Rotator Cuff Injuries

The rotator cuff is a group of four muscles and tendons around the shoulder that allow lift and rotation. Rotator cuff injuries range from inflammation (tendinitis), to partial tears, to complete tears. They are among the commonest causes of shoulder pain, especially in people over 40.

Symptoms

• Pain on top or front of the shoulder — often worse at night, lying on that side.
• Pain on lifting the arm — between 60° and 120° (painful arc); combing hair, reaching the back.
• Weakness — difficulty lifting or rotating.
• Clicking or catching sensation.
• Gradual loss of motion — particularly with "frozen shoulder" superimposed.
• Can be sudden (after fall, lifting heavy object) or gradual (overuse, degeneration with age).

Red flags

• Sudden inability to lift the arm after a fall — possible complete tear; urgent orthopaedic review.
• Shoulder pain with fever, redness, severe pain at rest — rule out infection, septic bursitis.
• Shoulder pain with chest symptoms — rule out cardiac cause (diaphragm-related referred pain).

Treatment

• Rest from aggravating activities, but keep the shoulder moving — prolonged immobilisation leads to frozen shoulder.
• Ice early, heat for chronic pain.
• NSAIDs short-term; topical gels.
• Physiotherapy — range-of-motion and targeted strengthening; mainstay of treatment.
• Steroid injection — selectively useful in severe inflammation or to allow physio; not repeated indefinitely.
• Surgery — arthroscopic repair for large or persistently symptomatic tears, especially in younger active patients; often day-care.
• PRP, shockwave — emerging options; mixed evidence.
• Consider underlying diabetes — slower healing, higher frozen shoulder risk.

Shoulder pain in over-40s is often self-treated for months with balms, massages, and painkillers. Pain that interferes with sleep or daily activity deserves evaluation — an ultrasound or MRI takes minutes and guides the right treatment.