][4][6] That is different from the tear itself going away, since a tear can get larger over time.[3] Whether your tear can be managed without surgery is decided at assessment.
Does my rotator cuff tear need surgery?
Not automatically. Non-surgical care is the usual starting point, and surgery is considered for specific situations such as ongoing pain despite treatment, a large or recent acute tear, or significant weakness. Across trials, surgery showed no clear overall advantage after 12 months. Your clinician weighs this for your shoulder.[1][4]
What does a cortisone injection do for a rotator cuff tear?
A cortisone injection is one option when rest, medicines and physiotherapy have not relieved the pain. It may help pain for some people, but it does not work for everyone, and sources differ on how much it helps. It does not by itself change the tear.[1][4]
How long does recovery take?
It depends on the tear and the treatment, so there is no fixed date. Without surgery, people who respond typically do so within about 6 to 12 weeks. After a repair, a sling is used for the first 4 to 6 weeks, and most people have functional movement and adequate strength by 4 to 6 months.[2][4]
What happens if I don’t treat a rotator cuff tear?
Symptoms often settle with non-surgical care over weeks to months,[6] but a tear can get larger over time.[3] Treatment does not always mean surgery. If pain or weakness persists or limits what you do, an assessment can explain the options for your shoulder.
Is my shoulder pain a rotator cuff tear, frozen shoulder (adhesive capsulitis) or impingement?
It is not possible to tell from a webpage. Assessment decides which one you have, and the other two have their own pages: frozen shoulder (adhesive capsulitis) and shoulder impingement (bone spurs). Shoulder-area pain can also come from a pinched nerve in the neck.[1]
Should I see a specialist orthopaedic surgeon or a GP first?
Either can be a reasonable starting point. A specialist orthopaedic surgeon who cares for shoulder problems can assess the shoulder directly, which suits a suspected tear or a problem that is not settling. Signs on this page that need urgent help are listed under Final next step.
Costs and insurance
Costs and insurance
Practicalities
Cost, Medisave and insurance
Ask the clinic team for current information about fees, panel status, pre-authorisation and expected payment arrangements. Insurance coverage and out-of-pocket costs depend on the individual policy and the insurer’s decision; no coverage is guaranteed.
A cost estimate for surgery can be given only after a consultation and assessment, once a surgical plan has been developed. Each individual condition is unique — implants used, time taken, and other factors contribute to the overall estimate. The estimate will be provided to you by the clinic should you decide on surgical management, and will also be used to assist in obtaining pre-authorisation from insurance where applicable.
Insurance panels. Dr Sean Leo, Orthopaedic Surgeon, is on the specialist panels of Great Eastern (GE Panel), HSBC Life (HSBC Life Shield) and Singlife (Singlife Shield), and on the Prudential Panel. AXA Insurance Singapore became part of HSBC Life in 2023, and former AXA Shield plans are now HSBC Life Shield plans.
Corporate health plans. Dr Leo is on the panels of both Alliance Medinet and iXchange, which administer medical benefits for many company health plans. If your company plan uses either panel, you can see Dr Leo as a panel doctor.
If your company uses a different panel. Some company plans still let you see a doctor of your choice outside their panel, then claim reimbursement. This varies from plan to plan, as may the co-payment, so please check your benefits with your company’s HR department.
Panel arrangements change from time to time, so please confirm with your insurer or your company’s plan administrator before your appointment.
Dr Leo is on the panels shown. If your insurer is not listed, you may ask whether co-management with an Orthosports surgeon partner on that panel is clinically and administratively appropriate. Orthosports surgeon partners are collectively on the panels of all Shield plans.
Specific benefits, pre-authorisation, reimbursement and cashless treatment depend on the individual policy and insurer approval and are not guaranteed.
Arrange a consultation: the appointment section is further down this page.
