Rotator Cuff Tears: Repair, Rehab or Regenerate?

Shoulder pain can be frustratingly persistent. It disrupts your sleep, limits your range of motion, and can reduce your ability to do even the simplest tasks—like lifting a kettle, putting on a coat, or reaching for the top shelf. One of the most common causes of shoulder dysfunction in adults over 40 is a rotator cuff tear.

Whether you’re an athlete, a manual worker, or simply someone experiencing age-related wear and tear, rotator cuff injuries demand more than rest and guesswork. With modern diagnostics and regenerative therapies, you no longer have to wait for your shoulder to “get bad enough” for surgery. The key is identifying the right approach—repair, rehabilitation, or regeneration—based on your condition and goals.

What Is the Rotator Cuff?

The rotator cuff is a group of four muscles and tendons that stabilise and move the shoulder joint:

• Supraspinatus (most commonly injured)

• Infraspinatus

• Teres minor

• Subscapularis

Together, they keep the ball of the upper arm bone (humerus) centred in the shoulder socket and allow for overhead lifting, rotation, and fine arm control.

When one or more of these tendons is damaged—either through repetitive use, trauma, or age-related degeneration—a rotator cuff tear can occur. This can be partial (fraying or thinning) or full-thickness (complete rupture).

Signs and Symptoms of a Rotator Cuff Tear

Rotator cuff tears often start subtly and worsen over time, particularly in degenerative cases. Acute tears, from a fall or sudden overload, tend to be more dramatic.

Common symptoms include:

• Dull, aching pain in the shoulder or upper arm

• Pain that worsens at night or when lying on the affected side

• Weakness when lifting or rotating the arm

• Clicking, catching, or limited range of motion

• Difficulty performing overhead tasks or lifting objects

While some people adapt and “push through” shoulder pain, this often leads to compensation, worsening the problem and increasing the risk of frozen shoulder or secondary injuries.

Causes and Risk Factors

Rotator cuff tears are more common than many realise—especially after the age of 40.

Degenerative tears occur gradually due to:

• Age-related tendon thinning

• Poor posture and shoulder biomechanics

• Repetitive overhead activities (e.g. painting, swimming)

• Weak or imbalanced shoulder stabilisers

Traumatic tears may result from:

• Lifting heavy objects suddenly

• Falling onto an outstretched arm

• Dislocations or high-impact injuries

At MSK Doctors, we use onMRI™ imaging to visualise the rotator cuff with precision, distinguishing between acute and chronic tears and evaluating tendon quality—key factors in choosing the right treatment.

Repair, Rehab or Regenerate?

Treatment options for rotator cuff tears depend on several factors: the size and location of the tear, your activity level, age, and how much function or pain you’re experiencing.

✅ Rehabilitation (Conservative Approach)

Best for: Partial tears, degenerative changes, low-demand individuals

Rehab focuses on restoring shoulder stability, strength, and motion without surgery.

Typical rehab includes:

• Rotator cuff and scapular strengthening

• Postural correction and thoracic mobility

• Cryo-ultrasound or shockwave therapy to reduce pain

• MAI-Motion™ to track movement control and avoid compensations

✅ Regenerative Therapy

Best for: Partial tears or tendon degeneration, patients seeking non-surgical options

Orthobiologics such as PRP (Platelet-Rich Plasma), micro-fragmented fat (mFAT), or exosomes may be injected under ultrasound guidance to stimulate tendon healing and reduce inflammation.

Combined with rehab, regenerative medicine can:

• Slow tendon degeneration

• Improve collagen quality and healing

• Reduce pain and restore function

• Delay or avoid surgery in appropriate patients

✅ Surgical Repair

Best for: Full-thickness tears, failed conservative care, active patients with loss of strength

Modern keyhole (arthroscopic) techniques allow for rotator cuff reattachment with smaller incisions, quicker recovery, and less pain.

At MSK Doctors, we also assess muscle quality (using onMRI™) to determine repairability and long-term prognosis. Post-op rehabilitation is essential to restore motion, strength, and shoulder control.

Risks of Delayed Treatment

Ignoring shoulder pain rarely pays off. Without treatment, rotator cuff tears may:

• Enlarge over time

• Lead to muscle atrophy and fatty degeneration

• Cause chronic stiffness or frozen shoulder

• Result in permanent strength loss

• Increase risk of joint degeneration and arthritis

Frequently Asked Questions (FAQs)

1. How do I know if my rotator cuff is torn?
Symptoms such as night pain, weakness lifting, or difficulty reaching may indicate a tear. Diagnosis is confirmed through clinical examination and imaging such as ultrasound or onMRI™.

2. Can a rotator cuff tear heal on its own?
Partial tears may improve with rehab and regeneration, but full-thickness tears typically do not heal without surgical intervention.

3. Is PRP effective for rotator cuff injuries?
Yes, PRP can promote healing in partial tears and tendinopathy. It’s often used as a non-surgical solution, especially when combined with rehabilitation.

4. How long is recovery after surgery?
Initial recovery ranges from 6–12 weeks, with full return to strength and activity taking 4–6 months, depending on the size of the tear and rehab commitment.

5. Can I exercise with a rotator cuff tear?
Yes—with guidance. Avoid overhead or heavy lifting and focus on controlled rehab exercises that strengthen stabilisers without stressing the tear.

6. When should I consider surgery?
If you have persistent pain, weakness, or functional loss despite rehab, or if imaging shows a large tear with risk of retraction, surgery may be the best option.

Conclusion: Rebuild Your Shoulder the Right Way

Rotator cuff injuries don’t just affect athletes—they’re a leading cause of shoulder pain and loss of function in adults of all backgrounds. The good news is that modern diagnostics, targeted rehab, and regenerative options offer multiple pathways to recovery—without unnecessary delays or surgery-first thinking.

At MSK Doctors, we specialise in evidence-led, patient-centred care. Whether you need rehab, imaging, injections, or surgical consultation, our goal is simple: restore your shoulder, your strength, and your confidence.

Book your shoulder consultation today—no referral needed.