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Shoulder Pain, Rotator Cuff Injury and Physiotherapy

Rotator cuff injury and Tear
Shoulder Pain

Something about the Shoulder Joint

The shoulder (glenohumeral) joint is a ball and socket joint and comprises a large spherical (humeral)

head and a small glenoid cavity. This anatomy of the shoulder joint makes it highly mobile but at the

expense of stability. Therefore, the shoulder joint is susceptible to injuries such as tendon or muscle

tear, dislocation and fracture (broken bone).

Rotator Cuff Muscle - the Big 4 muscles of the shoulder joint

The rotator cuff muscle comprises of 4 muscles, namely, Supraspinatus, Infraspinatus, Teres Minor,

Subscapularis, which attach to the shoulder like a cuff, and their functions are mainly for turning

(rotating) the upper arm inwards or outwards, hence the name “Rotator Cuff”. Biomechanically, the

rotator cuff muscles stabilise the shoulder joint by compressing the humeral head against the glenoid

cavity. These 4 muscles arise from the shoulder blade (scapula)and insert into the humerus. The

tendons of the rotator cuff muscles blend with the joint capsule and form a musculo-tendinous collar

which surrounds the back , upper and front aspects of the joint, leaving the lower aspect unprotected.

Shoulder Treatment Physiotherapy
Physiotherapy Treatment for Shoulder

Rotator Cuff Injury and Tear

Common causes of the rotator cuff tear or injury is from playing sports, repetitive strain or traumatic

injury such as road traffic accident and falls.

3 Common symptoms of Shoulder injury/ Rotator Cuff Injuries or Tear are:

1. Pain

Pain is a common symptom which can be at rest or only during shoulder movements. Sometimes

sleeping on the affected side can be painful. In some cases, even sleeping on the non-affected side

can cause pain in the affected side.

2. Stiffness

People experience a lack of range of movement in the shoulder joint, the stiffness can be related to

pain and or weakness of rotator cuff muscles or muscles around the shoulder joint complex. Normal

functional daily activities such as putting on or taking off clothes, washing or combing hair, reaching

for cupboard above head, can be difficult to perform.

3. Weakness

Weakness of the shoulder joint can be related to pain, functional or disuse weakness of the rotator

cuff muscles following the injury. Sometimes the shoulder joint muscles become “weak” due to poor

movement pattern or adaptive protective postures. The rotator cuff muscles work like a symphony

orchestra: they have to work in synchrony and harmony. The rotator cuff muscles work to stabilise

the shoulder blade (scapula) in order to allow the shoulder joint to move smoothly and with minimal

effort. If this mechanism is compromised, the shoulder movement can be painful and difficult.

Conservative Treatment for Shoulder Pain/ Rotator Cuff Injuries

Physiotherapy is the major nonsurgical treatment of shoulder pain and rotator cuff injuries. Accurate

physical and functional diagnosis is essential and is carried out by an experienced physiotherapist

who would identify the cause of the symptoms and other comorbid factors which perpetuate or

reinforce the symptoms. Other psychological barriers such as fear avoidance and catatrophisation

are identified and managed to allow maximal treatment outcomes following shoulder injuries.

Physiotherapy interventions include but not limited to:

Dry needling - with the aim to reduce pain, increase mobility and promote recovery

Manual therapy - to facilitate movement so that the shoulder joint movements are repeated with

minimal or no pain and to reinforce a more normal movement pattern to restore optimal functional


Shockwave therapy - can reduce pain, inflammation, increase mobility and assist with rotator cuff

tendon repair and recovery.

Home Exercise Program - it is important to maintain the range of movement gained after the

treatment, regain confidence with shoulder movements, and to prevent further complications such as

development into chronic pain and stiffness of the shoulder joint.

Postural awareness and correction - it is important to maintain an optimal posture in order to

prevent aggravation of shoulder symptoms.

Surgical treatment

Fractures in the Shoulder Joint

Most fractures can be healed with immobilisation in a sling for about 4 to 6 weeks. X-rays will be used

to determine whether the fracture has healed sufficiently to permit motion exercises. During the

immobilisation period, it is important to maintain flexibility of your elbow, wrist and fingers with

instructions from your physiotherapist.

In some cases, surgery may be required to stabilise the displaced fracture fragments to preserve

better congruence of bone and maximise mobility and function after the fracture site is healed.

Rotator Cuff Tear/ Injury

According to American Academy of Orthopaedic Surgeons (AAOS), in around 80% of people,

nonsurgical treatment may be effective in resolving rotator cuff issues, such as lack of movement, and


There is some evidence to suggest that surgery may not be more effective than conservative

treatment, and therefore nonsurgical treatment is often initially recommended.

Surgical treatment may be considered if nonsurgical treatment options have not been successful: The

surgery aims to manage shoulder pain, weakness or both.

In the case of larger tears, surgical intervention may be the better option.

However, there are some limitations to rotator cuff surgery.


It is critical to correctly identify the cause of shoulder pain in order to reduce pain, weakness and

improve mobility. Physiotherapy plays an important role in managing pain and symptoms associated

with shoulder injury or rotator cuff tears in a nonsurgical way.

Talk to your physiotherapist next time if you have shoulder injury or pain associated with rotator cuff


Hand on Physiotherapy Treatment
Principal Physiotherapist Kevin Lau


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