Can Vitamin D Deficiency Cause Rotator Cuff Tear? A Scientific Look

October 26, 2025 •

4 min read

Recent studies have reported that a significant percentage of patients with rotator cuff tears, as high as 44.3% in some populations, also have a vitamin D deficiency. This emerging data begs the crucial question: can vitamin D deficiency cause rotator cuff tear, or is it merely a correlated risk factor?

Quick Summary

Evidence suggests vitamin D deficiency is not a direct cause but is a significant contributing factor to rotator cuff pathology. The vitamin's role in tendon healing, inflammation, and muscle strength affects tear risk and surgical outcomes.

Key Points

Not a Direct Cause: Vitamin D deficiency is a contributing risk factor, not a proven direct cause of rotator cuff tears.
Impaired Tendon Healing: Low vitamin D levels are associated with compromised tendon-to-bone healing, which is a major factor in surgical repair success.
Increased Inflammation: The vitamin's anti-inflammatory properties are lost during a deficiency, which can contribute to tendinopathy and tissue damage.
Higher Retear Risk: Several studies report that vitamin D deficiency is correlated with higher rates of retears following rotator cuff surgery.
Muscle Weakness: Lack of vitamin D can lead to weaker rotator cuff muscles, increasing shoulder instability and injury risk.
Modifiable Risk Factor: Unlike age, vitamin D deficiency can be addressed with diet, sunlight, and supplementation to improve outcomes.
Promotes Collagen Synthesis: Vitamin D is vital for the production of collagen, the primary protein composing tendons, which ensures their strength and structure.

Understanding the Rotator Cuff and Its Vulnerability

The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, providing stability and enabling movement. Tears in the rotator cuff are one of the most common causes of shoulder pain and disability in adults. While trauma from a sudden injury, such as a fall, can cause a tear, most are degenerative, developing slowly over time due to age-related wear and tear. However, a growing body of research is exploring modifiable risk factors, with vitamin D emerging as a key area of interest.

The Multifaceted Role of Vitamin D in Tendon Health

Often called the 'sunshine vitamin,' vitamin D is crucial for more than just bone health. It plays a significant role in various physiological processes that directly affect the integrity and healing capacity of tendons and muscles, including:

Collagen Synthesis: Tendons are primarily composed of collagen, a protein that provides strength and structure. Vitamin D influences specialized tendon cells (tenocytes) to produce more high-quality type-I collagen. It also helps regulate matrix metalloproteinases (MMPs), enzymes that break down and remodel collagen. In a deficient state, an imbalance can occur, leading to weaker tendon tissue.
Inflammation Reduction: Vitamin D is a potent anti-inflammatory agent. Tendinopathy, the painful and dysfunctional state of a tendon, is often linked to chronic inflammation. Vitamin D helps downregulate inflammatory cytokines and decreases the production of matrix metalloproteinases, which can help protect against this degenerative process,.
Bone-Tendon Interface: The area where a tendon attaches to the bone is critical for shoulder function. Vitamin D promotes proper mineralization at this interface, which is vital for strength, especially after surgery. Animal studies have shown that vitamin D deficiency impairs healing at this site, leading to weaker repairs.
Muscle Homeostasis: Vitamin D receptors are found in skeletal muscle cells, and deficiencies have been linked to muscle weakness and atrophy. This weakening of the rotator cuff muscles can compromise shoulder stability and increase the risk of injury.

Scientific Evidence Linking Vitamin D and Rotator Cuff Issues

Numerous studies have investigated the relationship between vitamin D levels and rotator cuff health. The findings suggest a strong correlation, particularly concerning the quality of the tendon and post-surgical outcomes, rather than a direct cause-and-effect relationship for initial tears.

Impact on Degeneration and Healing

Increased Fatty Degeneration: A systematic review and meta-analysis published in 2025 found a significant correlation between higher vitamin D levels and lower rates of rotator cuff fatty degeneration (FD). FD is the infiltration of fat into the muscle, which is unequivocally linked to poor outcomes after a tear.
Impaired Surgical Outcomes: A 2022 cohort study found that preoperative vitamin D deficiency was associated with a higher retear rate (26.67% vs. 9.09%) and increased early pain (at 1 and 3 months) after arthroscopic rotator cuff repair. Another meta-analysis published in 2025 similarly revealed that vitamin D deficient patients were 22% more likely to require revision surgery.
Contradictory Findings: Not all studies show a direct link between low serum vitamin D and tear severity. A 2015 study found no correlation between vitamin D levels and tear size, extent of retraction, or degree of fatty infiltration. This highlights the complexity of the issue and suggests that serum levels alone may not tell the whole story, potentially overlooking tissue-level effects.

