Introduction
Shoulder pain can be surprisingly limiting. Simple tasks like washing your hair, reaching behind your back, or lifting a kettle can suddenly feel impossible.
One of the most common causes? Problems with the rotator cuff a group of four small but powerful muscles and tendons that stabilise the shoulder.
At London Bridge Sports Medicine (LBSM), we assess and treat shoulder injuries in everyone from overhead athletes to office workers.
Whether you’re dealing with irritation of the tendon (tendinitis/tendinopathy) or a small tear, most patients improve with a structured rehabilitation and sports medicine programme.
What Is the Rotator Cuff?
The rotator cuff comprises four muscles:
- Supraspinatus
- Infraspinatus
- Teres Minor
- Subscapularis
Together, they stabilise the ball-and-socket shoulder joint and allow for controlled lifting, rotation and overhead movement of the arm.
The supraspinatus tendon is by far the most commonly injured part of the rotator cuff. This is because it sits in a relatively narrow space under the acromion (the sub-acromial space), where it is repeatedly compressed during overhead movements.
Over time, this combination of poor blood supply, mechanical impingement and repetitive loading leads to tendon degeneration, micro-tearing and eventually structural failure.
The infraspinatus is the second most frequently involved, particularly in throwing and racquet sports where high rotational forces are generated, while subscapularis tears are less common and often associated with trauma or heavy lifting.
Rotator cuff injuries range from tendinopathy (painful degeneration or inflammation without a tear), through partial-thickness tears, to full-thickness tears, where the tendon is completely detached from the bone.
These are often graded by size: small (<1 cm), medium (1–3 cm), large (3–5 cm) and massive (>5 cm or involving more than one tendon), with larger tears typically causing greater weakness, night pain and loss of function.
Why Do Rotator Cuff Problems Occur?
Rotator cuff injuries happen for several reasons:
1. Overuse
Repetitive overhead movement, swimming, tennis, throwing sports, CrossFit, lifting activities, gradually overloads the tendon, causing microdamage and inflammation.
2. Biomechanical or postural issues
Poor scapular (shoulder blade) control or weakness of the larger rotator cuff muscles or larger shoulder muscles, can increase stress on the tendons, rather than the load being distributed through the muscles.
3. Age-related changes
The rotator cuff tendons become more vulnerable over the age of 40–50, due to general wear and tear. Hormones also play a big part in tendon health as we get older.
4. Acute injuries
A fall, heavy lift, or sudden wrenching movement can cause partial or full-thickness tears.
5. Occupation
Painters, electricians and manual workers often develop chronic shoulder overload, due to the repetitive nature of their work.
Symptoms of Rotator Cuff Tendinitis or Tears
Common symptoms include:
- Pain lifting the arm, especially above shoulder height
- Pain lying on the affected side
- Difficulty or weakness with overhead movement
- “Catching” or pinching sensations
- Night pain
- Reduced range of motion
- In tears: sudden weakness or difficulty lifting objects
Conditions That Can Mimic a Rotator Cuff Tear
1. Acromioclavicular Joint (ACJ) Pathology
- Presentation: Pain on the top of the shoulder, often tender to touch; worse with arm across-body movements or pressing exercises.
- Mimics rotator cuff: Pain during lifting and overhead activity.
- Key difference: Pain is very localised over the AC joint, with preserved shoulder strength and less night pain.
2. SLAP Tear (Labral Injury)
- Presentation: Deep shoulder pain with clicking, catching or instability; worse with overhead or throwing movements.
- Mimics rotator cuff: Pain with overhead activity and reduced performance.
- Key difference: Mechanical symptoms are more prominent; true weakness is less common than with rotator cuff tears.
3. Long Head of Biceps Tendinopathy
- Presentation: Pain at the front of the shoulder, sometimes radiating down the arm; worse with lifting or pulling.
- Mimics rotator cuff: Pain during arm elevation and activity.
- Key difference: Pain is more anterior and often reproduced with resisted elbow flexion or supination.
4. Subacromial Bursitis
- Presentation: Diffuse shoulder pain, often worse at night or when lying on the affected side.
- Mimics rotator cuff: Painful arc during lifting and night pain.
- Key difference: Strength is usually preserved; pain is inflammatory rather than due to tendon weakness.
6. Frozen Shoulder (Adhesive Capsulitis)
- Presentation: Progressive pain followed by marked stiffness and loss of shoulder movement in all directions.
- Mimics rotator cuff: Pain and difficulty using the arm.
- Key difference: Both active and passive movements are restricted, unlike rotator cuff tears where passive movement is preserved.
Assessment & Diagnosis at LBSM
Your clinician will take a detailed history of your pain, symptoms and mechanism of injury, if there was one. They will also perform a physical assessment, focusing on:
- Strength testing of the rotator cuff and throughout the upper limbs
- Impingement tests of the shoulder
- Range-of-motion analysis
- Scapular positioning and biomechanics
- Posture and functional movement
Diagnostic Ultrasound
Our sports medicine physicians are experts in diagnostic shoulder ultrasound, allowing us to see the rotator cuff tendons in real time; including tears, inflammation and bursitis. This can be done within your initial assessment in clinic.
MRI Scanning
If needed, we can arrange a rapid MRI to clarify the size and location of a tear.
Treatment Options at LBSM
The vast majority of rotator cuff problems do not need surgery and respond well to well-structured rehabilitation.
