Rotator cuff injuries: shoulder pain, tears, treatment and recovery
What the rotator cuff is, why it causes shoulder pain and weakness, how tears are diagnosed, what helps without surgery, and when surgery is considered.
Also known as: Shoulder Impingement
What a rotator cuff injury is
The rotator cuff is a group of four muscles and their tendons that wrap around the shoulder joint. They keep the top of the arm bone centred in the shallow socket and help lift and rotate the arm. Problems with the rotator cuff are one of the most common causes of shoulder pain.
Rotator cuff problems range from mild to severe:
- Tendinopathy — irritation and wear of the tendons, often from overuse
- Bursitis — inflammation of the fluid-filled sac above the tendons; this and tendinopathy are often called impingement
- Partial tears — the tendon is damaged but not torn right through
- Full-thickness tears — the tendon is torn through, sometimes pulling away from the bone
Many tears happen gradually with age and wear, and some cause no symptoms. Others follow an injury such as a fall or a sudden heavy lift.
Symptoms
- Shoulder pain, often felt on the outer side of the upper arm
- Night pain, especially when lying on the affected side
- A painful arc — pain when lifting the arm sideways or reaching overhead
- Weakness lifting the arm or turning it outwards
- Difficulty combing hair, reaching for a high shelf, fastening a blouse or bra, or putting a hand behind the back
- Clicking or crackling with movement
- After an injury, sudden pain and inability to lift the arm
Shoulder pain with a stiff joint that cannot be moved even by someone else may be frozen shoulder rather than a rotator cuff problem, a common condition in people with diabetes.
Causes and who is at risk
Risk is higher with:
- Age over forty, as tendons wear and their blood supply decreases
- Repetitive overhead work, such as painting, construction or plastering
- Overhead sports, such as cricket bowling, badminton, tennis, swimming and weightlifting
- Falls on an outstretched arm, or sudden heavy lifting
- Smoking and diabetes, which affect tendon health
- A family history of rotator cuff problems
How it is diagnosed
A physical examination is the starting point. The doctor will check how far you can move your arm actively and with help, test the strength of each rotator cuff muscle, and look for the painful arc and other signs. Examining the neck helps rule out a trapped nerve that can cause shoulder pain.
Ultrasound is quick and shows the tendons, tears and bursitis well in experienced hands. An MRI gives a more detailed picture and is often used when surgery is being planned. An X-ray does not show tendons, but shows bone spurs, arthritis or calcium deposits in the tendon.
Which doctor to see
A general physician can assess shoulder pain and start treatment. An orthopaedic surgeon, especially one who specialises in shoulders, is the right specialist when pain persists despite treatment, there is significant weakness, or a tear follows an injury. Physiotherapists, who are allied-health professionals, lead rehabilitation for most rotator cuff problems.
You can find orthopaedic surgeons in Bengaluru and physiotherapists on The Doctor Index, each with a registration you can check.
Treatment
Most rotator cuff problems, including many tears, improve without surgery. Treatment depends on your age, the type and size of the injury, how it happened and how much it affects your life.
Physiotherapy
Physiotherapy is the foundation. A structured programme of stretching and strengthening exercises restores movement and builds up the rotator cuff and shoulder blade muscles. It usually takes several weeks to a few months to see the full benefit. Changing how you do overhead tasks helps the tendons settle.
Pain relief and injections
Pain relief with paracetamol, anti-inflammatory gels or tablets for short periods, and ice or heat, can make exercises easier. Do not take anti-inflammatory tablets regularly without medical advice. A steroid injection into the space above the tendon can ease pain for a while, giving a window to do physiotherapy, but repeated injections may weaken tendons, so they are used sparingly.
Surgery
Rotator cuff repair, usually by keyhole (arthroscopic) surgery, reattaches the torn tendon to the bone. It is generally considered for sudden tears after an injury, especially in younger or active people, for large tears with significant weakness, or when pain and weakness continue despite a good trial of physiotherapy. Recovery is long: the arm is usually kept in a sling for some weeks, followed by months of rehabilitation. Some large, long-standing tears cannot be repaired, and other procedures may be offered. Your surgeon will decide based on your examination and scans.
Living with it and recovery
Keep the shoulder moving within comfortable limits — complete rest can lead to stiffness. Do your exercises regularly, even after pain eases, to prevent the problem returning. At work, keep tools and items at chest height where possible and take breaks from overhead tasks. Sleeping with a pillow under the affected arm may ease night pain. Stop smoking and manage diabetes to support tendon healing.
When it is an emergency
Call 112 or 108, or go to the nearest emergency department, for:
- Shoulder or left arm pain with chest pain, breathlessness, sweating or nausea — this may be a heart attack
- A fall followed by severe pain, deformity of the shoulder or inability to move the arm, which may mean a dislocation or fracture
- A hot, red, swollen shoulder with fever
- Sudden weakness or numbness of the arm with face drooping or slurred speech
Questions to ask at your appointment
- Is this a rotator cuff problem, and is there a tear?
- Do I need an ultrasound or MRI?
- Which exercises should I do, and for how long?
- Would an injection help, and how many is safe?
- Is surgery an option for my type of tear, and what is the recovery?
- Which activities should I avoid for now?
Common questions
Questions people ask
- Can a rotator cuff tear heal on its own?
- Torn tendons usually do not grow back together on their own, but many people with partial or even full tears regain good, pain-free function with physiotherapy as the surrounding muscles compensate. Surgery is considered when pain and weakness persist or after a significant injury.
- How long does recovery take after rotator cuff surgery?
- It varies with the size of the tear and the repair. Usually the arm is in a sling for some weeks, followed by gradual physiotherapy. Most people need several months before returning to heavy or overhead activities. Your surgeon and physiotherapist will guide each stage.
- Is it a rotator cuff problem or frozen shoulder?
- Both cause shoulder pain. In frozen shoulder the joint becomes stiff, so the arm cannot be moved far even when someone else lifts it. In rotator cuff problems the arm usually moves with help but is painful or weak when lifted actively. A doctor's examination can tell them apart.
- Should I stop using my arm completely?
- No. Resting from aggravating activities for a while is reasonable, but keeping the shoulder moving gently prevents stiffness. A physiotherapist can guide which movements are safe and how to build up gradually.
This condition is usually assessed by an orthopaedic surgeon. Every profile shows the doctor’s registration and what has been checked.
Orthopaedic surgeons in Bangalore
A few orthopaedic surgeons listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Rotator Cuff Injuries; ask the clinic whether the doctor sees it.
Related conditions
- Bursitis
- Carpal Tunnel Syndrome
- Dislocated Shoulder
- Fractures
- Herniated Disk
- Muscle Cramps
- Osteoporosis
- Scoliosis
Practical reading
All postsSources
- MedlinePlus, US National Library of Medicine — Rotator Cuff Injuries
- American Academy of Orthopaedic Surgeons OrthoInfo — Rotator cuff tears
- MedlinePlus, National Library of Medicine — Rotator Cuff Injuries — Public-domain health-topic summary
Rotator cuff injuries: shoulder pain, tears, treatment and recovery is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-2076.