Part of Rotator cuff tendinopathy
Rotator cuff tear or tendonitis: is my rotator cuff torn or inflamed?
Warning signs, and when to get help
Rotator cuff tear vs tendonitis: what is actually different?
One sheet of tendon, two words for different states of it. Four small muscles blend into that sheet where it wraps over the ball of your shoulder, and the whole thing is the rotator cuff. Tendinopathy, which you may see written as tendonitis in the USA or tendinitis almost everywhere else, means that tendon has become painful and is carrying load less well than it used to. A scan report may word that same state as tendinosis, which the 2026 Dutch guideline update lists inside subacromial pain syndrome, along with calcific tendinitis and degenerative tears of the cuff tendon at the top of the shoulder. A tear means some of its fibers have come apart.
OrthoInfo, the patient site of the American Academy of Orthopaedic Surgeons, divides tears into two kinds. A partial-thickness tear damages part of the depth of the tendon. A full-thickness tear goes the whole way through, so the tendon no longer has a continuous attachment to the bone. OrthoInfo splits that one again: in a full-thickness incomplete tear only part of the tendon has pulled off the bone, and in a full-thickness complete tear it has come away entirely. Both are full thickness, so a report using either wording is handled the same way, though not on this page: a full-thickness tear's own management and the surgery decision sit on rotator cuff tear treatment without surgery, and the section below on where the professional line falls explains why the split matters.
That split decides which page you need, not whether you need an operation. OrthoInfo's own list of what makes surgery a reasonable option to discuss includes how big the tear is, the quality of the tissue around it, how much strength and function have gone, and whether the tear came from a recent injury. Each of those is a judgment for the team examining the shoulder in front of them.
The difference between the two words, then, is structural. It describes tissue, not how bad a shoulder feels, and that is where most comparisons of the two go wrong.
How do I know if my rotator cuff is torn?
Not from how much it hurts. Khazzam and colleagues (2018) looked at 391 people with rotator cuff disease, 274 with tendinitis and 117 with tears, average age 57, and the state of the rotator cuff did not track with worse shoulder pain. Their study was a snapshot of one moment, so it shows an association and not a cause, and it says nothing about what any one shoulder will do next.
What narrows it down is the story and an examination by a doctor or physio. A scan gets added when the answer would change what happens next, not to put a name on the tissue. The 2026 update of the Dutch guideline asks for an ultrasound where a rupture of the tendon at the top of the cuff (supraspinatus) is suspected, partial thickness included, and for an MRI to be considered if ultrasound is not available or does not settle it. For what each scan can and cannot see, read do you need a scan for shoulder impingement.
A few things shift the odds without settling them: a sudden injury, an arm that has been weak since, and age. The first two are a reason to be seen, not to read on: if the pain started with a fall, a pull or another injury and the arm has been weak since, get medical advice the same day, and say how it happened and that the arm has been weak since. Age works the other way, and Australia's healthdirect says it plainly on its rotator cuff injury page: older people with rotator cuff injuries commonly have no symptoms at all.
Does a rotator cuff tear hurt more than tendonitis?
No, not on the evidence we have, and that is worth saying because much of what is written on this question says the opposite. The sudden sharp pain of a tear against the dull persistent ache of tendonitis is a story, not a finding. In Khazzam and colleagues' 391 patients, cuff status did not correlate with worse pain.
Pain is a poor witness here. Weakness is a better one, and it is also the one that changes how fast you need to be seen. A shoulder that hurts more this month than last month is common and is usually about load. That is not a reason to sit on it: the NHS says to see a doctor or physiotherapist if shoulder pain is getting worse, or if it has not improved after 2 weeks, and that holds whatever the report calls your tendon. An arm that cannot lift out to the side, or cannot hold itself up, is a different conversation, and the last section sets out how quickly that needs looking at.
Can rotator cuff tendonitis turn into a tear?
They sit on one spectrum, so there is less of a line to cross than the two words suggest. The 2025 physical therapy guideline for this condition puts rotator cuff tendinopathy and partial-thickness tears inside one scope, so its recommendations cover both (Desmeules and colleagues, 2025).
Cuff tears also become more common with age in shoulders that are not complaining. Sher and colleagues scanned 96 people with no shoulder symptoms at all in 1995: 34 percent had a cuff tear, and among the 46 of them aged over 60 it was 54 percent.
