Rotator Cuff Shoulder Pain: Causes, Recovery and Exercise

What the rotator cuff does

The rotator cuff holds the ball of the upper arm centred in its shallow socket while larger muscles move the arm. When the tendons are overloaded, irritated or torn, the shoulder becomes painful and weaker, especially with the arm away from the body.

Common causes

Most rotator cuff pain builds up gradually when the load on the tendons exceeds what they can tolerate:

• A sudden increase in overhead work, gym training or sport such as padel, tennis or swimming
• Repeated lifting or reaching, often combined with poor sleep or stress
• Age-related tendon changes, which are common after 40 and often painless
• A fall onto an outstretched arm or a heavy pull, which can cause an acute tear

How it is treated

Treatment starts with an assessment of strength, range of movement and shoulder blade control to confirm the diagnosis and rule out other causes such as a frozen shoulder or a problem in the neck.

The core of recovery is a graded exercise programme that rebuilds tendon strength and shoulder control, adjusted so pain stays at a manageable level. Hands-on treatment, advice on sleeping positions and changing aggravating activities for a while help settle pain so you can do the exercises.

Recovery from a tendon problem usually takes six to twelve weeks of consistent work. Large tears in younger, active people, or tears after an injury with clear weakness, may need a surgical opinion, followed by structured rehabilitation.

When to get it checked

Book an assessment if shoulder pain lasts more than two weeks, disturbs your sleep, or stops you from working, training or doing everyday tasks like dressing.

Seek prompt medical attention if you cannot lift your arm after an injury, the shoulder looks deformed, or pain comes with fever, chest pain or shortness of breath.