Rotator Cuff Injury
Strain, tendinopathy, or partial tears of the rotator cuff causing pain and weakness.
The rotator cuff is a group of four muscles — supraspinatus, infraspinatus, teres minor, and subscapularis — that center the humeral head in the glenoid and produce shoulder rotation. Rotator cuff injuries exist on a spectrum from tendinopathy (degeneration of the tendon without a tear) to partial-thickness tears to full-thickness tears. Cadaveric and MRI studies (Tempelhof et al., JSES) show partial- or full-thickness tears in over 50% of asymptomatic adults over age 60, meaning structural changes do not always equal pain.
Common presentations include weakness lifting the arm to the side or rotating it outward, deep aching pain at the lateral shoulder and upper arm, pain that worsens at night and disrupts sleep, and difficulty with overhead activities such as washing hair, putting on a jacket, or reaching into a cabinet. Sudden weakness after a fall or heavy lift may suggest an acute tear.
Risk rises sharply after age 40 and again after 60. Overhead athletes (baseball pitchers, swimmers, volleyball players), painters, electricians, and laborers with repetitive overhead demands are especially susceptible. Smokers, diabetics, and individuals with previous shoulder injuries have higher rates of tendon degeneration and slower healing.
A combined, root-cause approach.
Landmark trials including the Finnish Subacromial Impingement Arthroscopy Controlled Trial (FIMPACT) demonstrate that progressive loading rehabilitation produces outcomes equivalent to surgery for most non-traumatic rotator cuff issues. We assess tendon irritability, apply ART, instrument-assisted soft-tissue work, and dry needling to restore tissue quality, mobilize the shoulder and thoracic spine, and use a structured eccentric and heavy slow-resistance program to remodel the tendon and restore strength.
- ART and Graston for the cuff
- Joint mobilization
- Progressive loading rehab
- Postural correction
Related Conditions
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Numbness, tingling, or weakness in the hand from median nerve irritation — often higher up the arm than you think.
Shoulder Impingement
Pinching pain in the shoulder when reaching overhead, often from rotator cuff or scapular dysfunction.
Tennis & Golfer's Elbow
Tendinopathy on the outside (tennis) or inside (golfer's) of the elbow from overuse.