Partial tears can get bigger. Australia's healthdirect says that partial-thickness rotator cuff tears can progress to full-thickness tears over time, and that a repaired cuff can tear again. None of the sources cited on this page measures how often a painful tendon with no tear goes on to tear, or how often a partial tear becomes a full one, so no figure for either appears here. What you can influence is the load the tendon is being asked to take and how fast that load changes, which is what the rotator cuff tendinopathy program is built around.
Does a tear show on a scan, and does that settle it?
A tear usually shows up on a scan. Whether it is the reason your shoulder hurts is a separate question, and the figures below are why.
Among those 96 people with no shoulder symptoms, Sher and colleagues found 15 percent with a full-thickness tear and 20 percent with a partial-thickness one, and not one of the 25 aged between 19 and 39 had a full-thickness tear. The authors concluded that the tears they were looking at were compatible with shoulders that worked normally and did not hurt. Read the figure the way they measured it, in people with no shoulder symptoms, and what it tells you is this: a tear on a report in an older shoulder is common, and it can be silent.
The number does no work in the other direction. Those shoulders were not complaining, so it says nothing about a shoulder that has newly lost power, and a tear being common in people who feel nothing is no reason to leave an arm that cannot lift. Sher and colleagues made the surgical version of that point themselves: they warned against using an MRI scan on its own, without the clinical findings alongside it, to decide whether to operate.
UK shoulder surgeons say the same thing in their national care pathway. A cuff tear on imaging does not always correlate with the symptoms and does not imply a need for surgery in every case, a report of a partial-thickness tear is common, and such a tear can be painless or sometimes a reporting false positive (Kulkarni and colleagues, 2015).
The same pathway puts limits on the scan itself, and they run in both directions. It says imaging the cuff with ultrasound or MRI is rarely needed in primary care at all, that ultrasound depends on the person doing it and that its accuracy for finding cuff tears varies, and that a normal cuff ultrasound does not rule out other serious shoulder problems. So a clear scan is not an all clear for a shoulder that is getting worse, and a positive one is meant to be read by a shoulder surgeon next to your symptoms, what the arm can do and how it responded to treatment, rather than on its own.
What a report cannot tell you is how much your shoulder hurts, how much it can do, or what it needs this week. That part comes from you and from the person examining you.
Where the professional line actually falls
Not between tendinopathy and a tear. Between a partial-thickness tear and a full-thickness one.
You can see that line in the paperwork. The 2025 guideline states its own scope as rotator cuff tendinopathy with or without calcification and partial-thickness tears, and says in as many words that it excludes other rotator cuff diagnoses such as full-thickness tears. The GRASP trial, which ran across 20 UK NHS trusts, drew the same boundary when it chose who to enroll: people with a history of significant shoulder trauma, which the trial spelled out as a dislocation, a fracture or a full-thickness tear needing surgery, people with a frozen shoulder and people already being considered for an operation were all left out (Hopewell and colleagues, 2021).
In practice that tells you which page is yours. If your report says tendinopathy, tendinitis, tendinosis, impingement, subacromial pain or a partial-thickness tear, this cluster and the program it belongs to were written for you. If it says a full-thickness tear, the management, the surgery decision and the figures behind it are on rotator cuff tear treatment without surgery. If the cuff has already been repaired, follow the plan your surgical team gave you, and rotator cuff repair rehab covers that stage.
The repair line itself is not drawn in the same place by every surgeon, particularly for a tear that has come on with wear rather than with an injury, and they weigh the same scan differently depending on your age, your work, what the arm can still do and the state of the tissue. So where a surgeon or a surgical team has already given you a plan, a restriction or a date, theirs comes first and this page does not change it. Nothing here is a substitute for the appointment at which that decision is made.
Impingement, bursitis and a tear sit next to each other, and what bursitis adds to that group is worked through on impingement, bursitis or a rotator cuff tear.
Does the name change the treatment?
At the start, mostly not. If you are sitting with a report in your hand wondering what changes now, that is the answer.
The UK care pathway's nonsurgical treatment for these shoulders is rest, exercise, physiotherapy, pain relief and no more than two corticosteroid injections, with about 6 weeks of physiotherapy and a further 6 weeks if it is helping before a specialist referral is considered (Kulkarni and colleagues, 2015). In GRASP, 708 adults were spread across four treatment arms, and there was no evidence of a difference over 12 months between progressive exercise and best practice advice, with no serious adverse events in the trial.
