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Massive Rotator Cuff Tears

Massive rotator cuff tears involve two or more complete tendon tears (or one very large tear more than 5cm), causing significant shoulder weakness, difficulty lifting the arm overhead, and night pain - they occur in about 10-40% of all rotator cuff tears and are more challenging to repair, with treatment options ranging from physiotherapy and partial repairs to reverse shoulder replacement depending on age, activity level, and muscle quality.

📅Last reviewed: January 2026đŸĨBones & Joints

📖What is Massive Rotator Cuff Tears?

Massive rotator cuff tears involve two or more complete tendon tears (or one very large tear more than 5cm), causing significant shoulder weakness, difficulty lifting the arm overhead, and night pain - they occur in about 10-40% of all rotator cuff tears and are more challenging to repair, with treatment options ranging from physiotherapy and partial repairs to reverse shoulder replacement depending on age, activity level, and muscle quality.

đŸ”ŦWhat Causes It?

  • Degenerative wear and tear over time in people over 60 years (most common cause)
  • Progression from smaller rotator cuff tear left untreated over years
  • Acute traumatic injury (fall, lifting heavy object) in person with pre-existing partial tear
  • Failed previous rotator cuff repair with re-tear

âš ī¸Risk Factors

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You may be at higher risk if:

  • Age over 60 years (massive tears much more common with aging)
  • Smoking (impairs tendon healing, increases tear size progression)
  • History of smaller rotator cuff tear that wasn't repaired
  • Occupations requiring repetitive overhead work (painters, electricians)
  • Previous shoulder injury or surgery

đŸ›Ąī¸Prevention

  • ✓Treat small rotator cuff tears early before they enlarge to massive tears
  • ✓Quit smoking (reduces tear progression and improves healing if surgery needed)
  • ✓Maintain shoulder strength with regular exercises as you age
  • ✓Avoid repetitive overhead heavy lifting if you have known partial rotator cuff tear