Rotator cuff pain
Rotator Cuff Pain: Why the Shoulder Hurts and Why the Shoulder Isn't Always the Cause
The pain usually sits on the outside of the upper arm rather than on top of the shoulder. It catches when you lift the arm to the side, reach into the back seat of the car, put on a jacket or lift a bag into the overhead locker. At night, lying on that side becomes difficult.
This is one of the most common shoulder complaints, especially after 40, in padel, tennis and swimming players, in people who train with overhead presses, and in those who spend long days at a desk.
What the rotator cuff does
The rotator cuff is a group of four muscles that wrap around the ball of the shoulder. While the larger muscles lift the arm, the cuff keeps the ball centred in its shallow socket. It works in every arm movement, all day long.
The tendons of these muscles can become irritated and lose capacity when they are asked to do more than they are ready for. This is now usually described as rotator cuff related shoulder pain or tendinopathy. You may also hear the older term "impingement".
Why the tendon gets overloaded
The shoulder is the last link in a chain that starts at the ribs and spine. When something earlier in that chain doesn't move well, the cuff compensates:
A stiff upper back: a rounded thoracic spine limits how far the arm can rise, so the shoulder joint has to work at the edge of its range.
A shoulder blade that doesn't rotate: to lift the arm overhead, the shoulder blade has to rotate upward and tilt back. When it stays stuck, space for the tendon narrows.
Tight fascia at the chest and armpit: restrictions around the chest, the armpit and the large back muscle pull the shoulder forward and down.
Upper chest breathing: when breathing moves into the upper chest, the neck and upper shoulder muscles stay tense and lift the shoulder blade at the wrong time.
Old injuries further down the arm: a stiff wrist or elbow after an old fracture changes how you use the arm, and the shoulder takes up the slack.
Sudden load: a new sport, a holiday of swimming, a heavy move or a jump in training volume.
What a scan does and doesn't tell you
Ultrasound and MRI often show tendon changes or even partial tears. These findings are also common in people of the same age with no pain at all, and they become more common with every decade. A scan helps rule out certain problems, but it rarely explains on its own why your shoulder hurts now.
How physiotherapy can help
Exercise is the first-line treatment for rotator cuff pain, and it works best when the rest of the chain is addressed too:
Fascia work: releasing the chest, armpit, upper back and the back of the shoulder so the joint can move into its natural position.
Manual mobilization: improving movement of the upper back, ribs and shoulder joint.
Progressive cuff loading: from gentle holds that ease pain to strengthening through range and finally overhead and sport-specific work.
Shoulder blade control: retraining the timing of the muscles around the shoulder blade.
Breathing retraining: shifting breathing back to the diaphragm to quieten the neck and upper shoulders.
Load planning: adjusting training and work tasks while the tendon rebuilds.
A typical programme runs for around 12 weeks. Many people, including some with partial tears, regain comfortable movement with this approach.
Sudden inability to lift the arm after a fall, or shoulder pain together with chest pain or shortness of breath, needs urgent medical attention.
Shoulder pain treatment in Dubai
A personalized assessment looks beyond the shoulder to find what is overloading it. Physiotherapy in Jumeirah, Palm Jumeirah and across Dubai, with home physiotherapy available.
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