Modifiable Risk Factors vs. Non-Modifiable Factors

Understanding the different contributors to rotator cuff injuries is crucial for effective prevention and treatment. Vitamin D deficiency falls into the modifiable category, meaning it is a risk factor that can be influenced through lifestyle changes and supplementation.


Factor	Type	Impact on Rotator Cuff	Status (Sufficient vs. Deficient)
Vitamin D Level	Modifiable	Affects tendon healing, muscle strength, and inflammation.	Deficient: Poorer healing, increased inflammation, weakened muscle.
Age	Non-Modifiable	Natural tendon degeneration over time.	Over 40: Increased risk of degenerative tears.
Repetitive Stress	Modifiable (Activity)	Overuse weakens tendons over time.	High Repetition: Increased risk in athletes, painters, etc..
Blood Supply	Non-Modifiable	Decreases with age, impairing repair ability.	Poor Supply: Reduces body's capacity to heal.
Smoking	Modifiable	Negatively impacts tissue healing.	Smokers: Increased risk of tendon issues.
Bone Spurs	Non-Modifiable	Can rub against tendons, causing wear and tear.	Present: Weakens tendons over time.

Optimizing Vitamin D for Better Outcomes

For individuals with rotator cuff issues, ensuring adequate vitamin D levels can be a proactive step toward better recovery. This can be achieved through:

Sunlight Exposure: The most natural way to acquire vitamin D, though factors like geographical location, time of day, and skin tone affect synthesis.
Dietary Sources: Incorporating foods rich in vitamin D, such as fatty fish (salmon, tuna), fortified milk, and eggs.
Supplementation: For those unable to obtain enough through sun or diet, supplements are an effective option. Patel et al. found that pre-operative non-selective vitamin D supplementation for rotator cuff repair may even be cost-effective.
Testing: A simple blood test can determine serum vitamin D levels, allowing for targeted supplementation under a doctor's supervision.

Conclusion: A Modifiable Risk Factor, Not a Sole Cause

While evidence does not suggest that vitamin D deficiency is a direct or sole cause of rotator cuff tears, the association is compelling and clinically relevant. It is more accurately described as a significant contributing and modifiable risk factor. The vitamin's role in regulating collagen synthesis, modulating inflammation, and supporting muscle function means that low levels can compromise the overall health and resilience of the rotator cuff. For those at risk or recovering from a tear, ensuring sufficient vitamin D can promote better healing, decrease inflammation, and reduce the likelihood of complications like retears. Orthopedic surgeons and patients are increasingly recognizing the value of addressing nutritional factors, alongside established risk factors like age and overuse, in the management and prevention of rotator cuff pathology. Addressing vitamin D levels is a simple and cost-effective strategy to improve outcomes and enhance tendon integrity.

For further information on the immune system's role in rotator cuff health, readers can explore studies such as this one on immunomodulation of rotator cuff injury.

Frequently Asked Questions

While it's not considered a direct cause, low vitamin D is a significant contributing factor to rotator cuff issues. It can weaken tendons and muscles and impair healing, increasing your vulnerability to a tear, especially from other stressors like overuse or age.

Vitamin D plays a critical role in tissue healing, bone density, and regulating inflammation. Studies have shown that a deficiency can lead to higher rates of retears and poorer healing at the tendon-to-bone interface following rotator cuff repair,.

Yes, studies have found a high prevalence of vitamin D deficiency in patients with rotator cuff tears. For example, some research reported rates as high as 44.3% in a group of patients undergoing rotator cuff surgery.

Supplementation can address the modifiable risk factor of vitamin D deficiency, which supports overall tendon and muscle health. While it won't guarantee prevention, maintaining optimal levels can strengthen tissues and reduce inflammation, lowering the risk of injury from other causes.

There is evidence that low vitamin D is associated with more severe fatty degeneration within the rotator cuff muscles, which is a poor prognostic factor. However, studies are conflicting on whether it correlates with the initial tear size,.

Vitamin D helps regulate collagen production, reduce chronic inflammation, and promote proper mineralization at the tendon's attachment to bone. A deficiency can disrupt these processes, leading to weaker, more inflamed tendons and impaired healing,.

Given the high prevalence of vitamin D deficiency in patients with shoulder problems, it is a prudent step to discuss testing with your doctor. Correcting any deficiency can support better muscle function and healing, potentially improving your overall shoulder health.