The rotator cuff in the name given to a group of 4 muscles and tendons that work together to move and control the shoulder. You can develop pain over time or come on suddenly when starting a new activity you are not used to and cannot control.
Muscles and tendons can become irritated, tear or even rupture which can cause pain and change how the shoulder can be used. Often an umbrella term of tendinopathy is used (see our Tendinopathy information leaflet for more information).
Rotator cuff injury is a common condition. However risks of injury increase with age, manual occupations where lifting or working above your head is required, or sports that involve forceful arm movements, such as racquet sports.
The most common symptoms associated with a rotator cuff injury may include:
- Symptoms in and around the shoulder, however in some cases it can also be felt in the upper arm.
- Pain described as a dull ache deep in the shoulder when resting
- Arm weakness or shaper pains felt on lifting or moving the shoulder/arm
- Disturbed sleep particularly when lying on the painful side
- Shoulder and arm stiffness in the morning (which eases within 2 hours)
- Difficulty performing tasks with arms above head or behind your back, such as washing or dressing
Diagnosis is usually made from a consultation with your Health Care Professional, involving a detailed history of the onset of symptoms, current pattern of symptoms and your current functional ability.
An image/scan is often not required to confirm rotator cuff injury however one may be performed if the Health Care Professional needs further information to finalise the diagnosis or if surgery is being considered.
The primary aim of treatment is to help manage your pain. This allows you to move more and help you return to normal activities sooner. Initial treatment therefore is aimed at pain control. This might involve pain medication, or the use of heat or cold treatments.
Once your pain is under control, working on the movement and strength of your shoulder is what will help long term.
You can help to reduce pain, ease stiffness, strengthen your muscles and improve overall general fitness by keeping active. Below are some basic exercises specific to your shoulder to get you started.
It is normal to experience some discomfort when doing exercises, and individuals may start at different points. Pain should not increase excessively during or immediately after the activity. Discomfort should return to pre-activity levels 24-48 hours after the activity has finished.
The number (reps) and frequency (sets) of exercises suggested here are a guide, and should be performed to your personal tolerable pain levels. This means repetitions will vary between individuals and you should only go as far as is reasonably comfortable for you.
Isometric shoulder flexion
Sit or stand up straight facing a wall. Keep your affected arm by your side and bend your elbow to 90 degrees. Place your fist against the wall. Without moving your body, press your fist into the wall. Hold this position and then relax.
Isometric shoulder extension
Sit or stand up straight with your back to a wall. Keep your affected arm by your side and bend your elbow to 90 degrees. Place the back of your elbow against the wall. Without moving your body, press your elbow backwards into the wall. Hold this position and then relax.
Isometric shoulder external rotation
Sit or stand up straight next to a wall. Keep your affected arm by your side and bend your elbow to 90 degrees. Place the back of your wrist against the wall. Without moving your body, press your wrist into the wall as if turning your forearm outwards. Hold this position and then relax.
Isometric shoulder internal rotation
Sit or stand up straight next to a wall or door frame. Keep your affected arm by your side and bend your elbow to 90 degrees. Place the inside of your wrist against the wall. Without moving your body, press firmly into the wall as if turning your hand in towards your stomach. Do not allow your upper arm to drift too far away from your side. Hold this position, and then relax.
Isometric shoulder abduction
Sit or stand up straight next to a wall. Keep your affected arm by your side and bend your elbow to 90 degrees. Place the outside of your elbow against the wall. Without moving your body, press your elbow into the wall. Hold this position and then relax.
Unless you have a serious injury or have sudden continuous severe pain, you can usually treat your shoulder pain without having to see your doctor. If after 2 weeks of treating yourself you feel the pain isn’t any better or is worsening, you should see a Health Care Professional
You should also see a Health Care Professional if you:
- Have pain that doesn’t show any signs of improvement, within a couple of weeks of self help
- Have pain that has rapidly deteriorated or suddenly worsened despite self help
- Have pain, tingling, numbness or weakness in your face or arms
- Develop sudden stiffness in the shoulders and/or neck resulting in a lack of movement
- Are experiencing double vision, dizziness, nausea or sudden fainting
- Are noticing changes with your speech and/or difficulty swallowing
- Are noticing changes to your balance or walking pattern
- Are feeling clumsy or are falling more often
- Have a history of inflammatory arthritis, immuno-suppression, cancer, Tuberculosis (TB), drug abuse, AIDS or other infection
- Feel unwell, have a fever, or unexplained weight loss
- Are experiencing significant and regular changes to your usual sleeping pattern
- Have a history of recent injury (e.g. from a road traffic accident or a fall) or a history of shoulder surgery
- Have a new and visible deformed or misshapen shoulder
If you do not have any of the above, you may be able to effectively self manage your condition.