Injury or fatigue of the rotator cuff muscles can lead to poor control of the humeral head and wear of the supraspinatus against the acromion.  This is appreciated as pain over the outside of the shoulder through an arc when the arm is loaded away from the body.  Repetitive use of the arm at and above chest height is a common cause.

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Where this wear of the rotator cuff is ongoing, pain tends to wax and wane in proportion to load.  Eventually it is possible to wear a hole in the tendon. This is known as a rotator cuff tear. Less commonly, a violent injury may cause a rotator cuff tear in a normal tendon but usually a less violent injury aggravates an existing tear.

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The pain from a rotator cuff tear and impingement syndrome are similar.  Where the tear becomes very large, there may be a specific weakness, however typically the presentation is with a painful arc and night pain.

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The conservative management of rotator cuff tear is possible because usually a large proportion of the rotator cuff remains intact and this may compensate for the loss of the torn segment.  Therefore, selective strengthening of those remaining fibres may allow the shoulder to re-gain control and restore good function.  With the passage of time however, the rotator cuff tear will increase in size.

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If your pain or poor function is severe, your surgeon may recommend surgery.