Rotator Cuff Injury

Shoulder Pain

Pain over the outer shoulder that may spread into the upper arm.

Pain During Overhead Activities

Reaching into cupboards, lifting objects, or throwing may increase symptoms.

Night Pain

Pain when lying on the affected shoulder is common.

Weakness

Difficulty lifting the arm or reduced strength during pushing, pulling, or reaching.

Painful Arc

Pain while raising the arm, particularly between approximately 60° and 120° of elevation.

Difficulty Reaching Behind Your Back

Activities such as fastening a bra or tucking in a shirt may become painful.

Reduced Shoulder Function

Tasks such as dressing, washing your hair, or lifting groceries may become difficult.

Clicking or Catching

Some people notice clicking or catching during shoulder movement. This alone does not necessarily indicate a tear.

Tendon Overload

Repeated overhead activity can exceed the tendon's ability to recover.

Degenerative Changes

Age-related changes make rotator cuff tendons more susceptible to injury over time.

Traumatic Injury

Falls onto an outstretched arm, heavy lifting, or shoulder dislocations can cause acute tears.

Repetitive Overhead Work

Painting, construction work, swimming, throwing sports, and racquet sports increase tendon loading.

Muscle Weakness

Weakness of the rotator cuff or shoulder blade muscles can alter shoulder mechanics and increase tendon stress.

Poor Load Management

Sudden increases in gym training, throwing volume, or overhead work may overload the rotator cuff.

Adults Over 50 Years

Degenerative tendon tears become more common with age.

Overhead Athletes

Swimmers, tennis players, volleyball players, baseball and cricket players.

Manual Workers

Painters, electricians, carpenters, mechanics, and construction workers.

Weightlifters

Heavy overhead pressing and repetitive upper-body training.

Individuals with Previous Shoulder Injuries

Prior shoulder injuries increase the likelihood of future symptoms.

People Performing Repetitive Overhead Tasks

Occupational or recreational activities involving frequent overhead reaching.

Clinical Assessment

Medical History

• Pain location
• Night pain
• Weakness
• Previous injuries
• Sporting activities
• Occupation
• Difficulty with daily activities
• Sudden or gradual onset

Physical Examination

• Shoulder range of motion
• Muscle strength
• Functional tasks
• Shoulder blade movement
• Cervical spine screening when appropriate

Special Tests & Imaging

Special Tests

• Empty Can (Jobe) Test
• Full Can Test
• External Rotation Lag Sign
• Drop Arm Test
• Lift-Off Test
• Belly Press Test
• Hawkins-Kennedy Test
• Painful Arc Assessment

No single special test can accurately diagnose every rotator cuff injury. Diagnosis is based on your history, examination findings, and imaging when appropriate.

Imaging

Ultrasound and MRI can identify tendon tears and other shoulder pathology. Imaging may be recommended when a traumatic full-thickness tear is suspected, significant weakness is present, symptoms persist despite rehabilitation, or surgery is being considered.

Important: Many people, particularly over the age of 50, have rotator cuff tears on imaging without any pain or functional limitation.

Education

Understanding your diagnosis, modifying aggravating activities, and gradually reloading the shoulder are essential for recovery.

Exercise Therapy

Progressive strengthening of the rotator cuff and scapular muscles is considered the cornerstone of treatment.

Manual Therapy

Joint mobilization and soft tissue techniques may provide short-term symptom relief when combined with exercise.

Activity Modification

Temporary reduction of painful overhead activities while maintaining comfortable movement supports tendon recovery.

Medication

Pain-relieving medication may be appropriate under medical supervision during the early stages.

Injections

Subacromial corticosteroid injections may provide short-term pain relief for selected individuals but should be considered alongside rehabilitation.

Surgery

Surgery may be appropriate for acute traumatic full-thickness tears, persistent symptoms despite rehabilitation, significant functional weakness, or selected large or repairable tears. Many degenerative tears improve without surgery.

Target: Gentle shoulder mobility

Repetitions: 30–60 seconds × 2–3 sets

Target: Rotator cuff activation

Hold: 10 seconds × 10 repetitions

Target: Infraspinatus and teres minor

Repetitions: 10–15 × 3 sets

Target: Supraspinatus and deltoid

Repetitions: 10–15 × 3 sets

Target: Shoulder mobility and scapular control

Repetitions: 10–15

Target: Serratus anterior

Repetitions: 10–15 × 2–3 sets

Strengthen the Rotator Cuff

Regular strengthening improves tendon capacity and shoulder stability.

Strengthen the Shoulder Blade Muscles

Scapular control plays an important role in efficient shoulder movement.

Warm Up Before Sport

Prepare the shoulder before throwing, swimming, weight training, or racquet sports.

Progress Training Gradually

Avoid sudden increases in overhead activity or gym volume.

Improve Lifting Technique

Use appropriate technique during work and exercise to reduce unnecessary shoulder loading.

Complete Rehabilitation After Injury

Returning to sport too early increases the risk of reinjury.

Shoulder Pain

Frozen Shoulder

Shoulder Bursitis

Biceps Tendinopathy

Calcific Tendinopathy

Shoulder Instability

Acromioclavicular Joint Pain

Cervical Radiculopathy

Shoulder Osteoarthritis

Subacromial Pain Syndrome