Etiology — what causes it

Atraumatic, degenerative tears develop progressively with age — common in adults over 60 and often asymptomatic. Vascular changes, tendon degeneration, and chronic loading contribute. Distinct from traumatic tears in young adults, which often warrant surgical consideration.

Epidemiology — who gets it

Asymptomatic tears are present in roughly 20% of adults over 60 and 50% over 80 (Yamamoto et al., J Shoulder Elbow Surg). Symptomatic tears are less common than the imaging prevalence would suggest.

Clinical signs

Drop arm test, external rotation lag sign, hornblower sign, weakness on Jobe and external rotation testing. Imaging confirms tear size and location.

Symptoms

Anterolateral shoulder pain, weakness with overhead reaching, lifting, or reaching across the body. Night pain common. Functional limitation depends on tear size and patient demand.

Best evidence for chiropractic treatment

The MOON Shoulder Group (Kuhn et al., J Shoulder Elbow Surg) showed that structured exercise produces successful outcomes in approximately 75% of atraumatic small-to-medium full-thickness tears, with low subsequent surgical conversion. Exercise focuses on restoring strength in the deltoid and remaining cuff, scapular control, and graded function. Surgery is appropriate for younger patients with traumatic tears, large tears with significant functional limitation, and conservative care failures.

Subtypes

  • Partial-thickness tear. Bursal or articular sided. Rehab similar to tendinopathy.
  • Small/medium full-thickness. Less than 3cm. Conservative care has good outcomes in 75%.
  • Large/massive tear. Greater than 5cm or multi-tendon. Surgical consultation often appropriate; rehabilitation remains important regardless of decision.

When to seek emergency care

Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.

Bottom line

Atraumatic cuff tears often respond well to exercise-led care. Surgery is not the default — symptom and function-driven decisions matter most.