Shoulder pain and the rotator cuff

Causes and risk factors

Tendons may change with age or become irritated by repeated overhead activity. A fall or sudden pulling force can cause an acute tear, sometimes in a previously damaged tendon. The bursa, joint capsule or neck may also cause shoulder pain. Tendon findings therefore need to be interpreted in context. Age alone is neither a reason for surgery nor a reason to forgo careful assessment.

Typical symptoms

Lifting the arm sideways, reaching a high shelf or lying on the affected side often hurts. Night pain and reduced strength when lifting or rotating outwards may occur. Marked sudden weakness after a fall is particularly important. Frozen shoulder, calcium deposits and arthritis can cause similar symptoms. A single self-test cannot reliably establish the exact cause.

Diagnosis

We examine active and passive movement, strength, movements that provoke pain and, when necessary, the neck. It matters whether movement is limited by pain, a stiff capsule or loss of tendon function. Ultrasound or MRI can show the tendons depending on the question; X-rays help assess bone changes or calcium deposits. Before surgical decisions, tear size and location, muscle quality and personal demands are assessed together.

Non-surgical treatment

Appropriate exercise therapy often forms the basis of treatment. It strengthens the remaining tendon function and improves shoulder blade control. Activity is temporarily adjusted without unnecessarily prolonged immobilisation. Short courses of pain medication or selected injections may help. Benefits and risks are discussed individually. Improvement is usually gradual over weeks to months and cannot be guaranteed by a single device-based treatment.

Surgical options

Surgical consultation may help for a recent traumatic tear with substantial loss of function or persistent symptoms. Not every tear can be repaired, and repair is not the best choice in every situation. We explain the options and refer to a specialist shoulder centre when needed. Shoulder arthroscopy is not currently included among our own surgical procedures. Subsequent outpatient care can be coordinated by agreement.

Aftercare and rehabilitation

Without surgery, exercises and everyday activity are adjusted to progress. After tendon repair, healing initially needs protection; movement, active loading and strengthening follow an agreed staged plan. Premature loading may damage the repair, while prolonged complete immobilisation may restrict movement. Aftercare is therefore coordinated with the surgical team. A reliable return to overhead sports and heavy work often takes several months.

Common questions

Arrange a consultation

We discuss which treatment is suitable for your findings and which procedures are available within our outpatient service during a personal consultation. Outpatient operations take place at an external surgical centre.

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