Overview
The rotator cuff is a group of four muscles and their tendons surrounding the shoulder joint, providing stability and enabling arm rotation and elevation. Rotator cuff injuries range from tendinopathy (inflammation or degeneration) and partial tears to full-thickness tears. They are a common cause of shoulder pain and reduced arm function.
How common is it?
Rotator cuff tears become more common with age. Some cause pain or weakness, while others are found without symptoms.
Causes and risk factors
Rotator cuff injuries result from acute trauma, repetitive overhead activity, or degenerative age-related changes that weaken the tendon and make it susceptible to tearing.
Common risk factors
- Age-related tendon degeneration (most common cause of full-thickness tears)
- Overhead repetitive activity (painting, tennis, swimming, throwing sports)
- Acute trauma: fall onto outstretched hand or shoulder, heavy lifting
- Poor posture and shoulder biomechanics
- Subacromial impingement (narrowing of the space through which tendons pass)
- Smoking (reduces tendon blood supply)
- Diabetes (associated with tendon stiffness and tears)
Symptoms
- Pain in the outer shoulder and upper arm, typically worse with reaching overhead or behind the back
- Pain at night, especially lying on the affected side
- Weakness when lifting the arm or rotating the shoulder
- Difficulty combing hair, reaching behind the back, or fastening a bra
- Catching or clicking sensation in the shoulder
- Limited range of movement in severe cases
When to see a doctor
Arrange assessment if shoulder pain is worsening or not improving after about 2 weeks. Seek urgent assessment for pain after an injury, sudden severe pain, inability to move the arm, or new marked weakness.
Diagnosis
Clinical assessment: specific tests (Neer, Hawkins-Kennedy, empty can, drop arm sign). X-ray excludes bony pathology. MRI is the gold standard for soft tissue characterisation, distinguishing partial from full-thickness tears and guiding surgical decisions.
Treatments
Physiotherapy and rehabilitation
A supervised programme can improve shoulder strength, movement and symptoms. Exercises and progression depend on the tear and clinical assessment; recovery often takes several months.
Corticosteroid injection
A steroid injection may provide temporary pain relief to support rehabilitation. Repeated injections can weaken soft tissue; suitability and frequency require individual review. With diabetes, arrange glucose monitoring because levels may rise.
Surgical repair
Surgery may be appropriate for a traumatic tear, substantial weakness or persistent disability despite rehabilitation. The decision depends on the tear, function and general health; recovery takes months and outcomes vary.
Self-care and lifestyle
- Begin gentle pendulum exercises as soon as pain allows to prevent shoulder stiffening
- Avoid lying on the affected shoulder at night (use a pillow for support)
- Warm up properly before overhead activity
- Address posture (rounded shoulders increase subacromial impingement)
Prevention
Rotator cuff strengthening exercises, correct technique during overhead sports, and addressing posture reduce injury risk. Stopping smoking and optimising diabetes control protect tendon integrity.
Sources for targeted updates
Updated: 24 October 2026. Targeted corrections to frequency, urgent-care guidance, treatment, key facts. This update covers the named sections; a full review of the remaining guide is pending.