Clinically reviewed by What is rotator cuff
The rotator cuff is a group of four small muscles that wrap around the shoulder, hold the ball in its socket, and lift and rotate the arm. A tear means one of their tendons is partly or completely torn, most often the one running over the top of the shoulder.
People describe it as kandhe ka pattha phatna. Tears happen in two ways. Gradually, as the tendon wears with age, which is the common one after fifty. Or suddenly, from a fall, a yank on the arm, or catching a heavy weight.
Symptoms you might have
- Pain on the outside and front of the shoulder, often spreading down the upper arm
- A painful arc when lifting the arm out to the side, worst roughly between a third and two thirds of the way up, then easing as the arm goes higher
- Night pain, and being unable to lie on that side
- Weakness lifting the arm, reaching a shelf, or holding something out in front of you
- Difficulty reaching behind your back or putting on a shirt
Why it happens
- Age related tendon wear, which is the commonest cause after fifty
- Years of overhead work: painting, plastering, construction, loading
- Carrying heavy loads on one shoulder or on the head
- A fall onto the shoulder or onto an outstretched hand, including off a motorbike
- A sudden pull, such as grabbing something heavy as it falls
- Repeated throwing or overhead sport
- Diabetes and smoking, which make tendon problems more likely and slower to settle
- Weak shoulder blade muscles, which leave the cuff doing work it was not built for
When you should see a physiotherapist
Come in early. A shoulder that is rested and protected stiffens quickly, and a stiff shoulder is a longer problem than a sore one. Early assessment also tells you whether this is a cuff problem at all, because the neck and frozen shoulder cause similar pain.
See a doctor about imaging if you cannot lift the arm at all, or if it is clearly weak rather than only painful. An ultrasound scan or MRI shows the size of the tear.
Go to a hospital the same day after a fall if the shoulder looks out of shape, you cannot move it at all, or the arm is numb, cold or pale. That can be a dislocation or a fracture. Go the same day too if shoulder pain comes with chest pain, sweating or breathlessness, which is a heart emergency.
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اپائنٹمنٹ کے بارے میں پوچھیںAppointment ke liye poochein
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How it is treated
Treatment is built around strengthening what still works. Even with a torn tendon, the rest of the cuff and the shoulder blade muscles can be trained to lift and control the arm, and for most people that is enough to get the shoulder working again.
- Exercise therapy, the main treatment. Isometric holds first, then progressive rotation and lifting work over months
- Manual therapy to the shoulder, shoulder blade and upper back, to restore movement
- Shoulder blade retraining, because a shoulder blade that does not move well overloads the cuff
- Ultrasound for pain and tendon irritation in the early phase
- TENS or electrotherapy where night pain is stopping you sleeping
- Dry needling or hijama for muscles around the shoulder blade that are in spasm
- Activity advice, so overhead work and sleeping position stop re-irritating it
Many tears, including some complete ones, are managed well without surgery. Surgery is considered for a sudden complete tear in a younger or active person, for weakness that is not recovering, and for pain that remains after three to six months of rehabilitation. A shoulder surgeon decides that. We do not operate.
Exercises, and what to avoid
What helps
- Pendulum swings, letting the arm hang and swinging it gently, to keep the joint moving
- Isometric holds, pressing the arm gently against a wall without moving the shoulder
- Outward and inward rotation with a light band, elbow tucked in at your side
- Shoulder blade squeezes and rows, two or three times a week, which build the base the cuff works from
What to avoid
- Overhead lifting, pressing and reaching while the shoulder is painful and weak
- Sleeping on that side, and sleeping with the arm above your head
- A sling or complete rest beyond a few days after an injury, which leads to a stiff shoulder
- Pulling the arm into a hard stretch, or letting anyone force the shoulder through its range
What you can do at home
Sleep on your back or on the other side, with a pillow under the painful arm to support it. Many people sleep better propped up for the first few weeks.
Keep the arm moving below shoulder height. Use it for eating, dressing and light tasks. Doing nothing with it is what leads to stiffness.
Move the heavy and high things down to waist height at home and at work, so you are not reaching overhead twenty times a day.
Ice for the first two or three days after a fresh injury or a flare, 10 to 15 minutes with a cloth against the skin. Heat afterwards for stiffness, before your exercises.
Carry bags on the other side, and choose a bag you can wear rather than grip.
How long it takes
Pain, and night pain in particular, usually starts to settle within four to six weeks of proper treatment.
Strength and function take longer. Expect three to six months of consistent exercise for a tear managed without surgery, and that is the realistic timeline, not a cautious one.
A torn tendon does not knit back together, which is worth being clear about. What changes is the strength and control of everything around it, and that is what gets the arm working again.
It goes slower with diabetes, with smoking, and in a shoulder that has already stiffened. If surgery is done, recovery from that takes six to twelve months.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
کندھے کے اندر چار چھوٹے پٹے ہوتے ہیں جو بازو کو اٹھاتے اور گھماتے ہیں۔ عمر کے ساتھ گھسنے سے، یا گرنے سے، ان میں سے کوئی پھٹ جاتا ہے۔
پہچان یہ ہے کہ بازو کو سائیڈ سے اٹھاتے وقت بیچ میں سخت درد ہوتا ہے، رات کو اس کروٹ پر سویا نہیں جاتا، اور بازو اٹھانے میں کمزوری ہوتی ہے۔
ضروری نہیں کہ آپریشن ہو۔ زیادہ تر لوگوں میں ورزش اور مینول تھراپی سے کندھا ٹھیک کام کرنے لگتا ہے، لیکن اس میں تین سے چھ مہینے لگتے ہیں۔
کندھے کو بالکل بیکار نہ چھوڑیں۔ سلنگ لمبے عرصے تک نہ پہنیں، ورنہ کندھا جم جاتا ہے۔
گرنے کے بعد اگر کندھا اپنی شکل بدل لے، حرکت نہ کرے، یا بازو سن اور ٹھنڈا ہو جائے تو فوراً ہسپتال جائیں۔
Roman Urdu
Kandhe ke andar chaar chhote pattay hote hain jo baazu ko uthate aur ghumate hain. Umar ke sath ghisne se, ya girne se, in mein se koi phat jata hai.
Pehchan ye hai ke baazu ko side se uthate waqt beech mein sakht dard hota hai, raat ko us karwat par soya nahi jata, aur baazu uthane mein kamzori hoti hai.
Zaroori nahi ke operation ho. Zyada tar logon mein warzish aur manual therapy se kandha theek kaam karne lagta hai, lekin is mein teen se chhe mahine lagte hain.
Kandhe ko bilkul bekaar na chhoren. Sling lambe arse tak na pehnen, warna kandha jam jata hai.
Girne ke baad agar kandha apni shakal badal le, harkat na kare, ya baazu sun aur thanda ho jaye to foran hospital jayen.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
Understand your next steps
Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
Your online consultation includes a written plan you can refer to afterwards.
Questions people ask
Can a rotator cuff tear heal without surgery?
Why does my shoulder hurt most at night?
When is surgery needed for a rotator cuff tear?
Is it a cuff tear or a frozen shoulder?
Can I keep doing overhead work?
Related conditions
- Neck pain and stiff neck treatment
- Cervical spondylosis treatment
- Frozen shoulder treatment
- Shoulder impingement treatment
- Shoulder blade pain treatment