A torn rotator cuff usually occurs after some vigorous forceful activity including a fall. Those in the older age spectrum frequently can't recall any injury. Whether it is because of poor memory or just the fact that their tendon has been decaying slowly and ultimately just snapped is unclear. It appears that there is some of both occurring. There is certainly much better tissue quality to work on in the person who has a traumatic injury to the rotator cuff rather than the person who seems to have a degenerative spontaneous disruption. Controversy remains as to what role the overlying acromion has in the majority of patients with a torn rotator cuff. In some patients there is such a prominent bone developing spontaneously that it appears to rub a hole in the rotator cuff. In these same patients a quick forceful action may act somewhat akin to taking scissors across a tightly held piece of cloth resulting in a tear; people that fit into this category typically have an acromion described as "type 3"