# Rotator cuff injuries The rotator cuff is the muscles and tendons that steady the shoulder and lift the arm. Injuries range from pinching and tendon pain as the arm lifts (impingement) to partial and full tears. A tear can follow a fall on skis or a bike, or build over years of overhead work. We find the cause, settle the pain, then load the tendons step by step and rebuild strength. ## Symptoms - Pain on the outside of the upper arm when you lift it - A pinch or catch as the arm lifts out to the side or overhead - Pain at night, or when lying on the sore shoulder - Weakness lifting, carrying or reaching behind your back - Sudden pain and a weak arm after a fall onto the shoulder - An ache that builds over a season of overhead work, paddling or climbing - Hitching the shoulder up to get the arm out to the side ## Assessment How it began tells us a lot. A fall on skis or a bike points one way; pain that crept in over seasons of overhead work, paddling or climbing points another. Then we examine the shoulder: its range on its own and when we move it for you, and each cuff tendon under a strength test. We watch the shoulder blade, because a blade that moves poorly crowds the tendons under the bony roof of the shoulder (the acromion). We also check your neck, since a stiff neck or an irritated nerve can send pain and weakness into the shoulder. The pattern points to the cause. A pinch at one height as the arm lifts, easing above it, suggests the tendon catching (impingement). A sore tendon that still tests strong suggests tendon pain without a tear; clear weakness, especially after a fall, suggests a tear. If we suspect a full tear, we say so. A doctor or nurse practitioner can then order a scan and refer you to a surgeon if needed. ## Treatment Exercise is the main treatment for most rotator cuff problems, including many tears, and it builds in stages: - **Settle it:** we ease off what flares the pain, such as reaching overhead, heavy carrying and sleeping on that side, without resting the arm completely. - **Load the tendons:** a tendon gets stronger when it is worked a little harder than usual. We start light, for the cuff and the shoulder blade muscles, and add load a little at a time. Each step should make the pain no more than a little worse. - **Hands-on treatment:** joint and soft-tissue mobilization can free up a stiff, sore shoulder so the exercises work better. See [manual therapy](https://backinactionphysiotherapy.com/services/manual-therapy). - **Shockwave therapy:** one option for a tendon that has stayed sore a long while, including calcium deposits in it (calcific tendinitis). We use [shockwave therapy](https://backinactionphysiotherapy.com/services/shockwave-therapy) alongside the exercises. - **Strength and conditioning:** once the shoulder moves well, [strength and conditioning](https://backinactionphysiotherapy.com/services/strength-and-conditioning) builds the strength to push, pull, lift overhead and catch a fall. ### If you are having a repair Rehab follows your surgeon's protocol: a sling and protected movement first, then range of movement, then strength, with the surgeon's timing counting alongside testing. ## Getting back to sport Testing decides when you go back, not a date on the calendar. We compare strength, range and control with your other shoulder, in the positions your sport uses. Before that, we train the shoulder for its job. On a snowboard, every fall ends with a push up off the snow, a sudden load through the cuff with the arm out wide. Biking means bracing through the bars on rough trail and, in a crash, landing on the arm. Paddling and climbing load the cuff overhead, stroke after stroke and move after move. ## When to come in Book an assessment if shoulder pain is stopping you lifting, reaching or sleeping, or if the arm has been weak since a fall. Tendon pain that has hung around all season and is holding back work, study and sport belongs here too. Book before a repair, and after one when your surgeon says physiotherapy can start. Go to the emergency department right away, or call 911, if any of these happen: - the shoulder looks out of shape - you cannot move the arm at all after a fall - the arm or hand is numb, cold or pale - a hot, red, swollen shoulder with a fever - chest pain or pressure, shortness of breath, or pain spreading into the jaw ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) - [Michael Pearce, Physiotherapist, BSc PT](https://backinactionphysiotherapy.com/team/michael-pearce) - [Kelsey Rey, Physiotherapist, MPT, BHK](https://backinactionphysiotherapy.com/team/kelsey-rey) - [Keeley Wentzel, Physiotherapist, BSc Physiotherapy (Hons)](https://backinactionphysiotherapy.com/team/keeley-wentzel) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Manual Therapy](https://backinactionphysiotherapy.com/services/manual-therapy) - [Strength and Conditioning](https://backinactionphysiotherapy.com/services/strength-and-conditioning) - [Registered Massage Therapy (RMT)](https://backinactionphysiotherapy.com/services/massage-therapy) ## Frequently asked questions ### Do I need surgery for a rotator cuff tear? Not always. A tear that built up over years is often managed with a loading program. The shoulder can work well even though the tear itself does not knit back together. An operation comes up more often after a sudden tear that leaves the arm weak, or when strength does not return with rehab. Your doctor, nurse practitioner or surgeon makes that call with you. We rehab the shoulder either way, and our strength and movement testing gives the surgeon something concrete to weigh. ### Why does my shoulder hurt more at night? Pressure and position. Lying on the sore shoulder squashes the tendons, and lying on the other side lets the arm drag across your chest and stretch them. With the day's distractions gone, the ache also gets more attention. Try sleeping on your back, or on the good side hugging a pillow to rest the arm on. Pain that wakes you whichever way you lie, or comes with feeling unwell, needs a doctor or nurse practitioner. ### Can I keep skiing, biking or climbing with rotator cuff pain? Usually, within limits. Tendons like to be used. Keep moving, as long as what you do makes the pain no more than a little worse and settles by the next day. Overhead moves, hard pushing and pulling, and falls are the things to manage, so we adjust how much and how hard rather than stopping you. A shoulder that has been weak since a fall is different. Get it assessed before you head back out. ### Why does my shoulder pinch when I lift my arm? The tendon catching. As the arm lifts out to the side, the cuff tendons pass through a narrow space under the bony roof of the shoulder. A swollen tendon, a shoulder blade that moves poorly or a weak cuff can squeeze the tendon at one point in the arc. The pinch often eases once the arm is higher. Treatment settles the tendon and retrains the shoulder blade and cuff so the space stays open as you lift. ## Massage for recovery Massage therapists do not diagnose, so start with a physiotherapist. Once you have a diagnosis and a plan, our registered massage therapists can help with the recovery. [About massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy) *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*