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Rotator cuff injury

Expert reviewer, Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
Next review due October 2024

A rotator cuff injury is an injury affecting the muscles and tendons in your shoulder. It’s a common cause of shoulder pain, especially in older and active people. There are surgical and non-surgical options for treating rotator cuff injury.

A woman's shoulder

About rotator cuff injury

Your rotator cuff is the group of muscles and tendons that surround your shoulder joint. Tendons are strong bands of tissue that connect muscles to bones. Your rotator cuff helps to keep your shoulder stable and working well.

You can injure your rotator cuff suddenly, or it can happen over time, due to wear and tear on your shoulder joint.

Types of rotator cuff injury

There are different types of rotator cuff injury. The main ones are listed below.

  • Rotator cuff tear. This is when one or more of the muscles and tendons that make up your rotator cuff tears. You can have a partial or a full tear. A tear can happen suddenly, after a single injury. Or, it can develop gradually, over time.
  • Tendinopathy. This term covers many different conditions affecting the tendons around your shoulder. Some of the tendons can become trapped between a bone at the top of your arm and the top of your shoulder blade. This is called subacromial or shoulder impingement. The tendon can eventually tear over time.
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Causes of rotator cuff injuries

Most rotator cuff injuries develop slowly, over time. You’re more likely to develop them as you get older. This is because as you get older, the amount of wear and tear on your shoulder joint increases. Your tendon also can’t repair itself as well as you get older.

You’re also more likely to develop a rotator cuff injury if you do a lot of repeated overhead movements. This includes activities, such as throwing, painting, lifting weights and swimming front crawl.

You can also get a tear in your rotator cuff if you have a sudden (acute) injury to your shoulder. This might include a fall or other accident.

Symptoms of rotator cuff injuries

The main symptom of a rotator cuff injury is pain at the top and side of your shoulder. The pain can be a dull general ache, or it can feel severe and sudden if you tear your rotator cuff in an accident. Sometimes the pain can spread down towards your elbow.

Shoulder pain often gets worse if you’re doing something where you lift your arm or raise it above your head. You may also find that the pain is worse at night, especially if you sleep on the injured shoulder. In this case, it can affect your sleep and make you feel tired.

Other symptoms of a rotator cuff injury include:

  • a feeling of weakness when you lift or move your arm from the shoulder
  • being unable to move your shoulder fully
  • a clicking or grating sound when you move your shoulder

There are other problems affecting your shoulder that may cause these symptoms. If you have any of these symptoms, see your GP for advice. You can also go straight to a physiotherapist without seeing a GP. In some areas, you may be able to self-refer to a physiotherapist on the NHS. In others, you may be able to access physiotherapy through your GP practice. You can also choose to pay for private physiotherapy.

Diagnosis of rotator cuff injuries

Your physiotherapist or GP will usually be able to diagnose rotator cuff injury by asking about your symptoms and examining you. They’ll want to know about any injuries you’ve had, and about any activities that increase your pain. Your GP or physiotherapist will examine your shoulders and ask you to do certain movements to check how well your shoulder is working.

Sometimes your GP or physiotherapist may need to refer you to a specialist doctor. A specialist might recommend taking images of your shoulder to get a better look at the damage, and plan your treatment. Imaging tests they may recommend include:

Treatment of rotator cuff injuries

The type of treatment you’ll have depends on several factors. These include the type of injury you have, how severe it is, your age and how active you usually are.

Sometimes, your doctor may recommend surgery to repair a rotator cuff tear. A rotator cuff tear won’t usually heal on its own, without surgery. But non-surgical treatments can help to relieve pain and build up strength in your shoulder. Not all rotator cuff tears require surgery. For many people, non-surgical management can be enough to allow you to use your shoulder again.

Your doctor will discuss your options with you and help you to decide what’s best for you.

Self-help

Your doctor may advise a period of resting your shoulder first. Try not to lift heavy weights or do activities that involve lifting your arm over your head. You can gradually start to increase the activity you do when your shoulder starts to feel better.

You might find it helps to use an ice pack to help relieve pain. Wrap the ice pack in a towel or dishcloth before using it. Never put an ice pack directly on to your skin as it may cause damage or give you a burn.

If you need pain relief, you can take over the counter painkillers, such as paracetamol or ibuprofen. Your doctor or pharmacist may recommend certain other painkillers.

Physiotherapy

Your GP may refer you to a physiotherapist, or you may be able to access physiotherapy directly. They’ll show you some rotator cuff stretches and exercises you can do at home to help improve the strength and movement of your shoulder. The exact exercises you’ll need to do will depend on the type of injury you have. You may continue having physiotherapy sessions for up to six weeks. Many people make a good recovery within this time.

Steroid injection

If your shoulder pain is still severe despite trying the measures above, your doctor may offer you a steroid injection. A steroid injection can help to reduce swelling and pain in your shoulder. This may reduce your symptoms enough to be able to continue with physiotherapy exercises. However, steroid injections can have side-effects. Your doctor will help you to weigh up the risks and benefits of having one.

Surgery

Your doctor may suggest surgery as an option if you have a rotator cuff tear caused by a sudden injury. They may also suggest surgery if you have a long-term injury and other treatments haven’t helped.

Types of surgery for rotator cuff injury include open surgery, mini-open repair and keyhole surgery. Open surgery is usually for large tears and involves making a single large cut in your skin to do the operation. In keyhole surgery (arthroscopy), your surgeon inserts special instruments through small cuts in your shoulder joint to look inside and repair the tear. Mini-open repair involves using both arthroscopy and making a small cut to perform the operation. Your surgeon will discuss with you which type of surgery is best for you.

You’ll need to commit to a rehabilitation programme after rotator cuff surgery, to help regain the strength and movement in your shoulder. This can be a slow process. It can take six months or more to get back to normal function. But sticking to your rehabilitation programme will increase your chances of a successful recovery.

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Related information

  • Discover other helpful health information websites.

    • Rotator cuff injury. BMJ Best Practice. bestpractice.bmj.com, last reviewed 4 September 2021
    • Shoulder pain. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2017
    • Rotator cuff injury/subacromial bursitis. MSD Manual. www.msdmanuals.com, last full review/revision January 2020
    • Shoulder pain. Patient. patient.info, last edited 18 October 2021
    • Rotator cuff pathology. Medscape. emedicine.medscape.com, updated 24 February 2020
    • Tendinopathy. BMJ Best Practice. bestpractice.bmj.com, last reviewed 4 September 2021
    • Find a physio. Chartered Society of Physiotherapy. www.csp.org.uk, last reviewed 18 March 2021
    • Personal communication, Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa, 7 November 2021
    • Cho CH, Song KS, Min BW, et al. Anterolateral approach for mini-open rotator cuff repair. Int Orthop 2012; 36(1): 95–100. doi:10.1007/s00264-011-1305-8
  • Reviewed by Pippa Coulter, Freelance Health Editor, October 2021
    Expert reviewer, Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
    Next review due October 2024

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