Conditions We Treat
Rotator Cuff Injuries
At a glance
Rotator cuff injuries range from tendinopathy and subacromial pain (once called impingement) to partial-thickness and degenerative tears. The 2025 JOSPT clinical practice guideline recommends an active exercise programme as the first treatment, and manual therapy can help ease pain along the way. Scans are rarely needed at the start, but they are worth arranging after a fall, if a significant tear is suspected or if the shoulder is not improving.
You reach for the top shelf and a catch of pain grabs the outside of your shoulder, right around the point where your arm passes shoulder height. Pulling on a jacket hurts. You can no longer sleep on that side, and the ache seems to settle in the upper arm rather than the joint itself. Lifting a full kettle out to the side feels oddly weak.
The rotator cuff is a group of four muscles, the supraspinatus, infraspinatus, subscapularis and teres minor, whose tendons wrap the ball of the shoulder and help stabilise the joint (Desmeules et al., 2025). When those tendons are overloaded they become painful and sensitive. You may have been told you have impingement, subacromial pain syndrome or bursitis. These labels are now all grouped under rotator cuff tendinopathy, and the same guideline also covers calcific tendinopathy and partial-thickness tears.
Rotator cuff changes become more common as we age. A pooled analysis of 30 studies covering 6,112 shoulders found the prevalence of rotator cuff abnormalities rose from 9.7% in people aged 20 and younger to 62% in those aged 80 and older, with a similar pattern whether or not people had symptoms (Teunis et al., 2014). That is why a scan showing a degenerative tear does not, on its own, explain your pain. Guidelines advise against imaging to confirm tendinopathy in the early stages, and suggest considering it if symptoms have not improved within a maximum of 12 weeks of appropriate care, with ultrasound as the first choice (Desmeules et al., 2025).
Telling a rotator cuff problem apart from frozen shoulder is a key part of the assessment. Rotator cuff problems tend to build with repetitive overhead activity or follow a strain such as a fall onto the shoulder, often with a painful arc around shoulder height and pain or weakness when the cuff muscles work against resistance. Frozen shoulder causes a global loss of both active and passive movement, with turning the arm outward usually the most restricted. A significant loss of passive movement points away from the rotator cuff (Kelley et al., 2013). The neck is screened as part of every shoulder assessment too (Desmeules et al., 2025).
Treatment starts with load. The guideline recommends an active rehabilitation programme of motor control and resistance exercise as the initial treatment, together with clear education on your condition, activity modification and self-management (Desmeules et al., 2025). Your rehabilitation programme is built around your work, your sport and what the shoulder can tolerate now, then progressed as it gets stronger. Hands-on care sits alongside it. A 2024 meta-analysis of 24 randomised trials and 1,110 participants found that combining manual therapy with exercise improved pain and function more than exercise alone (Liu et al., 2024). That manual therapy can include soft tissue work and mobilisation of the shoulder, shoulder blade, upper back and neck (Desmeules et al., 2025).
Some shoulders need a little more. For subacromial pain, a meta-analysis of eight trials with 538 participants found that adding dry needling to other conservative treatment produced better pain and disability outcomes than conservative treatment alone (Griswold et al., 2023). Where an ultrasound or X-ray shows calcium deposits in the tendon, the guideline supports shockwave therapy to help reduce pain and disability (Desmeules et al., 2025), and we cover that in detail on our page on shockwave for calcific tendinopathy.
Tears deserve their own word. For degenerative tears, a structured rehab programme is a sensible first step. A review of six randomised trials comparing surgical repair with conservative care found that the differences in pain and function at 12 and 24 months were small and did not reach a clinically meaningful level (Brindisino et al., 2021). A shoulder that suddenly becomes weak after a fall or a heavy pull is a different situation. Imaging is appropriate after trauma or when a full-thickness tear is suspected, and if your pain and function remain severe despite up to 12 weeks of good care, the guideline recommends referral to a specialist such as an orthopaedic surgeon or sports physician (Desmeules et al., 2025). We arrange both directly. Shoulder pain that comes with chest pain or breathlessness, fever or chills, a visible deformity or a history of cancer should be checked by a doctor first (Desmeules et al., 2025).
