Shoulder Pain – The Rotator Cuff

Shoulder problems are a significant cause of morbidity and disability in the general population.

Shoulder pain in the UK population is estimated to be around 7%, which can increase to 26% in the elderly. Shoulder problems can lead to an inability to work and perform domestic and social activities, as well as leading to serious economic hardship for affected individuals and their families (1).

The shoulder is made up of the humerus (long arm bone), scapula (shoulder blade) and clavicle (collar bone). The shoulder is stabilised by muscles and ligaments which maintain the humeral head in a central position.

The rotator cuff muscles are made up of four muscles which help move the shoulder in various positions.

The rotator cuff can tear by direct and indirect means:

  • Age – unfortunately as we age the rotator cuff tends to weaken increasing the risk of tear.
  • Injury – such as falling, over stretching or overuse causing degeneration then tear.
  • Genetics also play a role in shoulder pathology.
  • Indirect injuries – including shoulder instability or poor strength of the scapula muscles.

Treatment depends on the cause of symptoms and includes:

  • Rest and activity modification
    • It is important to stay active and mobile to avoid the shoulder tightening further or adopting a compensation pattern of movement.
  • Pain medication and anti-inflammatories
    • Reducing pain will allow the shoulder to move in a normal pattern.
  • Physiotherapy
    • Correcting the shoulder mechanics by releasing areas of tightness and strengthening areas of weakness is vital to improve shoulder pain.
  • Cortisone injection
    • Injections can be used in the acute as well as chronic shoulder to reduce pain and allow the shoulder to function normally. This can also be used as a diagnostic tool.
  • Surgery
    • Deciding to have surgery for the shoulder would be guided by your shoulder consulant. Here is Consultant Harry Brownlow sharing his thoughts on whether to operate on the rotator cuff.


Whether you decide to have surgery or not ultimately the shoulder needs to be strong and flexibile in order to function as normally as possible which is where Physiotherapy helps both pre and post-operatively.


Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral L. Linsell J. Dawson K. Zondervan P. Rose T. Randall R. Fitzpatrick A. Carr. Rheumatology, Volume 45, Issue 2, 1 February 2006.