Rotator cuff injury / rotator cuff tendinopathy
The rotator cuff helps centre and control the shoulder. Injury can range from overload-related tendinopathy through to partial tears or larger traumatic tears. Many cuff-related problems improve well with the right rehabilitation, but some need imaging or onward referral.
Possible presentations
- Pain lifting the arm or controlling lowering
- Night pain and difficulty sleeping on that side
- Weakness, especially after a fall or sudden overload
- Clicking or catching sensations in some cases
Assessment
- Clinical examination to differentiate cuff pain from frozen shoulder, arthritis or referred neck pain
- Strength testing and functional assessment
- Diagnostic ultrasound can be very useful for tendon quality, bursitis and tear assessment in the right clinical context
Treatment
- Graduated loading for the cuff and scapular muscles
- Activity modification while keeping the shoulder moving
- Pain-control strategies to allow rehabilitation
- Injection may be considered in selected bursitis / inflammatory presentations but is not a substitute for restoring strength and control
When referral may be needed
- Acute traumatic weakness
- Suspected full-thickness tear
- Failure to improve despite appropriate rehabilitation
- Concern about significant structural damage
When to get assessed
Assessment is useful if symptoms are persistent, recurring, limiting work or sport, or if you are unsure whether physiotherapy, imaging or injection is the most appropriate next step.
How ultrasound can help
Ultrasound is not automatically required for every patient. It is most useful when it will change management, improve diagnostic confidence or guide treatment safely.
Where injection fits
Injection is considered only where clinically appropriate after discussion of risks, benefits and alternatives. The aim is usually to reduce pain enough to progress rehabilitation, not to replace rehabilitation.