Rotator cuff problems

The rotator cuff is the group of tendons that hold the shoulder in place and lift and rotate the arm. Most problems are wear related rather than the result of a single injury. The tendons sit in a narrow space beneath the bone, and with the repeated overhead loading of daily life and work they can become irritated, thicken or develop small tears. A sudden fall or a heavy lift can also tear a tendon outright.

Several things make this more likely:

• Age, as the tendons naturally lose some of their resilience over time
• Repetitive overhead activity, whether at work, in the home or through sport
• A previous shoulder injury, and in some people a general tendency to tendinopathy

Often it is a combination, and not one clear cause.

Rotator cuff problems tend to share a recognisable pattern. Features may include:

• Pain in the shoulder and upper arm, often worse when reaching up or out
• Pain at night, particularly when lying on the affected side
• Weakness, or difficulty lifting or rotating the arm
• A catching sensation with certain movements

Rotator cuff problems can often be recognised from the history and examination of the shoulder. Confirming what is happening to the tendons, and how severe it is, guides the right treatment and distinguishes it from other causes of shoulder pain.

Ultrasound is particularly well suited to the rotator cuff. It shows the tendons in detail, can confirm inflammation or a tear and its extent, and helps direct treatment accurately. Dr Borukhson uses point-of-care ultrasound during the consultation, so the shoulder can often be examined in the same visit. Where she judges another type of imaging, such as an MRI, to be more appropriate, she will refer for it. You can read more on the ultrasound clinic page.

Many rotator cuff problems improve with a structured programme of exercise and physiotherapy to restore strength and movement, alongside activity modification and pain relief. Where pain is limiting progress, an ultrasound-guided injection into the shoulder can help. Larger or persistent tears may be referred for a surgical opinion. The plan is agreed with you.

The aim is to keep the shoulder moving while letting the tendon settle. Rest is not the answer, and complete avoidance tends to stiffen the joint, so it helps to stay gently active within comfort and to do the exercises you are given consistently.

• Adjust rather than abandon activities, lowering shelves or breaking up overhead tasks where you can
• Keep up the strengthening programme even once the pain begins to ease, as this is what restores lasting strength
• Take simple pain relief if you need it to stay active and to sleep

Recovery is usually gradual, measured in weeks to months rather than days, and steady progress is normal. Most people regain good use of the shoulder. Setbacks happen and do not undo your overall progress.

Most rotator cuff problems are not urgent and settle with time and the right exercises. Some patterns, though, are worth acting on sooner.

Arrange a prompt review if:

• Your shoulder became suddenly weak after a fall or a heavy lift, or you cannot lift the arm at all, which can signal a significant tear
• Pain is severe, steadily worsening, or persistent night pain is disturbing your sleep
• There is little improvement after several weeks of treatment

Seek urgent medical care if the shoulder is hot, swollen and very painful with fever, as a joint infection needs same-day care. Seek urgent care too if you develop numbness, pins and needles or weakness spreading down the arm or hand, as this points to a nerve in the neck or arm rather than the cuff and needs separate assessment.

Shoulder pain that is not settling is worth assessing to confirm the cause and put in place an effective plan. If you have ongoing shoulder pain or weakness, a specialist review, with ultrasound where helpful, can clarify it and guide treatment.

How are rotator cuff problems diagnosed?

They can often be recognised from your symptoms and an examination of the shoulder, but confirming what is happening to the tendons guides the right treatment and helps tell them apart from other causes of shoulder pain. Ultrasound is particularly well suited to the rotator cuff, showing the tendons clearly and confirming inflammation or a tear and its extent. Dr Borukhson uses point-of-care ultrasound during the consultation, so the shoulder can usually be assessed in the same visit.

Can a rotator cuff problem heal without surgery?

Most do. Many rotator cuff problems improve with a structured programme of exercise and physiotherapy to rebuild strength and movement, alongside easing the activities that aggravate it and using pain relief. Where pain is holding back progress, an ultrasound-guided injection can help. Surgery is generally reserved for larger or persistent tears that do not respond, and even then it is one option to discuss rather than an automatic step.

How long does it take to recover?

Recovery varies with the type and severity of the problem and how consistently the exercises are done. Many people notice gradual improvement over several weeks to a few months rather than days, and steady progress with physiotherapy usually matters more than any single treatment. Sticking with the programme, even once the pain begins to ease, gives the best chance of restoring lasting strength and movement.

Why is my shoulder more painful at night?

Night pain, especially when lying on the affected side, is a very typical feature of rotator cuff problems and does not mean something is seriously wrong. Pressure on the shoulder and the loss of daytime distraction often make it more noticeable. Sleeping on the other side, supporting the arm with a pillow and keeping up with treatment usually help. Persistent night pain that disturbs sleep is a good reason to have the shoulder assessed.

How is a rotator cuff problem different from a frozen shoulder?

Both cause shoulder pain, but the pattern differs. Rotator cuff problems tend to cause pain and weakness on reaching or lifting, often with a catching sensation, while the joint usually still moves. A frozen shoulder is dominated by progressive stiffness, with movement becoming markedly restricted in most directions. They are managed differently, so confirming which you have matters. Examination usually leads here, and ultrasound during the consultation supports it by assessing the cuff and checking for a tear.