Shoulder Pain – Who and What are the Rotator Cuff?

Most people will have only heard of the rotator cuff when they were told they have a rotator cuff strain or tear.  Rotator cuff injuries occur more often in people who provide repetitive overhead movements for example, swimmers, painters and tennis players.

But what does the Rotator cuff mean? Where is it and what does it do?

As a whole the rotator cuff is made up of 4 muscles and tendons that help provide strength and stability to the shoulder during movement. These muscles are located around the shoulder blade and form a cuff around the shoulder joint and attach onto the top of the long arm bone.

Each muscle is used in a variety of upper limb movements including reaching, tucking a shirt in behind and raising the arm to the side. They are pivotal to almost every movement of the shoulder joint. A balance of muscle strength and muscle flexibility is essential to the normal functioning of the shoulder and the entire shoulder girdle.

The 4 Rotator Cuff Muscles

  1. Supraspinatus
  2. Infraspinatus
  3. Subscapularis
  4. Teres Minor

As the shoulder joint has poor bony stability (hence why it is so mobile), it means our muscles are more vulnerable to injury.

Common injuries include:

  • Tendonopathy – this is often caused by a number of different mechanisms but perhaps the most common is due to an increase in the load and force on the tendon. Other factors such as anatomical varients of the shoulder blade, muscle shortening or altered shoulder / scapula mechanics which all place more load on the cuff tendons and increase the risk of tendonopathy.
  • Tear – These can either occur as a result of worsening tendonopathy (degeneration) or as a result of more significant trauma e.g following a fall, fracture or shoulder dislocation.


Most diagnoses can be established from clinical history and examination. By observing shoulder movements and testing the individual muscles of a shoulder – Physiotherapists and Doctors can confirm rotator cuff injury. Occasionally an XR maybe required to look at the anatomy of the shoulder. When there is a more severe injury, or a number of muscles / tendons injured then the most effective scan is an MRI.

Treatment Options

The good news is that the majority of rotator cuff injuries can be successfully treated conservatively / non-operatively with Physiotherapy.

Normalising the shoulder mechanics by correcting muscle imbalances and control accompanied with activity modification will provide the biggest amount of relief.

This alongside anti-inflammatory medications, ice and taping can all facilitate recovery from these injuries.

If you have been experiencing shoulder pain during your gym workouts or have been noticing a painful shoulder at night time, get it checked out. Often some simple corrective exercises can keep you working at your best without causing further injury.