Rotator Cuff Injuries in Tennis Players: Does a Tear Mean You Need Surgery?

If you have been told you have a rotator cuff tear, the word tear probably did most of the work in that sentence. It sounds like something that has to be repaired, especially if you play a sport built on reaching overhead, and rotator cuff tear surgery can start to feel like a decision somebody has already made for you.

So here is a finding worth sitting with. When researchers scanned overhead athletes who had no symptoms at all — no pain, still competing — 40 percent of their dominant shoulders showed rotator cuff tears on MRI. None of their other shoulders did. In professional baseball pitchers with nothing wrong, roughly half had tears on imaging.

The good news? For many tennis players, a cuff problem is managed without an operation, and the research generally supports trying that first. What matters is not the word on the report. It is how your shoulder works and what you want it to do.

At Rooted Motion Physical Therapy, we believe you deserve to know what a scan can and cannot tell you before anyone talks about surgery. Let us walk through it.

What Does the Rotator Cuff Actually Do?

The rotator cuff is four muscles and their tendons wrapped around the ball-and-socket shoulder joint. They steady the joint, help position your arm, pass force into the shot — and, most importantly for tennis, slow the arm down afterward.

Imagine the Brakes on a Car

Brake pads do not wear out because the car goes fast. They wear out because the car has to stop. The engine gets the credit; the brakes take the damage.

Your rotator cuff is the brakes. During a serve the arm accelerates to roughly 2,420 degrees per second, and the muscles at the back of the cuff have to bring that under control after contact — on every serve, all season. The key idea: your cuff is rarely injured by hitting the ball. It is worn down by stopping your arm afterward.

Why Do Some Tears Hurt and Others Do Not?

Because a tear is a description of tissue, not a diagnosis of your problem. Cuff injuries in tennis are usually gradual wear-and-tear rather than a single moment. Younger players more often show partial tears on the underside of the tendon. Tears that go all the way through become more common after 50 and may reflect age as much as sport — they are uncommon before 35.

Those two situations are not the same problem and should not get the same plan. A small partial tear in a competitive 30-year-old and a full-thickness tear in a 62-year-old weekend player are different conversations entirely.

So Should You Get an MRI?

Sometimes, but it helps to know what you are buying. MRI is very good at finding tissue changes. The difficulty is that finding them does not establish what is causing your symptoms — as those asymptomatic athletes show. Changes can also appear right after competition and take up to a week to settle, so a scan taken the day after a tournament is not showing the same shoulder as one taken after a rest week.

A useful scan is one that answers a question your clinician has already formed from examining you. The goal is not to fix the MRI. The goal is a shoulder that works.

What Does It Usually Feel Like?

• A dull, hard-to-pinpoint ache that has built over weeks.

• Pain after serving or overhead work rather than during it.

• Getting tired early in a session.

• Losing serve speed or accuracy before losing comfort.

• Pain spreading toward the outer upper arm.

Obvious weakness is less common in younger players, because bigger muscles nearby compensate well enough to hide a cuff problem on a simple strength test. Several different problems produce similar symptoms, so a careful examination is more useful than guessing from where it hurts.

Why Try Rehabilitation First?

The tennis research identifies non-surgical care as the first-line treatment, and it says something blunt about why: surgical results in high-level players are unpredictable, so non-surgical treatment should be exhausted before an operation is considered.

A full course generally means at least three months, though the timeline depends on the injury and on you. That is longer than most people expect and shorter than most people fear.

A tennis-specific program usually includes restoring movement where it is limited, strengthening the cuff and the muscles controlling the shoulder blade, building trunk and leg strength, adding overhead endurance, and then a graded return to serving. Technique belongs in the plan too: not bending your knees enough during the serve significantly increases the load on your arm.

What About a Cortisone Shot or PRP?

A cortisone injection may give short-term relief and can occasionally create a window that makes rehabilitation possible. The evidence in athletes specifically is limited, results in the general population are mixed, and injections are used cautiously in younger players because of concerns about tendon health.

On platelet-rich plasma, the tennis review is blunter: there is no literature on PRP for cuff injuries in athletes, and in the general population it has not outperformed the comparison treatments for cuff tendon pain. Neither injection rebuilds capacity or fixes your training load.

When Does Surgery Make Sense?

When you still have real pain and loss of function after a well-managed course of non-surgical care, or when the size of the tear, an injury, your age and the quality of the tissue make an operation the better option. That is a conversation for you and an orthopedic specialist.

One nuance worth knowing: in younger, high-level athletes the threshold for repairing a partial tear is deliberately higher, and cleaning up the tendon is often preferred over repairing it — partly because a repair can tighten a shoulder that needs extreme range to serve.

If You Do Have Surgery, What Should You Expect?

Honest numbers, because they are better to hear now than afterward. Pooled across sports, roughly 85 percent of athletes return to sport after cuff surgery and about 66 percent return to the same level. Among professional and competitive athletes, that second figure falls to around 50 percent, and in one review only 38 percent of overhead athletes reached their previous level.

In tennis specifically, one group of 51 players saw 78 percent return to play — but only 2 of the 8 elite players regained their previous level and ranking. The pattern across this research is consistent: outcomes are good for the older recreational player with a full-thickness tear, and much less certain for the younger, higher-level player with a partial one.

That is not an argument against surgery. It is an argument for going in with the right expectations, and for rehabilitation afterward that is built on criteria rather than a calendar.

The Rooted Motion Difference

Care is one-on-one, in your own home, and built around the tennis you want to get back to. Here is what you can expect:

• An evaluation of how the shoulder actually functions, not only what hurts.

• Straight talk about what your imaging does and does not explain.

• A progressive strengthening plan for the cuff and the shoulder blade.

• Trunk and lower-body work, so your shoulder stops covering for them.

• A staged serving progression when you are ready for it.

• Convenient concierge mobile physical therapy delivered where you are.

Because recovery is not just about a tendon — it is about getting back on court with a shoulder you trust.

Ready to Find Out What Your Shoulder Can Still Do?

A tear on a report does not decide this on its own. How your shoulder moves, how strong it is, how it holds up late in a match, and what you want to play — those decide it.

Ready to move better and live rooted? Contact Rooted Motion Physical Therapy to schedule a one-on-one evaluation and begin a personalized rotator cuff plan.

Research Used for This Article

1. Alrabaa RG, Lobao MH, Levine WN. Rotator Cuff Injuries in Tennis Players. Current Reviews in Musculoskeletal Medicine. 2020;13(6):734-747. DOI

2. Fu MC, Ellenbecker TS, Renstrom PA, Windler GS, Dines DM. Epidemiology of injuries in tennis players. Current Reviews in Musculoskeletal Medicine. 2018;11(1):1-5. DOI

3. Cools AM, Johansson FR, Borms D, Maenhout A. Prevention of shoulder injuries in overhead athletes: a science-based approach. Brazilian Journal of Physical Therapy. 2015;19(5):331-339. DOI

Educational disclaimer: This article is for general education and is not a substitute for an individualized evaluation. Seek prompt medical care after a traumatic injury or dislocation, for a sudden major loss of strength, or for new numbness, tingling or weakness in the arm.