Rotator cuff related shoulder pain
The rotator cuff is a group of 4 muscles which fuse together to form a tendon, a thick band which attaches onto the upper arm. This supports the shoulder joint and assists with movements of the upper arm.
What is rotator cuff related shoulder pain?
Rotator cuff problems are one of the most common causes of shoulder pain, and is often experienced when lifting your arm away from your body, or by lying on your side in bed. You may be familiar with terms such as ‘bursitis’, ‘tendinitis’ and ‘impingement’, however your shoulder pain is often due to a combination of factors. Therefore, the term "rotator cuff related shoulder pain" is a more accurate way to describe a number of different issues which could include tears in the muscle or tendon, inflammation (in the tendon itself and the surrounding fluid filled cushion, called a bursa) and muscle weakness.
Who does it affect?
Rotator cuff related shoulder pain can affect adults of any age though it is more common around middle age and may develop gradually, for example due to the normal aging process, or in response to a change in the amount or way you are using your arm. It may also happen suddenly due to a trauma, such as a fall. Other lifestyle factors such as being overweight and smoking may increase the chance of developing shoulder pain, and having it for a longer period of time.
Rotator cuff related shoulder pain rehabilitation
A physiotherapy assessment can help to identify whether you need to be referred for further investigations, however often rotator cuff related shoulder pain does not require X-rays or scans, and will get better over a few months with activity modification, lifestyle changes and exercises. If your pain is very severe and you are finding it difficult to exercise, sleep or manage daily activities, a cortico-steroid injection may be discussed, and can be given by a specially trained physiotherapist in the Musculoskeletal Therapy department.
Your physiotherapist may give you advice regarding possible adaptations to make in your day to day activities, work and lifestyle. If you are affected at work by your shoulder problem, or off work due to your shoulder problem you may also be referred for an assessment by an occupational therapist in Group Rehabilitation (opens in new window) >
Your physiotherapist will also give you some exercises to do regularly at home to help gradually build up strength and movement in your shoulder in ways that are important to you. It is vital that you do these exercises regularly and frequently over the course of several weeks or months, as it can take some time for your shoulder to improve. It is normal for these exercises to provoke your shoulder pain and it is safe to continue with these exercises. However, if you are finding the pain is not an acceptable level to you or you are concerned at all, then please discuss this with your physiotherapist.
See below for some exercises for rotator cuff related shoulder pain. Aim to start off with a manageable number of repetitions, 2 or 3 times per day and increase the difficulty as time goes on. If you find that your pain is getting worse, try reducing down the exercises until things settle down a little, then build back up again gradually.
If your shoulder problem fails to improve over time with therapy input, you may be referred to the Derby Shoulder Unit to establish if there are any surgical options available to you.
Rotator cuff repair surgery
If you have surgery, you will be referred for physiotherapy post-operatively, where the aims of rehabilitation are to regain strength and movement as your shoulder recovers from the surgery. The post-operative rehabilitation is usually guided by a protocol, which has been agreed by the surgeons and the therapy team in order to gain the best possible outcome of the surgery, whilst protecting any surgical repairs as they heal. It is important to remember that surgery is part of the solution; however rehabilitation is also extremely important in order to regain your muscle strength and movement to enable you to return to your usual activities.
2 weeks post-surgery
You will be referred to physiotherapy where your first appointment is usually at around 2 weeks post-op. Your physiotherapist will take a history from you to establish your ongoing needs and goals of rehabilitation. They will also check that the wound is healing as expected and ensure you are happy with the exercises you were given immediately following the surgery. It is important to take regular pain relief to keep your shoulder as comfortable as possible. You may be referred to the occupational therapists in Group Rehabilitation for return to work advice and rehabilitation, particularly if you have a physically demanding occupation.
4-6 weeks post-surgery
At this point you will start to wean out of your sling and start using your arm gently. It is normal that your shoulder will still feel quite sore, and your arm will be difficult to move. The aim of rehabilitation at this stage is to start gently moving your operated arm with some support to take the weight. Your movement will become easier with time and practice. As your shoulder muscles become stronger and your arm feels easier and more comfortable to move, you can reduce the amount of support given during the exercises. It is likely that you will continue to require pain relief to enable you to perform the exercises and do light everyday activities such as getting dressed.
- Download 4-6 week exercises - early exercises [pdf] 364KB (opens in new window) >
- Download 4-6 week exercises - later exercises [pdf] 133KB (opens in new window) >
6-12 weeks post-surgery
The aim of this stage of rehabilitation is to start building up the strength in your shoulder to improve your ability to move your arm and perform activities such as lifting and pushing.
You can usually consider returning to driving at 6-8 weeks, providing you have adequate strength and range of movement to be able to control your vehicle and perform an emergency stop if required. You can also consider returning to work if your occupation is not too physically demanding, for example if you work at a desk. If you have a physically demanding occupation, such as working in a warehouse or in construction, you can usually aim to return at around 3 months post-surgery. It may be recommended that this is on a phased return and/or performing amended duties initially.
Although every person is different, it can take around 12 months for you to regain the majority of your strength and movement back in your shoulder following rotator cuff repair surgery.