My MRI Says I Have a Rotator Cuff Tear but I Don't Remember Injuring It—How Did This Happen?

The Confusing Diagnosis

You went in for an MRI expecting answers, and you got one—just not the answer you expected. The report says you have a rotator cuff tear. But you didn't fall. You didn't get hit. You can't point to a single moment when something went wrong.

This scenario plays out in my exam room several times a week. Patients arrive holding their MRI reports with a mixture of confusion and concern. "How can something be torn if I didn't tear it?" a bookkeeper from Durango asked me recently. It's a fair question, and the answer reveals something important about how our bodies change over time.

Two Different Kinds of Tears

Rotator cuff tears fall into two broad categories, and understanding the difference helps explain your situation.

Traumatic tears happen suddenly. You fall off a ladder, catch yourself awkwardly, or have your arm wrenched during an accident. One moment the tendon is intact; the next moment it's torn. These tears often come with a specific memory—patients can tell me exactly when it happened, sometimes down to the hour.

Degenerative tears develop gradually. The tendon weakens over months or years, fraying like a rope that's been rubbing against a rough surface. Eventually, the fibers give way—not because of a single dramatic event, but because the tissue simply wore out. These tears often have no associated injury because there was no injury. The damage accumulated slowly, below the threshold of what you'd notice day to day.

Your MRI is probably showing a degenerative tear. And you're far from alone.

How Common Is This?

Studies examining people with no shoulder pain at all have found rotator cuff tears in a surprising percentage of the population. In people over fifty, roughly a quarter have rotator cuff tears they don't know about. By age seventy, that number approaches fifty percent. Most of these people have never had shoulder symptoms.

This doesn't mean rotator cuff tears are harmless—they can certainly cause pain and dysfunction. But it does mean that tears can exist without injury and sometimes without symptoms. Your body has been quietly developing this condition, possibly for years, before it finally started causing enough trouble to prompt an MRI.

A cattle rancher from Dolores told me he'd been using his shoulders hard for forty years without a problem. "Why now?" he asked. The answer was that the wear had been accumulating all along. His tendons finally reached a threshold where normal activities started producing pain.

What Causes Degenerative Tears

Several factors contribute to tendon breakdown over time.

Blood supply diminishes with age. The rotator cuff tendons have a region near their attachment point where blood flow is naturally limited. As we get older, this area becomes even more vulnerable. Without robust blood supply, the tissue can't repair the microscopic damage that occurs during normal use.

Bone spurs develop in many people. A spur on the underside of your acromion—the bony roof of your shoulder—can rub against the rotator cuff tendons every time you raise your arm. Decades of this friction gradually shreds the tendon fibers.

Repetitive overhead activity accelerates wear. If your job or hobbies involve reaching above shoulder level, you're putting more stress on these tendons than someone who works at desk height. Painters, carpenters, electricians, and anyone who regularly works with arms overhead accumulates damage faster.

Genetics play a role too. Some people inherit tendons that are more prone to degeneration. If your parents or siblings have had rotator cuff problems, your risk is elevated.

Smoking impairs tendon healing and accelerates breakdown. The chemicals in cigarette smoke reduce blood flow to tissues that already have marginal circulation.

Why It Started Hurting Now

If the tear developed slowly, why did symptoms appear when they did? Sometimes there's a minor triggering event—not enough to cause a tear, but enough to irritate an already-damaged tendon. You might have lifted something heavy, slept in an awkward position, or started a new exercise routine.

Other times, the tear simply progresses past a tipping point. A partial tear becomes a larger partial tear. Fibers that were hanging on finally let go. The tendon that was managing your normal activities can no longer handle the load.

A quilter from Pagosa Springs noticed her shoulder pain started right after she spent a weekend rearranging her sewing room. She assumed she'd injured herself moving furniture. Her MRI revealed an old degenerative tear with some new inflammation. The weekend project didn't cause the tear—it just aggravated a condition that had been brewing for years.

What This Means for Treatment

Degenerative tears and traumatic tears don't always require different treatments, but understanding which type you have helps set appropriate expectations.

Degenerative tears are often partial thickness, meaning some tendon fibers remain attached. These tears may respond well to non-surgical treatment—physical therapy, activity modification, and sometimes injections. The goal is to strengthen surrounding muscles and reduce inflammation while your body adapts to its new baseline.

Some degenerative tears do require surgery, particularly if they're large, if they're progressing, or if conservative treatment fails. But the absence of a traumatic injury doesn't automatically mean your tear is minor. Degenerative tears can become full-thickness tears over time.

The key is matching treatment to your specific situation: the size and location of your tear, your symptoms, your activity level, and your goals.

The Imaging Disconnect

One thing I emphasize to patients is that MRI findings don't always correlate with symptoms. Two people with identical-looking tears on imaging can have completely different experiences. One might have severe pain and weakness; the other might have barely noticed anything was wrong.

This is why we treat the person, not the MRI. Your imaging provides important information, but it's one piece of the puzzle. How you feel, how you function, and what you want to be able to do all factor into treatment decisions.

A fly fishing guide from Durango had an MRI showing a moderate partial tear. He had minimal pain and full strength. We agreed to monitor his situation with physical therapy rather than jumping to intervention. Two years later, he's still guiding trips without limitation. Another patient with similar imaging findings needed surgery because her symptoms were affecting her work as a dental hygienist. Same MRI, different people, different decisions.

Moving Forward

Learning you have a rotator cuff tear without remembering an injury can feel unsettling. It raises questions about what else might be happening in your body without your awareness. But this diagnosis also provides an explanation for symptoms that might have seemed mysterious.

Degenerative rotator cuff tears are common, treatable, and don't automatically mean surgery. Most people with these tears improve with appropriate conservative care. Understanding how you got here—even without a specific injury—helps us plan where to go next.

Your shoulder has been working hard for decades. The wear it's showing isn't a sign of failure; it's a sign of use. Now we focus on managing that wear so you can keep doing what matters to you.

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ou can email Doctor Butzen at doctorbutzen@gmail.com if you have questions. He may request an office visit for complex concerns that require face-to-face discussion.