Rotator Cuff Injury

The rotator cuff is a group of 4 tendons (attached to 4 muscles) that supports the shoulder joint. Imagine that the shoulder joint is a ball on a tee, except the tee moves up and down with the ball too. Together, the rotator cuff provide stability to ensure the ball does not fall off the tee when you move your shoulder up and down.

Most of the time, the rotator cuff is injured through overuse from repetitive stress and micro-trauma like a worn-out rope. This either causes the tendons to tear or cause a partial injury which makes them more vulnerable to tears In other times, it could be from a severe traumatic injury such as falling on an outstretched arm, sudden force when pushing or pulling or a shoulder dislocation.

In most cases, they occur through either only overuse or overuse AND a traumatic mechanism. The tear can affect just one or multiple tendons and can be full or partial tears. Age-related changes, inflammatory or autoimmune health conditions, or smoking can also reduce the strength of the tendons which places you at a higher risk of having a rotator cuff tear.

What are the symptoms of a rotator cuff tear?

Patients with rotator cuff tears often have problems doing overhead activities such as lifting the arm up beyond 90 degrees. They may feel sharp pain with or without a feeling like a shoulder is going to “give way”.

The pain can be localized around the shoulder joint, usually at the very top or the front and, less commonly around the back of the joint.

How can a physiotherapist and exercise physiologist help?

Difficulty and pain with overhead activities is often the hallmark symptom of many shoulder joint pathologies. It is like a patient coming into the doctor’s office with a fever- the cause could be so many things! In fact, pain with overhead activities is just a sign that there is an impingement of the subacromial space of the shoulder joint.

Impingement happens when the ball does not sit properly on the tee, causing the ball to hit on the bone above the shoulder joint- which can be painful! As a result, impingement can happen because of 2 things.

1. The socket/tee is not moving in sync with the ball. This means there is a problem with the muscles around the shoulder blade (which makes up the socket/tee).

2. The ball is not moving in sync with the socket/tee. This means there is a problem with either the rotator cuff, muscles or ligaments around the shoulder joint.

Because of this, a physiotherapist can help to figure out exactly what components and muscles are not activating properly to allow the shoulder to move smoothly. We then tailor our rehabilitation according to your symptoms and personal goals so that you can get back to your activities- such as getting that cup from the shelf without pain! After you reach a certain level of function exercise physiologists can help you with the advances phase of rehabilitation and ensure your shoulder is strong enough so that you don’t have another injury!


Sambandam, S.N., Khanna, V., Gul, A. and Mounasamy, V., Rotator cuff tears: an evidence based approach. World J Orthop 2015; 6: 902-18.

Itoi, E., 2013. Rotator cuff tear: physical examination and conservative treatment. Journal of Orthopaedic Science, 18(2), pp.197-204.


Please remember that medical information provided by Optimum Health Solutions, without consultation with a health care professional, must be considered as an educational service only and is not a substitute for a medical consultation.

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