Rotator cuff injury

Updated: Oct 11


The rotator cuff is a group of muscles and tendons that surrounds the shoulder joint (head humerus and glenoid) and keeps the head of the humerus stable in the joint socket. A rotator cuff injury to the shoulder can lead to severe shoulder pain, which is often worse when trying to sleep on the affected side. If left untreated, a rotator cuff injury can degenerate into tendinosis and even lead to a tendon tear in the shoulder.

In this type of "shoulder tendonitis" the supraspinatus tendon is the most frequently injured. The set of rotator cuff tendons are: the supraspinatus, subscapularis and infraspinatus tendons. The biceps is among the first two and is often affected, being one of the main causes of shoulder pain. Let's see what are the symptoms of a rotator cuff injury, its possible causes and risk factors, and how to cure a difficult-to-reach tendonitis in the shoulder.

Who is affected by a rotator cuff injury?

People who perform repetitive overhead movements in their jobs or sports more often suffer rotator cuff injuries. Some examples are painters, carpenters, mechanics, cleaners and people who practice certain sports such as tennis, handball, basketball, swimming, ... The risk of suffering a rotator cuff injury increases with age due to tendon wear.


How can we suspect that we have this shoulder tendonitis? What are the symptoms of a rotator cuff injury? They are mainly two. On the one hand, as we have said, it usually causes severe shoulder pain. On the other, it can significantly limit the range of motion.

Shoulder pain from rotator cuff injury

One of the most common and obvious symptoms of a rotator cuff injury is the appearance of shoulder pain. This pain can present in different ways and at different stages of the injury. Let's see what types of pain can be associated with this shoulder tendonitis:

  • Dull, radiating pain: This is an insidious dull shoulder pain that can radiate to the elbow (but never reach the hand).

  • Night pain: A type of pain that disturbs sleep, particularly when lying on the affected shoulder. Night pain is a typical symptom of rotator cuff injury.

  • Pain when lifting the arm: Pain in the shoulder hinders / limits activities in high planes such as combing hair, drying hair, lifting weights, touching the back….

  • Loss of strength: In advanced stages, shoulder pain may be accompanied by weakness in the arm and loss of strength.

In these cases, other injuries that can be confused with the cuff injury must be ruled out, such as cervical injuries, muscle contractures, instabilities or dislocations ...


There are several possible causes of a rotator cuff injury. However, the most common cause of rotator cuff injury is the mixture of "normal wear and tear" of the tendon and sports or work activities above the plane of the eyes. All this means that the tendon works more “tighter” and, therefore, its compression, inflammation and wear and, finally, the rupture of the supraspinatus tendon.


1. Age: As you age, your risk of a rotator cuff injury increases. Rotator cuff tear or supraspinatus tendon tear are more common in people over 50 years of age. The same natural "wear and tear" of tissues can affect tendons (tendinosis) and joints (osteoarthritis).

2. The practice of certain sports: Athletes who regularly perform repetitive arm movements are at increased risk for rotator cuff injury. That is, tennis players, handball, swimmers, ball throws…. Like, for example, runners are at greater risk of affecting the patellar tendon.


I.Early stages of rotator cuff injury

The first stages of a rotator cuff injury usually include an inflammation of the tendon or tendonitis of the shoulder, especially of the supraspinatus tendon. This inflammation can also be accompanied by so-called subacromial bursitis (the "pad" that allows the supraspinatus tendon to glide).

II. From shoulder tendinosis to chronic inflammation

If the inflammation phase of the tendons cannot be resolved, the rotator cuff injury may worsen. The presence of sustained shoulder tendonitis will cause tendon wear or tendinosis. Shoulder tendinosis will weaken the tendon, aggravate "wear and tear," and can lead to chronic inflammation.

III. Rotator cuff or shoulder tendon tear (partial or total)

Persistence in the tendinosis phase of the rotator cuff injury, without specific treatment, can lead to a rotator cuff tear or tendon tear. If a supraspinatus tendon rupture -especially- (partial or total) is suffered, the most effective treatment is surgery. With a tendon tear, rotator cuff surgery should be performed as soon as possible. If you do not intervene surgically, the "hole" in the tendon will get bigger and bigger and will become irreparable.


No tendon rupture

Many people recover from rotator cuff injury with physical therapy exercises that improve flexibility and strength in the muscles that surround the shoulder joint. Thanks to these exercises, they achieve muscle rebalancing of the joint. Physical therapy for a rotator cuff injury is usually useful in the early stages, when there is still no tendon rupture.

With tendon rupture

Sometimes a shoulder rotator cuff tear can occur as a result of trauma or a bad gesture. In this circumstance, medical attention should be received as soon as possible from a specialist in this type of injury. As we have said, a ruptured tendon in the shoulder will almost certainly require surgical repair. We insist, rotator cuff surgery should be performed as soon as possible, since the natural evolution of this type of injury is towards progression.

What factors influence when choosing treatment for a rotator cuff injury?

As we have said, the most conservative treatment options (physiotherapy) or repair with surgery will depend, above all, on this presence or absence of a rupture of the supraspinatus tendon of the shoulder (especially). Despite this, there are other factors that will influence when choosing treatment for a rotator cuff injury. Let's see what they are:

The phase of injury that we are in: In the initial phases and if there is no breakage, physical therapy may be enough to rebalance the muscles of the joint and correct the injury.

Age: In advanced ages the risk of rupture increases and the healing capacity worsens.

The sport that the patient practices: The difference between an athlete who mainly uses his arms and one who does not should be taken into account.

The work: If the work performed by the patient involves the use of the arms or not.

The affected arm: Whether the rotator cuff injury affects the dominant arm or not.

The number of affected tendons: Usually the supraspinatus tendon is mainly affected, then the long portion of the biceps is added and finally the infraspinatus.

The size of the tear: It can range from a simple “fraying” of the tendon to a complete rotator cuff tear (multiple tendons).

Kyros Therapy - Sports & Recovery

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2020 by  Oscar Artacho