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Book OnlineCommon symptoms of a rotator cuff injury
- Pain lifting your arm out to the side, often worst around shoulder height
- A catch or painful arc when reaching overhead
- Pain reaching behind your back or into a back pocket
- Night pain, especially lying on the affected side
- An ache over the outside of the shoulder that spreads into the upper arm
- Weakness lifting, carrying or rotating the arm
- Pain putting on a jacket or reaching for a seatbelt
- Pain with throwing, swimming, tennis or gym pressing
- Sudden weakness or inability to lift the arm after a fall
Rotator cuff problems are managed first with a clear diagnosis and a well-planned rehab programme. If your shoulder has been sore for more than a few weeks, getting assessed early helps you start the right treatment sooner.
Located on Rivonia Road in Morningside, we treat patients from Sandton, Bryanston, Rivonia, Fourways and across Johannesburg.
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Frequently Asked Questions
Many can be managed well without surgery. For rotator cuff tendinopathy and partial-thickness tears, the 2025 JOSPT clinical practice guideline recommends an active exercise programme as the first treatment. For tears more generally, a review of six randomised trials found that the differences in pain and function between surgical repair and conservative care at one and two years were small and did not reach a clinically meaningful level. If your shoulder is not improving, we refer you to an orthopaedic surgeon or sports physician for their opinion.
They describe the same group of problems. Subacromial impingement, subacromial pain syndrome and subacromial bursitis are now considered to fall under the broader diagnosis of rotator cuff tendinopathy. Whichever label you have been given, the same guideline recommendations on assessment and rehabilitation apply.
Usually not at first. Current guidelines advise against imaging to confirm rotator cuff tendinopathy in the early stages, because a clinical examination is the starting point and rotator cuff changes on scans are common in people with no pain at all. A scan is worth arranging after a fall or other trauma, when a full-thickness tear is suspected or if the shoulder has not improved within 12 weeks of appropriate care. Ultrasound is generally the first choice. As primary contact practitioners, we can refer you directly.
The main clue is what happens when someone else moves your arm. With a rotator cuff problem, lifting the arm is painful, often with a catch around shoulder height, but the joint itself still moves when it is lifted for you. Frozen shoulder causes a global loss of both active and passive movement, with turning the arm outward usually the most restricted. A thorough examination tells the two apart.
Yes. Chiropractors assess the shoulder, neck and upper back and treat rotator cuff problems with exercise-based rehabilitation, load management and hands-on care. A 2024 meta-analysis of 24 randomised trials found that combining manual therapy with exercise improved pain and function more than exercise alone. Where a scan or specialist opinion is needed, we refer you directly.
Guidelines recommend an active exercise programme as the first treatment, together with advice on activity modification, rather than complete rest. The aim is to ease off the aggravating load for a while, not to stop using the arm. We help you work out which movements to ease back on and how to build the tendon's capacity again step by step.
References
- Desmeules F, Roy JS, Lafrance S, et al. Rotator cuff tendinopathy diagnosis, nonsurgical medical care, and rehabilitation: a clinical practice guideline. Journal of Orthopaedic & Sports Physical Therapy. 2025;55(4):235-274.
- Liu S, Chen L, Shi Q, Fang Y, Da W, Xue C, Li X. Efficacy of manual therapy on shoulder pain and function in patients with rotator cuff injury: a systematic review and meta-analysis. Biomedical Reports. 2024;20(6):89.
- Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. Journal of Shoulder and Elbow Surgery. 2014;23(12):1913-1921.
- Kelley MJ, Shaffer MA, Kuhn JE, et al. Shoulder pain and mobility deficits: adhesive capsulitis. Journal of Orthopaedic & Sports Physical Therapy. 2013;43(5):A1-A31.
- Griswold D, Learman K, Ickert E, Tapp A, Ross O. Dry needling for subacromial pain syndrome: a systematic review with meta-analysis. Pain Medicine. 2023;24(3):285-299.
- Brindisino F, Salomon M, Giagio S, Pastore C, Innocenti T. Rotator cuff repair vs. nonoperative treatment: a systematic review with meta-analysis. Journal of Shoulder and Elbow Surgery. 2021;30(11):2648-2659.