So the first move is the same whichever of the two words you were given, as long as the shoulder came on gradually and the report does not say full thickness. A full-thickness tear sits outside the 2025 guideline's scope, so its first move is set on rotator cuff tear treatment without surgery and with the team managing it. The caveat about gradual onset comes from the trial, not from us. GRASP excluded people with a history of significant shoulder trauma, naming a dislocation, a fracture and a full-thickness tear needing surgery, so none of its reassurance reaches an arm that has been weak since an injury.
The rotator cuff tendinopathy program sets out what the exercises are and how much of them. For the movements worth changing while the shoulder is sore, read the worst exercises for a rotator cuff problem. How long any of it takes is a question in its own right, answered on how long rotator cuff tendonitis takes to heal. If the nights are the worst part, that is usual and not diagnostic, and how to sleep with rotator cuff pain explains what a bad night does and does not mean.
See a doctor or physio if the shoulder is getting worse, if it has not improved after 2 weeks, as the NHS advises, or if you are not confident the pain is coming from the cuff at all. Pain referred from the neck, a frozen shoulder and arthritis can all feel similar, and each needs a different plan.
When a cuff problem needs seeing sooner
Everything above is about a shoulder that came on gradually and is behaving itself. Not every shoulder is, and the point that pain does not tell you much is never a reason to wait when one of the following is going on.
Read this part as separate from the comparison. An arm that has been weak since a fall or a sudden pull needs medical advice the same day, and say how it happened and that the arm has been weak since. The injury does not have to have been to the shoulder on its own: OrthoInfo notes that an injury-related cuff tear can come alongside a broken collarbone, a dislocated shoulder or a wrist fracture, so a shoulder that will not work after any of those needs the same timing.
Sudden, very bad shoulder pain, or suddenly not being able to lift or move the arm at all, is also the same day. So is new numbness, pins and needles that do not go away, or weakness that is getting worse. A shoulder that is hot, red and swollen, or shoulder pain with a fever, means going to an emergency department the same day.
What makes the injury one urgent is not how much it hurts. UK shoulder surgeons list an acute cuff tear caused by a traumatic event among the shoulder red flags, which means an urgent referral to a specialist, ideally seen at the next available outpatient clinic, rather than the usual course of exercises first (Kulkarni and colleagues, 2015). If a program of exercises is all that is offered for an arm that has been weak since an injury, say again how it happened and ask whether a specialist opinion is needed.
Not everything that hurts in a shoulder is a shoulder problem. Shoulder or arm pain that comes with shortness of breath, sweating or feeling sick can be a heart attack, and that means calling emergency services straight away.
If chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked. If you faint while exercising, call emergency services, even if you feel fine again quickly.
The warning list below gives the full set of signs with how fast to act on each. None of them is settled by what the report calls your tendon.
One sign in the list below appears three times, at three different speeds. Pain at night or at rest that is constant, that no rest or change of position eases at all, and that keeps getting worse is a same-day matter if you are being treated for cancer now, a within-a-day-or-two matter if you have had cancer at any time or are losing weight without trying, and otherwise needs checking within a few days. If you cannot tell which of those you have, treat it as the more urgent one.
Related exercise programs
- Rotator cuff tendinopathy
- Rotator cuff tear without surgery
- Shoulder impingement
- Rotator cuff repair rehab
Warning signs
Get emergency help now
- Emergency: chest pain or tightness, which may spread to your arm, neck or jaw, or shoulder or arm pain that comes with shortness of breath, sweating or feeling sick. This can be a heart attack. Call emergency services straight away.
- Emergency: the shoulder is hot, red and swollen, or you have a fever or feel unwell. This can be a joint infection, which needs treatment quickly. Go to an emergency department the same day, and call emergency services if you feel very unwell.
- Emergency: the shoulder feels as if it has slipped out of place, looks a different shape or suddenly locks so you cannot move the arm, or the pain is severe after a fall or an injury. Go to an emergency department straight away, without driving yourself, and do not try to put the shoulder back in yourself.
- Emergency: your arm, hand or fingers turn cold, pale, blue or gray compared with the other side. Call emergency services or go to an emergency department straight away, and do not drive yourself. The blood supply to the arm may be blocked.