Below is our patient-friendly breakdown of the treatment pathway.
1. Specialist Physiotherapy & Functional Shoulder Rehab
Physiotherapy is the cornerstone of rotator cuff recovery.
Your programme will target:
Strengthening the rotator cuff
Controlled loading helps the tendons heal and adapt, strengthening your shoulder and giving it good stability within the joint.
Supraspinatus and external rotator strengthening is often the key muscle to target in most cases.
Scapular (shoulder blade) control
Weakness around the shoulder blade often drives tendon overload.
Rehab includes serratus anterior, lower trapezius and postural work.
Posture and functional movement retraining
Correcting workspace setup, lifting mechanics and sports technique is often essential.
Gradual return-to-sport progression
Especially important for swimmers, tennis players, golfers and overhead athletes.
Typical recovery timeline:
- Tendinitis / tendinopathy: 6 – 12 weeks
- Small partial-thickness tears: 8 – 16 weeks
Progress depends on consistency and load management.
2. Sports Medicine Treatments
Our sports physicians offer targeted evidence-based treatments that often work alongside physiotherapy.
Shockwave Therapy (ESWT)
Shockwave is a non-invasive treatment that helps chronic tendinopathy.
How it works
- Stimulates cellular healing
- Reduces pain tissue sensitivity
- Increases blood flow
- Encourages tissue remodelling
Who it benefits
- People with persistent supraspinatus or infraspinatus tendinopathy
- Patients who haven’t improved with rehab alone
- Athletes needing quicker symptom reduction
What it feels like
A tapping or pulsing sensation, mildly uncomfortable but well tolerated.
Treatments last 10 minutes and are usually repeated weekly for 3–6 sessions.
Ultrasound-Guided Injection Therapy
Injections are not usually used as a first-line treatment, however if pain is the main limiting factor that is preventing rehab progress and quality of life, then it is an excellent next step option.
Corticosteroid Injection
- Helpful for tendinopathy and subacromial bursitis or acute inflammation
- Provides rapid relief, enabling rehab
- Short-term strategy, not a cure
- Effects can last weeks to months
PRP (Platelet-Rich Plasma)
- Uses your own growth factors
- Suitable for chronic tendinopathy or small tears
- Slower onset but longer-lasting benefit
- A regenerative rather than anti-inflammatory treatment
Pros & Cons of Injections
Pros:
- Pain reduction
- Faster rehabilitation
- Useful for athletes approaching an event
Cons:
- Does not fix a tear
- Steroid must be used cautiously
- PRP may cause soreness for a few days
Your clinician will explain whether an injection is appropriate, or whether rehab alone is the better option.
3. Nutritional Support for Tendon Repair
Our sports nutritionist offers support with:
- Meal plans with adequate daily protein intake
- Omega-3 intake to support anti-inflammatory pathways
- Weight management for overall joint health
- Advice on supplements to support joint and tendon health
Nutrition doesn’t replace rehab, but helps with healing and tissue repair and ensures the tendon responds to loading more effectively.
4. When Is Surgery Needed?
Rotator cuff surgery is considered when:
- There is a large or full-thickness tear
- The shoulder is significantly weak
- Night pain is severe and persistent
- There has been no improvement after 3 – 6 months of structured rehab
- The tear was caused by an acute traumatic injury in an active, younger individual
At LBSM, we work closely with London’s leading orthopaedic shoulder surgeons, ensuring rapid communication between your sports physician, physio and surgeon.
Surgical Options
Arthroscopic Rotator Cuff Repair
Keyhole surgery used to reattach or repair torn tendon fibres.
Subacromial Decompression
Sometimes used alongside repair to relieve impingement.
Debridement
For certain degenerative tears that are not suitable for repair.
Post-Operative Rehabilitation
Rehab after surgery is highly important in order to ensure you return to your full strength and activity level. Without it you are likely to continue to have problems, or even cause the surgery to fail.
0 – 6 weeks
- Sling for protection
- Gentle, passive movement only
- Pain and swelling control
6 – 12 weeks
- Gradual active movement
- Begin isometric strengthening
- Scapular positioning and retraining
12 – 20 weeks
- Progressive strength and endurance exercises for rotator cuff and global shoulder muscles.
- Sport-specific preparation
4 – 9 months
- Full return to overhead or contact sports
(Varies by tear size and sport)
Frequently Asked Questions
Is rotator cuff tendinitis the same as a tear?
No, tendinitis involves irritation; a tear means tendon fibres have separated.
How long does recovery take?
Most tendinopathy cases improve in 6 – 12 weeks with rehab.
Small tears take 8 – 16 weeks conservatively.
Do I always need surgery for a tear?
Not at all, many partial tears heal well with rehab and sports medicine care.
Can I keep training?
Often yes, with modifications. Your clinician will guide you on load management.
Are injections safe?
Yes, when used correctly, especially under ultrasound guidance.
Will physio fix a small tear?
Strengthening and movement retraining can often compensate extremely well, reducing symptoms long-term.
Ready to Improve Your Shoulder Function?
Whether you’ve had a recent injury or months of persistent shoulder pain, the LBSM team is here to help.
With expert diagnostics, world-class rehabilitation, targeted sports medicine treatments and fast access to top surgeons where needed, you’ll receive complete, coordinated care from start to finish.
