Home / Conditions / Rotator cuff injury
The rotator cuff is four muscles and their tendons, wrapped around the top of the shoulder to lift and turn the arm. Injury ranges from an irritated tendon to a tear. Many tears come on gradually with age, and some cause no pain at all — so which kind it is decides whether exercise or surgery is the right answer.
Rotator cuff pain comes from three broad kinds of problem. They can feel alike, but how it came on, and whether the arm is weak, point to which it is — and to very different treatment.
| Tendon irritation | A wear tear | An injury tear | |
|---|---|---|---|
| Who it happens to | Active people, overhead work or sport | Usually over 50 or 60 | Any age, often over 40 |
| How it came on | Gradually, with overhead use | Gradually, often with no clear injury; sometimes both shoulders | A fall or heavy lift, sometimes with a tearing feeling |
| What you notice | A painful arc raising the arm; strength mostly normal | Ache, night pain, some weakness — or no pain at all | Sudden weakness lifting the arm |
| What usually helps | Exercises, sometimes an injection | An exercise programme first; surgery if it does not settle | Prompt assessment; repair works best within a few weeks |
Sudden weakness lifting the arm after a fall or heavy lift should be seen within a week or two, because a fresh tear repairs best early. A shoulder that looks out of shape after a fall may be dislocated: call the clinic and come in the same day, or go to an emergency department if we are closed.
Four muscles start on the shoulder blade, and their tendons join to form a cuff over the ball at the top of the arm bone. Together they keep the ball centred in its shallow socket, and lift and turn the arm.
What a picture cannot show is why the top tendon suffers most. It runs through a narrow space under the bony roof of the shoulder, where it is pinched each time the arm is raised, and its blood supply thins with age — which is why wear tears become common later in life.
It also explains the pain. The old name, tendinitis, suggests inflammation, but an irritated cuff tendon is mostly one that has been overloaded faster than it could adapt — which is why the right exercises, not simply rest, are what help it recover.
Rotator cuff tear treatment depends on the kind of tear and how active you are, and tendon irritation is treated differently again. Most people start with exercise; surgery is kept for injury tears and for tears that do not settle.
A programme to strengthen the cuff and control the shoulder blade is the first treatment for tendon irritation and wear tears. Improvement usually builds over several weeks to a few months.
A steroid injection into the space above the cuff can ease the pain enough to make the exercises possible. It is used sparingly, since repeated injections may weaken the tendon.
Where calcium has built up in a cuff tendon, known as calcific tendinitis, shockwave therapy is offered here, and this is one of the conditions where its evidence is strongest. It is not a treatment for a tear.
A torn tendon can be reattached to the bone through keyhole surgery — early for an injury tear, or later for a wear tear that has not settled. For large tears that cannot be repaired, a tendon transfer or a reverse shoulder replacement are options. Recovery takes months.
Rotator cuff injury here is seen by Dr Jeffrey Tan Gek Meng, a Senior Consultant Orthopaedic Surgeon. His subspecialty is foot and ankle, and he also practises across general orthopaedics, which his profile says includes rotator cuff injury. He is a Fellow of the Royal College of Surgeons of Edinburgh and consults in English, Mandarin, Malay, Hokkien and Hainanese.
No. Many tears, especially those that come on gradually with age, settle with an exercise programme. Surgery is mainly for tears from an injury in active people, and for tears that do not improve with exercise.
A tear does not grow back together by itself, but many stop hurting, and the muscles around it can learn to compensate with the right exercises. That is why a wear tear is usually treated with exercise first.
Lying on the affected shoulder presses on the tendons, and at rest there is less to distract from the ache. Night pain is one of the most typical signs of a rotator cuff problem.
No, though they can feel similar. In frozen shoulder the joint stiffens, so the arm will not move far even when someone else moves it. With a rotator cuff problem, someone else can usually move the arm further than you can yourself.
The arm is usually in a sling for several weeks, followed by months of exercises. Most people take six months to a year to recover fully.
No. Bring any shoulder X-ray, ultrasound or MRI reports, and be ready to say how the pain started.
Shoulder pain · Frozen shoulder · Neck pain · Shockwave therapy
Tell us how the pain started. A fall or heavy lift with sudden weakness needs seeing sooner than a gradual ache.