Get help now, day or night
- Since your operation, the shoulder is hot, red and swollen, you have shoulder pain with a fever, or the redness, warmth, swelling or pain in your shoulder is not getting better or is getting worse, for example the shoulder pain keeps building both when you move and when you rest. This can be an infection in the shoulder joint. Contact your surgical team straight away, day or night, or the ward you went home from, and if you cannot reach them, go to an emergency department the same day.
Get help today
- Same day: sudden, very bad shoulder pain, or you suddenly cannot lift or move your arm at all. Get medical help the same day.
- Same day: the pain started after a fall, a pull or another injury, especially if the arm has been weak since, for example you cannot lift it out to the side or hold it up. This can be a broken bone or a torn tendon. Get medical advice the same day, and say how it happened and that the arm has been weak since, because UK shoulder surgeons advise urgent referral for a rotator cuff tear caused by an injury.
- Same day: a sudden pop or tearing feeling in the shoulder that brings sharp pain, new weakness or trouble lifting the arm. Stop and contact your surgical team the same day, or get medical advice the same day if you have not had surgery.
- Same day: since your operation, the arm has lost movement or strength it had gained, so lifting or turning it is weaker or much more painful than it was a week or two ago, or you notice clicking, grating or a new catch in the shoulder. A repair can pull off the bone without a pop, and when it does the usual sign is lift that was coming back and has gone again, sometimes with little new pain. Rest the arm, leave out any exercise that makes it worse, contact your surgical team the same day and ask whether the repair needs checking. If you cannot reach them, get urgent medical advice.
- Same day: pins and needles or numbness in the arm that does not go away, no feeling in part of the arm, or weakness that is getting worse. Get medical advice the same day. For pain spreading down the arm from your neck, ask for an urgent appointment with your doctor. If one side of your face or body suddenly goes numb or weak, or your speech becomes slurred or muddled, call emergency services, even if it goes away.
- Same day: severe pain in both shoulders that has come on recently. Get medical advice the same day.
- Same day: you are over 50 and have aching and stiffness in both shoulders, often in the neck or hips too, that is worst in the morning and lasts more than 45 minutes after you get up. This can be an inflammatory condition (polymyalgia rheumatica) rather than a rotator cuff problem. If you also get a new headache, pain or tenderness at your temples or on your scalp, or jaw pain when you eat or talk, get medical advice the same day, and if your vision changes, call emergency services. Even without those extra signs, see your doctor within a few days about the aching and stiffness.
- Same day: pain at night or at rest that is constant, that no rest or change of position eases at all, and that keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: new shoulder pain and you have had cancer, now or in the past, or you are losing weight without trying. See your doctor within a day or two and mention it.
- Within a day or two: pain at night or at rest that is constant, that no rest or change of position eases at all, and that keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Within a few days: night pain is common with this condition, but get checked within a few days if the pain is constant, no rest or change of position eases it at all, and it keeps getting worse.
- Within 2 weeks: shoulder pain that is getting worse, or that has not improved after 2 weeks, or it is very difficult to move your arm or shoulder. Book an appointment with a doctor or physiotherapist, as the NHS advises.
- Within 2 weeks: pain at night that stops you sleeping, which may be worse than during the day. Book an appointment with a doctor, an urgent care doctor or a physiotherapist, as Healthify New Zealand advises.
Common questions
Is my rotator cuff torn or inflamed?
Nothing you can feel at home separates the two reliably. That is the finding itself, not a way of dodging the question. Khazzam and colleagues (2018) studied 391 people with rotator cuff disease, 274 with tendinitis and 117 with tears, and the state of the cuff did not track with worse shoulder pain. A story and an examination narrow it down, and a scan is added when the answer would change what is done next. There is one version of this question that is urgent. The pain started after a fall, a pull or another injury, especially if the arm has been weak since, for example you cannot lift it out to the side or hold it up. This can be a broken bone or a torn tendon. Get medical advice the same day, and say how it happened and that the arm has been weak since, because UK shoulder surgeons advise urgent referral for a rotator cuff tear caused by an injury.
Can rotator cuff tendonitis turn into a tear?
They sit on one spectrum, so a hard line between them is not really there to cross. The 2025 physical therapy guideline handles rotator cuff tendinopathy and partial-thickness tears as one group (Desmeules and colleagues, 2025), and cuff tears get more common with age even in shoulders that give no trouble: 34 percent of 96 people with no shoulder symptoms had one when Sher and colleagues scanned them in 1995. Australia's healthdirect does say that partial-thickness tears can progress to full-thickness tears over time. None of the sources cited on this page measures how often that happens, so no figure for it is given here. If you have had shoulder surgery, your surgeon's or physio's plan comes first and overrides everything on this page.