Sources
References
References
- American Academy of Orthopaedic Surgeons (AAOS). Rotator Cuff Tears. OrthoInfo. Available at: https://www.orthoinfo.org/diseases–conditions/rotator-cuff-tears
- American Academy of Orthopaedic Surgeons (AAOS). Rotator Cuff Tears: Surgical Treatment Options. OrthoInfo. Available at: https://www.orthoinfo.org/treatment/rotator-cuff-tears-surgical-treatment-options/
- American Academy of Orthopaedic Surgeons (AAOS). Rotator Cuff Tears: Frequently Asked Questions. OrthoInfo. Available at: https://www.orthoinfo.org/diseases–conditions/rotator-cuff-tears-frequently-asked-questions/
- May T, Garmel GM. Rotator Cuff Injury. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. NCBI Bookshelf NBK547664. Available at: https://www.ncbi.nlm.nih.gov/books/NBK547664/
- Sußiek J, Buchmann S, Beitzel K, Lappen S, et al. Patient-specific risk factors for repair failure and poor functional outcome after rotator cuff repair: an umbrella review. BMC Musculoskelet Disord. 2026;27:167. doi:10.1186/s12891-025-08608-w. PMCID: PMC12930581. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12930581/
- NHS inform (NHS Scotland). Rotator cuff problems. Available at: https://www.rightdecisions.scot.nhs.uk/media/32klwb3d/rotator-cuff-problems-nhs-inform.pdf
Final next step
Final next step
Next step
Final next step
Reading about a problem is a starting point. An assessment brings together the history, an examination where needed and any useful tests, and helps you and your clinician decide what to do next. How much physical examination is needed is a matter of clinical judgement. It may be limited when pain makes an examination unreliable, or when imaging clearly shows a problem that matches the symptoms, such as a fracture seen on an X-ray or an MRI scan that clearly shows an injury consistent with the symptoms. The Singapore Medical Council and the UK General Medical Council both allow remote medical consultations, where a physical examination is not possible, with safeguards: the doctor must be clear about the limits of an opinion formed without an examination, and whether an in-person examination is needed, or referral to other services, is left to the clinical judgement of the attending doctor.
Signs that need urgent help
Some symptoms should not wait for a routine appointment. Each item below says where to go.
After an injury
- After a fall or other injury, the shoulder looks out of place or has changed shape, you cannot move your arm, or the shoulder is painful, bruised or swollen. Go to an emergency department or call 995.
- After an injury, the arm or hand is numb, tingling, cool to the touch, or has turned white or purple. Go to an emergency department or call 995.
- After a fall, you have intense pain, a snapping feeling and sudden weakness in your upper arm. Arrange a prompt assessment.
At any time
- A joint, such as the shoulder, is suddenly very painful, hot, red and swollen (redness may be harder to see on darker skin), especially with a fever or feeling generally unwell. Go to an emergency department or call 995.
- You have chest pain that feels tight or like squeezing, or chest pain that spreads to your arm, neck or jaw, or you have severe difficulty breathing. Go to an emergency department or call 995.
- Your shoulder symptoms come with fever, night sweats or weight loss. Arrange an urgent same-day assessment.
If you are admitted by the doctor at the urgent care centre of one of these private hospitals, the Parkway Pantai hospitals (Mount Elizabeth Orchard, Mount Elizabeth Novena, Gleneagles and Parkway East), Farrer Park Hospital and Thomson Medical Centre, you may ask for Dr Sean Leo to be your attending orthopaedic surgeon. If you are instead discharged and referred for orthopaedic follow-up, you may contact the clinic to arrange an appointment. Both are subject to the hospital’s admission processes and to Dr Leo’s availability.
Was this page helpful?
Arrange a consultation
Appointments are arranged through the OrthoSports clinic team. Send your details below, or message or call the clinic.
Leave your details and the clinic team will reply to arrange a time.
Message the clinic on WhatsApp
-
38 Irrawaddy Road, #10-41 Mount Elizabeth Novena Specialist Centre, Singapore 329563 Map for Orthosports@Novena (opens Google Maps)
-
1 Farrer Park Station Road, #15-17 Connexion, Singapore 217562 Map for Orthosports@Connexion (opens Google Maps)
WhatsApp is for clinic enquiries only. It is not an emergency service and is not monitored for urgent care. Website or messaging contact is not an emergency-response service. For a medical emergency, use your local emergency service.
- OrthoKinetics does not provide emergency or urgent care through this webpage or its WhatsApp contact.