Rotator cuff syndrome

Shoulder pain’s most common cause is rotator cuff syndrome, which is due to the rotator cuff muscles being pinched - either due to an injury or prolonged wear and tear. You may be suffering a dull ache in your shoulder, especially if you sleep on the injured side. Read on for information about symptoms, causes, treatment and effective exercises.

Pierre Schydlowsky Specialist MD in rheumatology

Rotator cuff syndrome

Shoulder pain is often caused by what is known as rotator cuff syndrome, which occurs when the tendons in the rotator cuff of the shoulder blade get pinched.

Of all the joints in your body, the shoulder has the greatest mobility. It consists of four joints. The two largest joints are formed by the attachment between the upper arm bone and the shoulder blade, as well as the attachment between the shoulder blade and the chest wall.

The attachment between your upper arm bone and you shoulder blade consists of a very small socket and a large head. This combination gives the arm the ability to move in many different directions. From a structural point of view, this high flexibility of the ball and socket joint means a high risk of becoming destabilized. Several anatomical structures help compensate and stabilize the shoulder. These include the joint capsule, the ligament, the diaphragm and the rotator cuff itself.

The rotator cuff

  • The most common cause of pain in the shoulder is the so-called rotator cuff syndrome.
  • The rotator cuff is a group of four muscles that are placed like ‘cuffs’ around the head of your upper arm bone. The function of these muscles is to stabilize your shoulder joint during movement.
  • Shoulder pain arises when your rotator cuff muscles become clamped or pinched under the shoulder bone ceiling.
  • Alternatively, pain can arise due to the muscles becoming sore and swollen from overloading.

The rotator cuff consists of four smaller muscles, which form a series of ‘cuffs’ around the head of the upper arm bone. The most important function of the rotator cuff is to stabilize the shoulder joint during movement. The shoulder blade needs to be positioned and move correctly for the shoulder to function normally.

The four muscles of your rotator cuff protrude (jut out) from the shoulder blade, slide under a bone ceiling and attach to your upper arm. Different conditions can cause the rotator cuff to be clamped under the bone ceiling, which can result in your tendons becoming pinched.

Causes

Damage to your rotator cuff is often the result of performing intense, repetitive or unusual arm movements above shoulder height e.g. when you are painting a ceiling or playing badminton. With age, your tendons weaken naturally, increasing your risk of injury.

Symptoms

When your shoulder is overloaded, the tendon becomes sore and swollen. This is a sign of inflammation. Your tendon can also become trapped under the bone ceiling, which results in even greater pressure being put on the tendon. In this case, your shoulder needs relief and controlled rehabilitation exercises.

Diagnosis and treatment

Relief

Your shoulder must, first and foremost, be relieved of all kinds of painful loads, especially when using the shoulder in its outer positions.

Rehabilitation exercises

Start by performing controlled exercises consisting of small movements. This will typically be in the form of low resistance movement exercises, which stimulate your shoulder and help it return to normal functionality.


As your rehabilitation progresses, you will need to put greater focus on the muscle balance around your shoulder as well as the strength and stability of the muscles controlling your shoulder blade and the small rotator cuff tendons.

Strength exercises can prepare you to cope with everyday activties’s arm loads and pressures. They help the arm and shoulder handle loads and perform normal activities involving lifting the arm above shoulder height. The best way to strengthen this area of your body is high resistance strength training.

Exercises for Rotator cuff syndrome

  1. Shoulder pull
    5 reps

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    • Relax your shoulders by letting them fall down.
    • Retract your shoulders so that your shoulder blades are brought together.
    • Hold the position for 10 seconds and then return to the starting position.
    • Perform 5 repetitions.
  2. Standing infraspinatus exercise (medium resistance)
    10 reps x 3 sets

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    • Stand up.
    • Use a mediumresistance exercise band.
    • Keep your arm tight to the body and pull your shoulder slightly back.
    • Bend your elbow 90 degrees, and place the exercise band around your hand and hold it with the other hand.
    • Now turn the arm outwards so that the exercise band is tightened.
    • Perform 3 sets of 8 repetitions with each arm.
  3. Lattissimus dorsi stretch
    30 sec. x 3 sets

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    • Stand with your arms over your head.
    • Grab one of your elbows with the hand of the opposite arm.
    • Lift your arms and push the elbow backwards as far as possible, and slightly towards the other shoulder.
    • Hold the stretch for 30 seconds and perform 3 repetitions with each arm.

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About the author

Pierre Schydlowsky is a specialist MD and Ph.D. of rheumatology with a diploma in sports medicine. He has published multiple research papers on shoulder and ski injuries and is teaching various advanced courses in sports medicine at Danish Universities.