Does a rotator cuff tear show on an MRI scan?
Usually, and that is exactly why a report needs reading next to the shoulder it came from. When Sher and colleagues scanned 96 people with no shoulder symptoms at all in 1995, 34 percent of the group had a cuff tear, 15 percent of the group through the whole thickness of the tendon and 20 percent part of the way through, and among the 46 who were over 60 it was 54 percent. UK shoulder surgeons put the same point in their care pathway: a cuff tear on imaging does not always match the symptoms and does not mean an operation is needed in every case, and a report of a partial-thickness tear is common and can be painless (Kulkarni and colleagues, 2015). The same pathway says ultrasound depends on the person doing it, that its accuracy for cuff tears varies, and that a normal cuff ultrasound does not rule out other serious shoulder problems, so a clear scan is not an all clear for a shoulder that is getting worse. Do you need a scan for shoulder impingement sets out what each scan can see and what the words in a report mean.
Does a rotator cuff tear always need surgery?
No. UK shoulder surgeons state in their care pathway that a cuff tear found on a scan does not imply a need for surgery in every case, and their nonsurgical care is rest, exercise, physiotherapy, pain relief and no more than two corticosteroid injections (Kulkarni and colleagues, 2015). The decision for a full-thickness tear is its own subject and sits on rotator cuff tear treatment without surgery, not here. A tear caused by an injury is the exception that moves fast: the pain started after a fall, a pull or another injury, especially if the arm has been weak since, for example you cannot lift it out to the side or hold it up. This can be a broken bone or a torn tendon. Get medical advice the same day, and say how it happened and that the arm has been weak since, because UK shoulder surgeons advise urgent referral for a rotator cuff tear caused by an injury.
References
- Khazzam MS, Mulligan EP, Brunette-Christiansen M, Shirley Z. Sleep quality in patients with rotator cuff disease. Journal of the American Academy of Orthopaedic Surgeons. 2018;26(6):215-222. https://doi.org/10.5435/JAAOS-D-16-00547
- Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. Journal of Bone and Joint Surgery (American). 1995;77(1):10-15. https://pubmed.ncbi.nlm.nih.gov/7822341/
- Desmeules F, Roy JS, Lafrance S, et al. Rotator cuff tendinopathy diagnosis, nonsurgical medical care, and rehabilitation: a clinical practice guideline. Journal of Orthopaedic and Sports Physical Therapy. 2025;55(4):235-274. https://doi.org/10.2519/jospt.2025.13182
- Kulkarni R, Gibson J, Brownson P, Thomas M, Rangan A, Carr AJ, Rees JL. Subacromial shoulder pain. BESS/BOA Patient Care Pathways. Shoulder and Elbow. 2015;7(2):135-143. https://doi.org/10.1177/1758573215576456
- Hopewell S, Keene DJ, Marian IR, et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 x 2 factorial, randomised controlled trial. The Lancet. 2021;398(10298):416-428. https://doi.org/10.1016/S0140-6736(21)00846-1
- Lambers Heerspink FO, Veen EJD, Dorrestijn O, et al. Update of guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopedic Association. Part 1: preventive measures, diagnostics, and non-surgical treatment of subacromial pain syndrome. Acta Orthopaedica. 2026;97:91-98. https://doi.org/10.2340/17453674.2026.45365
- American Academy of Orthopaedic Surgeons. Rotator cuff tears. OrthoInfo. https://www.orthoinfo.org/diseases--conditions/rotator-cuff-tears/
- healthdirect. Rotator cuff injury. https://www.healthdirect.gov.au/accidents-and-injuries/rotator-cuff-injury
- Healthify He Puna Waiora. Shoulder pain. https://healthify.nz/health-a-z/s/shoulder-pain
- NHS. Shoulder pain. Page last reviewed 22 May 2023. https://www.nhs.uk/symptoms/shoulder-pain/
- NHS. Heart attack. Page last reviewed 31 March 2026. https://www.nhs.uk/conditions/heart-attack/
Written and checked by the PocketPhysio editorial team. Last updated 2026-11-05.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.