ConditionBones, joints & muscles
Rotator Cuff Syndrome (Rotator Cuff Tendinopathy)
Rotator cuff syndrome is shoulder pain caused by irritation, degeneration or partial tearing of the rotator cuff tendons, often with inflammation of the overlying bursa. It is the most common cause of shoulder pain in adults. Typical symptoms are a dull ache on the outer upper arm, pain when lifting the arm out to the side or overhead, and pain lying on that shoulder at night. Most people improve within 3 to 6 months with activity modification and a structured exercise program; injections and surgery help some.
Also called: Rotator cuff tendinopathy, rotator cuff tendinitis, subacromial pain syndrome, shoulder impingement syndrome, rotator cuff disorder
At a glance
- What it is
- Painful irritation or wear of the rotator cuff tendons, often with subacromial bursitis.
- Who gets it
- Adults over 35, people doing repetitive overhead work or sports.
- Symptoms
- Outer shoulder or upper arm pain, painful arc when lifting the arm, night pain, mild weakness.
- Diagnosis
- Examination; ultrasound or MRI if a tear is suspected or symptoms persist.
- Treatment
- Activity modification, strengthening exercises, pain relief, steroid injection for short-term relief; surgery for tears or persistent symptoms.
When to get help
Call 911 or go to the ER
- Shoulder or arm pain with chest pressure, breathlessness or sweating (possible heart attack)
See a doctor within a day or two
- Sudden inability to lift the arm after a fall or heavy lift (possible acute rotator cuff tear)
- A hot, red, swollen shoulder with fever
- A deformed shoulder after injury
Book a routine appointment
- Shoulder pain lifting the arm or at night lasting more than 2 to 4 weeks
- Weakness lifting or rotating the arm
- Shoulder pain that does not improve after 6 to 12 weeks of exercises
- Shoulder pain with neck pain and tingling down the arm
Usually safe to manage at home
- Mild shoulder ache after unusual overhead activity, with full movement, improving with rest and gentle exercise
What the rotator cuff does
The rotator cuff is a group of 4 muscles (supraspinatus, infraspinatus, teres minor and subscapularis) whose tendons wrap around the head of the upper arm bone. They keep the ball centered in the shallow shoulder socket and help lift and rotate the arm. The supraspinatus tendon runs under a bony arch (the acromion), cushioned by the subacromial bursa, and is the tendon most often affected.
What causes rotator cuff syndrome
- age-related tendon degeneration: tendons lose blood supply and resilience after 40
- overuse: repetitive overhead activity at work (painting, construction, stocking shelves) or sport (swimming, tennis, baseball)
- sudden increase in activity
- posture and shoulder blade control: rounded shoulders and poor scapular movement reduce the space for the tendons
- bone spurs under the acromion, contributing to "impingement"
- diabetes, smoking and high cholesterol, which impair tendon health
Older ideas that pain is caused purely by tendons "pinching" on bone have been revised; tendon overload and degeneration are now thought to be central, which is why exercise is the main treatment.
Symptoms
- dull ache on the outer side of the shoulder and upper arm, sometimes down to the elbow
- painful arc: pain when lifting the arm out to the side between roughly 60 and 120 degrees
- pain reaching overhead or behind the back (doing up a bra, tucking in a shirt)
- night pain, especially lying on the affected side
- mild weakness, often due to pain
- clicking or catching
Significant weakness, especially after an injury, suggests a rotator cuff tear.
How it differs from other shoulder problems
| Condition | Key difference |
|---|---|
| Frozen shoulder | Marked stiffness: the shoulder will not move even when someone else moves it |
| Rotator cuff tear | Significant weakness, often after injury or in older adults |
| Shoulder arthritis | Grinding, stiffness, X-ray changes |
| Cervical radiculopathy | Neck pain, tingling below the elbow |
| AC joint problems | Pain on top of the shoulder |
Diagnosis
A doctor or physical therapist examines movement, strength and specific tests that stress each tendon. Imaging is not always needed initially:
- X-ray: for arthritis, bone spurs and calcium deposits (calcific tendinitis)
- ultrasound: shows tendons, tears and bursitis
- MRI: for suspected significant tears or before surgery
Treatment
Activity modification
Reduce, but do not stop, aggravating activities, especially repeated overhead work. Complete rest leads to stiffness and weakness.
Exercise
A progressive exercise program, ideally guided by a physical therapist, for at least 6 to 12 weeks is the cornerstone:
- range-of-motion exercises (pendulum swings, wall slides)
- rotator cuff strengthening with resistance bands (external and internal rotation)
- shoulder blade (scapular) stabilizing exercises
- gradually progressing load, accepting mild discomfort that settles within 24 hours
Pain relief
- NSAIDs or acetaminophen (paracetamol), following the label dose; topical NSAIDs
- ice or heat
- sleeping on the other side with a pillow supporting the arm
Injections
A corticosteroid injection into the subacromial space can relieve pain for several weeks, allowing exercises to progress. Repeated injections are limited because they may weaken tendons.
Surgery
Considered when symptoms persist despite at least 3 to 6 months of good-quality rehabilitation, or for significant tears. Options include rotator cuff repair. Trials have shown that subacromial decompression (removing bone from under the acromion) adds little over exercise for pain without a tear, so it is now used more selectively.
Outlook
Most people recover or improve substantially within 3 to 6 months, though some have symptoms lasting a year or more. Keeping up strengthening exercises helps prevent recurrence.
Frequently asked questions
What is rotator cuff syndrome?
Rotator cuff syndrome is shoulder pain caused by irritation, wear or partial tearing of the rotator cuff tendons, often with an inflamed bursa. It causes pain lifting the arm, reaching overhead and lying on the affected side.
Why does rotator cuff pain get worse at night?
Lying on the affected shoulder compresses the tendons and bursa, and lying flat changes blood flow and arm position. With fewer distractions, pain is also more noticeable. Sleeping on the other side with a pillow supporting the arm can help.
What exercises help rotator cuff syndrome?
Pendulum swings, wall slides, and strengthening with resistance bands for external and internal rotation, plus shoulder blade squeezes and rows, are commonly used. A physical therapist can tailor and progress them over 6 to 12 weeks.
How long does rotator cuff syndrome take to heal?
Most people improve significantly within 3 to 6 months with exercise and activity changes. Some take up to a year. Persistent pain or weakness may need imaging to check for a tear.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons (OrthoInfo): Shoulder Impingement/Rotator Cuff Tendinitis
- American Academy of Orthopaedic Surgeons: Management of Rotator Cuff Injuries, Clinical Practice Guideline (2019)
- NHS: Rotator cuff disorders
- MedlinePlus: Rotator cuff problems
- British Elbow and Shoulder Society: Patient care pathway for subacromial shoulder pain