A rotator cuff tear is an injury where one or more of the tendons or muscles of the rotator cuff of the shoulder get torn. Symptoms may include shoulder pain, which is often worse with movement, limited range of motion, or weakness. This may limit people's ability to brush their hair or put on clothing. Clicking may also occur with movement of the arm. Tears may occur as the result of a sudden force or gradually over time. Risk factors include certain repetitive activities, smoking, and a family history of the condition. Diagnosis is based on symptoms, examination, and medical imaging. The rotator cuff is made up of the supraspinatus, infraspinatus, teres minor, and subscapularis. The supraspinatus is the most commonly affected. Treatment may include pain medication such as NSAIDs and specific exercises. It is recommended that people who are unable to raise their arm above 90 degrees after 2 weeks should be further assessed. In severe cases surgery may be tried, however benefits of surgery are unclear as of 2019. Rotator cuff tears are common. Those over the age of 40 are most often affected. The condition has been described since at least the early 1800s. Signs and symptoms Many rotator cuff tears have no symptoms. Both partial and full thickness tears have been found on post mortem and MRI studies in those without any history of shoulder pain or symptoms . However, the most common presentation is shoulder pain or discomfort. This may occur with activity, particularly shoulder activity above the horizontal position, but may also be present at rest in bed. Pain-restricted movement above the horizontal position may be present, as well as weakness with shoulder flexion and abduction. Abnormal mobility or function of the scapula (scapular dyskinesia) may be present and is related to lower functional scores; it unclear whether scapular dyskinesia is a cause, effect or compensation for rotator cuff pathology. Risk factors Epidemiological studies strongly support a relationship between age and cuff tear prevalence, with the most common cause being age-related degeneration and, less frequently, sports injuries or trauma. Those most prone to failed rotator cuff syndrome are people 65 years of age or older; and those with large, sustained tears. Smokers, people with diabetes, individuals with muscle atrophy or fatty infiltration, and those who do not follow postoperative-care recommendations also are at greater risk. In a 2008 study the frequency of such tears