Rotator Cuff Disorders Info
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Video transcript
The rotator cuff is a group of tendons that wrap around the top of the upper arm bone at the shoulder joint, and hold the ball in its socket. A tear causes pain on the outer shoulder and upper arm, and weakness when you reach or lift. It can come on slowly with wear over the years, or suddenly after a fall or a heavy pull. Many people find the pain is worst at night, and that lying on that side wakes them. Reaching overhead for a high shelf or when hanging laundry often brings it on. Not every tear needs surgery, and many shoulders do well without it. Physiotherapy strengthens the muscles around the shoulder, so they share the load and ease the pain. Anti-inflammatory medication, and sometimes a cortisone injection, can settle a painful flare. Adjusting how you do overhead tasks gives the tendons a chance to calm down. If the shoulder stays strong and comfortable enough, this may be all that is needed. When a tear is large, or the weakness and pain persist, the tendon can be repaired. It is keyhole surgery, done through small incisions as an overnight procedure. The torn tendon is brought back to its place on the bone, and held there with small anchors while it heals. Any rough or worn tissue is tidied up at the same time. You go home the next day, with the arm supported in a sling. Recovery is steady, and asks for a little patience, because tendon healing to bone takes time. The arm rests in a sling for the first few weeks, to protect the repair, and you will not be able to drive while it is on. Physiotherapy moves through stages, gentle movement first, then active movement, and strengthening later on. Most people are using the hand for light tasks early, with fuller strength returning over several months. Following the program closely gives the tendon the best chance to heal.
Rotator cuff disorders: common causes of shoulder pain, ranging from mild ache to debilitating injury.
What you're feeling
You might notice that shoulder pain is very common as you get older. This condition affects many people, and the likelihood of having it increases with age. You may feel pain in the front of your shoulder or deep inside the joint. Sometimes, you might also feel pain related to the long head of the biceps tendon, which runs along the front of your arm.
Your symptoms can vary widely and do not always match how severe a tear looks. You might have had pain for a long time, or it might have started recently. The length of time you have felt pain does not tell your surgeon how bad the tear is. Many people report feeling mechanical issues, like catching or grinding, in the affected shoulder. You may find that simple daily tasks become difficult, such as reaching behind your back to fasten a bra or tucking in a shirt.
Pain often flares up at night or after you have been active. You might struggle to sleep on the side of the injured shoulder. While some people have tears without any pain, others find that these tears cause significant discomfort and dysfunction. Your surgeon will look at your specific symptoms to understand what is happening, as the pain often comes from a complex mix of tissues rather than just one single problem.
What's actually happening
Rotator cuff disease is common and becomes more frequent as you get older. Your shoulder relies on a group of tendons to keep the ball of your upper arm bone centered in the socket. When these tendons tear, the ball can move upward during movement. This upward shift is like a door hinge that has lost its bottom pin; it rubs against the bone above it instead of gliding smoothly. Over time, this rubbing causes wear-and-tear arthritis, which is damage to the smooth cartilage coating on your bone ends.
Your surgeon knows that the size of the tear does not always predict how you will feel. Your mental health and your expectations for recovery are often stronger drivers of pain and function than the tear itself. Untreated tears can lead to further joint damage, but both surgery and non-surgical care can be effective. In many cases, procedures like a superior capsular reconstruction or a tendon transfer act like a new gasket or shock absorber. They stop the ball from migrating upward and restore the normal position of your joint.
Even with a massive tear, other muscles in your shoulder can sometimes step in to help move the joint correctly. However, if the joint becomes unstable or the bone shape changes, the mechanics remain complicated to fix. Your surgeon aims to restore the normal anatomy of the joint capsule so your shoulder moves as it should. While short-term results are generally good, one year of recovery does not guarantee long-term outcomes. The goal is to reduce pain and improve your daily life, but the exact path depends on your specific shoulder mechanics and your personal goals.
What we can do about it
Your journey often starts with self-management and physiotherapy. This approach works well for many people, especially as rotator cuff disease becomes more common with age. You can try specific physical therapy exercises for two years, and about 75% of patients with non-traumatic tears find this effective. Even after 13 years, about 90% of patients treated without surgery report no or only slight pain. About 70% of these patients have no disturbance in their daily activities. Your surgeon may also suggest avoiding shoulder motions that cause impingement, which is when the tendon rubs against bone.
If you need more relief, medical management can help. Your surgeon might discuss pain medication or anti-inflammatories to reduce swelling. However, there is little evidence that corticosteroid injections manage rotator cuff disease effectively in the long term. You should be careful with these injections; they should be avoided if you plan to have surgery within the next six months. Similarly, platelet-rich plasma (PRP) injections do not appear to offer short-term benefits for chronic conditions. While some treatments aim to improve function, arthroscopic rotator cuff repair remains the favored surgical option for better shoulder movement.
Surgery is considered when conservative care reaches its limit or if you have a traumatic tear. Your surgeon might recommend arthroscopic rotator cuff repair, a minimally invasive procedure that is safe and effective for many. This surgery is durable over time, with good results seen after 36 months. For older patients aged 75 and above, surgery can still achieve high success rates with good pain relief. In cases where the tear is massive and irreparable, other options like partial repair or a reverse shoulder prosthesis may be used to restore balance or replace the joint.
When to see someone
See your GP if you have shoulder pain that does not improve with rest. Ask for a specialist review if you notice weakness, instability, or your shoulder locks or gives way. Seek help if symptoms interfere with sleep or work. Sudden worsening of pain is also a reason to visit. While many tears cause no pain, untreated chronic tears can lead to wear-and-tear arthritis. If your diagnosis remains unclear after an exam, your surgeon may use your symptom, such as shoulder pain, to guide care.
