Shoulder pain can make everyday tasks extremely difficult. Reaching into a cupboard, lifting a cup of coffee, doing the dishes, or even sleeping comfortably can become a challenge. Pain related to the rotator cuff is one of the most common causes of shoulder pain, accounting for up to 80% of painful shoulder presentations.
If you’ve been told you have a rotator cuff tear on a scan, it’s natural to wonder whether surgery is necessary. The good news is that many people improve significantly with physiotherapy and exercise-based treatment, even when scans show a tear.
What is a rotator cuff tear?
The rotator cuff is a group of four muscles and their tendons that help stabilise and move the shoulder joint.
A rotator cuff tear occurs when one or more of these tendons become damaged. Tears can happen suddenly after trauma, such as a fall, but many develop gradually over time. These changes are very common as we get older, even in people with no shoulder pain. A large 2026 study involving 602 adults, known as the FIMAGE study, found that 96% of pain-free shoulders had some form of rotator cuff abnormality on imaging. Importantly, this does not mean something is wrong or needs to be fixed, as imaging findings do not always correlate with pain levels or shoulder function and should be considered alongside the clinical picture by a healthcare professional.
In many cases, ultrasound or MRI imaging may show changes within the rotator cuff tendons and surrounding structures. These findings can include:
- Partial thickness or full thickness tears
- Subacromial bursitis
- Rotator cuff tendinopathy
- Do all rotator cuff tears need surgery?
This is one of the biggest misconceptions around shoulder pain. Many people assume that if a scan shows a tear, surgery is necessary. However, current research, including multiple systematic reviews and large clinical trials, shows that physiotherapy and exercise therapy can provide similar improvements in pain and function to surgery for many patients, and should be considered the first-line treatment for most degenerative, non-traumatic tears. Long-term studies with follow-ups of up to 10 years have shown that people who complete a structured rehabilitation programme can achieve lasting improvements without surgery, even in cases of full-thickness tears.
However, not all rotator cuff tears are managed the same. Full-thickness tears that occur following a traumatic event may require a different approach. If the tear is larger and sustained via a traumatic mechanism, it is appropriate to seek an opinion from an orthopaedic surgeon.
When is physiotherapy recommended?
Physiotherapy is commonly recommended as the first-line treatment for most degenerative rotator cuff tears. Treatment is individualised and may include a combination of education, exercise therapy, and manual therapy depending on the person’s presentation and goals. The aim is to improve the shoulder’s capacity, reduce pain sensitivity, and restore confidence with movement.
What about injections?
Injections can provide short-term pain relief for some people. However, their benefits may reduce over time, with limited additional improvement beyond around 12 weeks compared to placebo or no treatment in many cases. Current 2025 clinical guidelines suggest that injections may have a role for short-term symptom relief in select cases, but they are not recommended for routine or first-line use.
The bottom line
Physiotherapy and exercise therapy are effective first-line treatments for many people, particularly those with degenerative tears. A rotator cuff tear does not automatically mean you need surgery. The most important step is an individualised approach based on your symptoms, function, and goals.
If you are experiencing ongoing shoulder pain or have been diagnosed with a rotator cuff tear, consulting with an experienced physiotherapist can help guide the most appropriate treatment pathway.
References
Desmeules, F., Roy, J.-S., Lafrance, S., et al. (2025). Rotator cuff tendinopathy diagnosis, non-surgical medical care and rehabilitation: A clinical practice guideline. Journal of Orthopaedic & Sports Physical Therapy. https://doi.org/10.2519/jospt.2025.13182
Ibounig, T., Järvinen, T. L. N., Raatikainen, S., et al. (2026). Incidental rotator cuff abnormalities on magnetic resonance imaging. JAMA Internal Medicine, 186(4), 406–414. https://doi.org/10.1001/jamainternmed.2025.7903
Kuhn, J. E., Dunn, W. R., Sanders, R., et al. (2024). Nonsurgical treatment of symptomatic, atraumatic full-thickness rotator cuff tears: A prospective multicenter cohort study with 10-year follow-up. Journal of the American Academy of Orthopaedic Surgeons, 32(23), 1061–1073. https://doi.org/10.5435/JAAOS-D-24-00841
Fahy, K., Galvin, R., Lewis, J., & McCreesh, K. (2022). Exercise as effective as surgery in improving quality of life, disability, and pain for large to massive rotator cuff tears: A systematic review and meta-analysis. Musculoskeletal Science and Practice, 61, 102597. https://doi.org/10.1016/j.msksp.2022.102597
Karjalainen, T. V., Jain, N. B., Heikkinen, J., Johnston, R. V., Page, C. M., & Buchbinder, R. (2019). Surgery for rotator cuff tears. Cochrane Database of Systematic Reviews, 12(12), CD013502. https://doi.org/10.1002/14651858.CD013502 Mohamadi, A., Chan, J. J., Claessen, F. M., Ring, D., & Chen, N. C. (2017). Corticosteroid injections give small and transient pain relief in rotator cuff tendinosis: A meta-analysis. Clinical Orthopaedics and Related Research, 475(1), 232–243. https://doi.org/10.1007/s11999-016-5002-1
Jack is an experienced, APA Titled Musculoskeletal Physiotherapist with a clinical focus on shoulder conditions. He holds a Bachelor of Exercise Science, a Doctor of Physiotherapy, and a Master of Musculoskeletal Physiotherapy. Jack works at Langwarrin Sports Medicine Centre, where he uses an evidence-based approach to assess and manage shoulder pain, helping patients return to their previous level of function and get back to the things they love.