The rotator cuff is the group of four muscles and tendons that hold the ball of the shoulder in its socket and control its movement. Problems with it are the most common cause of shoulder pain, and they range from irritated tendons to partial and full tears.
Typical symptoms are pain on reaching overhead or behind you, pain lying on that side at night, weakness when lifting the arm out to the side, and a nagging ache over the outside of the upper arm rather than the shoulder itself.
More information
Does a tear need surgery
Usually not, which surprises people. Rotator cuff tears are extremely common in people over fifty with no shoulder pain at all, and the presence of a tear on a scan does not by itself mean it needs repairing. A great many cuff tears become pain free and functional with a properly progressed strengthening programme, because the remaining cuff and the surrounding muscles can be trained to do the job.
Surgery is genuinely appropriate for some people, particularly after a significant traumatic tear in a younger arm, or where a well executed rehabilitation programme has not worked. If we think that applies to you we will say so and write to your GP.
What treatment involves
Settling the pain enough to be able to load the tendon, then a progressive strengthening programme. The loading is the treatment, and it needs to continue for months rather than weeks. Cuff programmes fail most often because they are stopped when the pain goes, which is usually well before the tendon has adapted.
The night pain question
Pain that wakes you when you roll onto that shoulder is characteristic and is not a sign of anything sinister. Sleeping with a pillow supporting the arm often helps while treatment takes effect.
Frequently Asked Questions
Does a rotator cuff tear always need surgery?
How long does rotator cuff rehabilitation take?
Why does my shoulder hurt most at night?
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