There are two primary causes of tears or ruptures in rotator cuff tendons. One is acute trauma. An individual may have an accident or fall on an outstretched arm which may result in a rotator cuff tear. Likewise, in some people who fall and dislocate their shoulders, they may sustain a tear of the rotator cuff.
Rotator cuff ruptures are rare in patients under 40, and substantial trauma is required to tear the rotator cuff tendons from the bone in a young patient. In older patients, less trauma is required. In some, the rotator cuff simply wears and frays until it gradually pulls apart secondary to use of the shoulder. This sometimes is aggravated by spurring.
Patients who experience a fall or other injury to the shoulder will, of course, have pain at the time of injury. As the pain subsides, they will sometimes notice at least some difficulty or inability to raise the arm overhead. This movement will usually be associated with pain.
In patients with rotator cuff tears secondary to wear and to degenerative changes, pain with use of the arm in the overhead position is usually the typical primary symptom. Sometimes, there will be associated cracks, pops, and noises in the shoulder that are painful. Often they will experience pain at night and difficulty sleeping.