Rotator Cuff Tears: Not Just an “Old Person” Injury
I was one of the few surgeons operating last week due to the holidays, and interestingly, shoulders were the hot commodity of New Year’s week.
Several of my cases involved rotator cuff tears, with patients ranging from 35 to 60 years old. That stood out to me. Before I was a military surgeon, the majority of my rotator cuff patients were over 60. This is a very different population.
In these younger patients, the tears were partial-thickness tears, meaning the tendon was not completely torn off the bone. Clinically and surgically, these can sometimes be more challenging to treat than full tears.
From a surgical standpoint, rotator cuff repair is a demanding procedure. It’s done arthroscopically, through a camera, in a very tight space. Even a small amount of bleeding or swelling can turn a homerun case into a much longer surgery.
The Rotator Cuff
The rotator cuff is made up of four muscles whose tendons attach to the shoulder:
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Together they’re often referred to as SITS.
What actually tears is usually the tendon, not the muscle itself. The most commonly torn tendon is the supraspinatus. When this tendon is significantly torn, patients often have difficulty lifting the arm, sometimes described clinically as a “drop arm.”
How Age Affects Rotator Cuff Tears
Age plays a major role in how these injuries present.
In patients over 60, rotator cuff tears are more common and are often full-thickness tears, meaning the tendon is completely detached from the bone. Also, in this population, a shoulder dislocation raises immediate concern for a cuff tear.
In younger, athletic populations such as military members and jiu jitsu athletes, rotator cuff tears are less common and are more often partial thickness or small focal tears, typically in the 30–50 age range.
Younger patients who dislocate their shoulder are far more likely to tear the labrum, not the rotator cuff, which leads to a very different treatment pathway.
I saw a few patients in their 30s recently who took several months to come see me because their age did not meet the typical age of a rotator cuff. The lesson here is that if a young person has a traumatic injury to the shoulder with pain and the inability to raise the arm (or significant weakness with elevation), they may have a rotator cuff tear!
Risk Factors I See Most Often
In active populations, rotator cuff pathology is rarely random.
Common contributors include:
Repetitive overhead or grappling activity
Poor scapular control
Strength imbalances between internal and external rotators
Training through pain or fatigue
Inadequate recovery
Many partial tears are degenerative plus overload, not purely traumatic.
Final Thoughts
Rotator cuff tears are no longer just an “older athlete” issue.
Partial tears in younger, active patients can happen and require thoughtful decision-making. Not every tear needs surgery, but ignoring symptoms or repeatedly loading a compromised tendon often makes things worse.
Early evaluation and addressing underlying mechanics can preserve shoulder function long-term.
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Dr. Megan Lisset Jimenez
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