Rotator Cuff Injuries

Osteopath treating a patient's shoulder at Newhill Osteopathy Injury Clinic

The rotator cuff is a group of muscles and tendons that steady and move the shoulder, and problems with it are one of the most common causes of shoulder pain. In the great majority of cases they settle well with the right exercises and hands-on treatment, without ever needing surgery.

At Newhill Osteopathy in Horley we treat a lot of painful shoulders, from one that has become sore reaching overhead or behind, to a nagging ache that disturbs sleep night after night. This page explains the kinds of rotator cuff problem we treat, what tends to cause them, and what an appointment actually involves.

What types of rotator cuff problem can osteopathy help with?

Rotator cuff tendinopathy (wear and overuse)

The most common picture we see. The tendons become irritated and painful, usually with lifting, reaching overhead or putting on a coat, and often with an ache down the outer arm. It tends to build gradually rather than start with one dramatic moment.

Shoulder impingement

A pinching pain felt as you lift the arm out to the side, often worst through the middle of the movement and easing again at the top. It frequently goes hand in hand with cuff tendinopathy.

Rotator cuff tears

Tears sound alarming, but many – particularly the smaller, wear-related ones – settle well with exercise and time and never need an operation. We assess how the shoulder is coping, help you strengthen it, and refer you on for a specialist opinion if that is the right thing to do.

Bursitis

The small fluid-filled cushion in the shoulder can become inflamed alongside a cuff problem, adding to the pain when you lift or lie on it. It usually calms as the underlying irritation settles.

Telling it apart from a frozen shoulder

Rotator cuff problems are often confused with a frozen shoulder, but they behave differently and are treated differently. Working out which one you have is an important part of your first appointment.

Pain referred from the neck

Not all shoulder pain starts at the shoulder. A stiff neck can refer pain into the shoulder and arm, so we always check the neck rather than treating the shoulder in isolation.

Why do rotator cuff problems happen?

There is rarely one single cause. It is usually a mix of everyday things:

  • Overhead activity – painting and decorating, racquet sports, swimming or trade work that keeps the arm up for long spells.
  • A sudden increase in load – a big one-off job, or ramping up at the gym faster than the shoulder is ready for.
  • Age-related tendon changes – the cuff tendons become a little less forgiving with the years, which is completely normal.
  • A fall or a wrench – a sudden pull or landing on the arm can strain the cuff.
  • Weak control around the shoulder blade – if the shoulder blade does not move well, the cuff ends up taking more strain.
  • A stiff neck or upper back – when these do not move freely, the shoulder does more than its share of the work.
  • Too little recovery – tendons need time to adapt, and they protest when they do not get it.

What happens at your appointment?

  • We listen first. Where the pain sits, what brought it on, which movements aggravate it, how it affects your sleep, and what you have already tried.
  • We examine you. We look at how the shoulder moves and test its strength, and we check the neck, upper back and nerves too, to make sure we are treating the real source of the problem.
  • Hands-on treatment. Soft tissue work, gentle mobilisation of the shoulder, upper back and neck, and other techniques chosen to suit you. You can say no to anything.
  • Practical advice. A graded exercise plan to rebuild the shoulder’s strength and tolerance, tips for easier sleep, and a realistic plan to keep the problem from returning.

Simple things you can try at home

  • Keep the shoulder moving gently within comfort – resting it completely tends to leave it stiffer and slower to recover.
  • Ease off the particular overhead or reaching movements that flare it up, rather than stopping using the arm altogether.
  • Gentle pendulum swings – letting the arm hang and circle loosely while you lean forward – to keep the joint mobile.
  • Ice for ten to fifteen minutes after something has aggravated it; warmth can be more soothing for a stiff, achy shoulder.
  • For sleep, try lying on the other side with a pillow hugged in front of you to support the sore arm, and avoid lying directly on it.

Please see a doctor first if your shoulder pain followed a significant fall or accident and you cannot lift the arm at all, if the shoulder looks misshapen or you felt a sudden marked weakness after an injury, if the joint becomes hot, red and swollen with a fever, if you have numbness, pins and needles or weakness spreading down the arm, or if you have severe pain that is steadily worsening or leaves you feeling generally unwell. These need medical attention rather than osteopathy.

More reading

You can also see everything we treat on our conditions page.

Frequently asked questions

What exactly is the rotator cuff?

It is a group of four muscles and their tendons that wrap around the top of the arm and hold the ball of the shoulder snugly in its socket. Their job is to steady the joint and help you lift and rotate the arm, which is why a rotator cuff problem so often shows up as pain when you reach overhead, put on a coat, or fasten a seatbelt. Because the shoulder is such a mobile joint, it leans heavily on these muscles working well, and they are a very common source of shoulder pain.

Do I need surgery for a rotator cuff tear?

Usually not, and this reassures a lot of people. Many rotator cuff tears – particularly the smaller, wear-related ones that come on gradually – settle well with the right exercises and time, without ever needing an operation. Plenty of people have some degree of tear on a scan and no pain at all. Surgery tends to be reserved for larger tears, those following a significant injury, or cases that have not responded to a proper course of treatment. We will give you an honest view, work with you on strengthening the shoulder, and refer you on if we think a specialist opinion would help.

How is a rotator cuff problem different from a frozen shoulder?

They are often confused, and telling them apart matters because they behave differently. With a rotator cuff problem the shoulder is usually painful and weak in certain movements, but if someone else lifts your arm for you it will generally still move. A frozen shoulder, on the other hand, gradually stiffens so that the shoulder becomes genuinely stuck – it will not move far even when someone else tries to move it for you – and it tends to run a long, slow course over many months. We work out which pattern you have at your first appointment, because the treatment and the outlook are not the same.

Why is my shoulder so much worse at night?

This is one of the most common things people mention, and it is typical of a rotator cuff problem. Lying down takes away the support the arm has during the day, and rolling onto the sore shoulder puts direct pressure on the irritated tendons, so the ache often flares just as you are trying to sleep. It does not mean anything is seriously wrong. Many people find it helps to lie on the other side with a pillow hugged in front of them to support the sore arm, and to avoid sleeping directly on it while it settles.

How long will a rotator cuff problem take to get better?

Honestly, it is often a matter of weeks to a few months rather than days, because tendons are slow to change and the shoulder is in use all day long. The encouraging part is that the large majority improve well with hands-on treatment and a graded exercise plan, without injections or surgery. Sticking with the exercises is the part that really counts, and we will give you a realistic idea of your own timescale, and keep an honest eye on your progress, once we have examined you.

Book an appointment

If shoulder pain is getting in the way of work, sport or sleep, we would be glad to help. Call 01293 369 442, email [email protected], or book online.

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