Shoulder Problems

Rotator Cuff


The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm (humerus) to the shoulder blade (scapula). The rotator cuff tendons provide stability to the shoulder; the muscles allow the shoulder to rotate.

The muscles in the rotator cuff include:

  • Teres minor
  • Infraspinatus
  • Supraspinatus
  • Subscapularis

Each muscle of the rotator cuff inserts into the scapula, and has a tendon that attaches to the humerus. Together, the tendons and other tissues form a cuff around the humerus.

Impingement pain may be caused by inflammation or injury to the rotator cuff tendons resulting from trauma, overuse, weakness, poor posture, or a faulty movement pattern. The rotator cuff can become irritated or inflamed when it becomes pinched between the acromion (the roof portion of the shoulder) and the humeral head (the ball portion of the shoulder joint). Some common causes of impingement syndrome are repetitive throwing, lifting, or overhead activities such as painting. Impingement syndrome may cause your shoulder to ache or a sharp pain when trying to reach behind your back. The pain is often felt at the front of the shoulder or in the upper arm.

A Rotator cuff strain or tear may be caused by trauma, such as a fall on an outstretched arm or trying to lift something too heavy, or by age related wear and tear changes to the tendon. Ongoing impingement may also result in a rotator cuff tear. Your arm may feel weak with pain in to the shoulder and/or upper arm. Minor strains and tears will often heal with rest and physiotherapy. Larger tears may need to be repaired with surgery, especially if you place a lot of demand on your shoulder. Tests done during the physiotherapy assessment can determine the severity of a tear.

Tendonitis of the rotator cuff tendons can occur with overhead use of the arms in repetitive activities such as painting, cutting a hedge or throwing. It can also occur by keeping the arm in one position for a long time, maybe when asleep or working on a keyboard. The tendons can become inflamed and swollen resulting in impingement between acromion and humerus.

Frozen Shoulder or Capsulitis refers to a condition which causes inflammation of the joint capsule. This results in pain and a progressive loss of movement of the shoulder. This may occur after trauma, such as a fall or fracture, but often begins for no apparent reason, and is more common after the age of 40. In the initial acute phase, anti-inflammatory medications and sometimes a steroid injection may be the treatment of choice. When stiffness is the main problem, then physiotherapy can be very helpful to assist regaining mobility and function.