Shoulder Rotator Cuff Injuries
What Is a Shoulder Rotator Cuff Injury?
The shoulder is one of the most mobile joints in the body, it allows you to lift, reach, throw, and rotate your arm in multiple directions. However, this mobility comes at the cost of stability, making the shoulder especially vulnerable to overuse and injury. One of the most common sources of shoulder pain in active individuals is injury to the rotator cuff. The rotator cuff injury range from mild sprains (Grade 1) to full tears (Grade 3). Other associated injuries might include AC joint sprains, dislocations and subluxations, labral tears and fractures.
Rotator cuff injuries can result from sudden trauma, such as falling on an outstretched hand, or from chronic overuse due to repetitive overhead activity. Age, poor posture, scapular instability, or previous shoulder injuries can all contribute to the likelihood of developing rotator cuff issues.
What Is the Rotator Cuff?
The rotator cuff is a group of four small muscles and their tendons, supraspinatus, infraspinatus, teres minor, and subscapularis, that surround the shoulder joint. These muscles work together to stabilise the head of the upper arm bone (humerus) within the shallow socket of the shoulder blade (glenoid). They also help control movements like lifting the arm overhead, rotating the arm, and reaching behind the back.
Symptoms of Rotator Cuff Injury
Symptoms of a rotator cuff injury typically include pain when lifting the arm or reaching overhead, a dull ache deep in the shoulder, weakness (especially with external rotation), night pain that interferes with sleep, and difficulty performing daily tasks such as dressing, reaching behind the back, or carrying objects. Some individuals may also feel clicking or catching during shoulder movement. In more severe cases, range of motion may be limited, and the shoulder may feel unstable.
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Shoulder Rotator Cuff Injury Treatment
When it comes to treatment, rotator cuff injuries are managed either conservatively (non-surgically) or through surgery, depending on the severity of the damage, the individual’s activity level, and how well they respond to initial rehabilitation.
Non-Surgical Treatment
Non-surgical treatment is typically the first line of management for most tendinopathies and partial tears. This includes targeted physiotherapy to reduce inflammation, restore mobility, improve scapular control, and progressively strengthen the rotator cuff and surrounding muscles. Manual therapy, soft tissue work, taping, or dry needling may be used to support pain relief and improve muscle recruitment. Activity modification and gradual return to load are essential to avoid reinjury. With a structured rehab plan, many people can fully recover function without the need for surgery.
Surgical Treatment
Surgical treatment may be considered for full-thickness tears, long-standing injuries that have not improved with conservative care, or in individuals who require full shoulder function for work or sport. Surgery typically involves reattaching the torn tendon to the bone using sutures or anchors, followed by a structured postoperative rehabilitation programme. Recovery after rotator cuff surgery can take several months and often involves a period of immobilisation in a sling, followed by progressive physiotherapy to restore range of motion, rebuild strength, and retrain movement patterns.
The Major Goals of Rotator Cuff Rehabilitation
Regardless of whether treatment is surgical or non-surgical, shoulder rehabilitation plays a central role in long-term recovery. The goals of rotator cuff exercises are to reduce pain and inflammation, restore pain-free range of motion, improve scapular stability and motor control, and progressively rebuild shoulder strength and endurance.
Retraining proper movement patterns, especially scapulohumeral rhythm , is critical to avoid compensation and prevent secondary problems in the neck, spine, or opposite shoulder. Functional rehab also focuses on return-to-sport or return-to-performance conditioning, depending on the individual's goals, ensuring that the shoulder is prepared for the specific demands of their activity.
A successful outcome depends not just on healing the injured tissues but on addressing the underlying biomechanical imbalances, strength deficits, or technique issues that contributed to the injury in the first place.