What Causes a Rotator Cuff Injury & When Do You Seek Help?

The shoulder is one of the most mobile joints in the body, but also one of the most vulnerable. Unlike the hip joint, the shoulder’s ball-and-socket structure is shallow, which makes it more reliant on soft tissue structures like the rotator cuff for stability and movement control. Over time, age or repetitive overhead movements can place strain on these tendons, leading to irritation, inflammation, or even partial tears. When this happens, you may experience pain, weakness, or difficulty lifting your arm, especially when lying on the affected side.

If these symptoms begin to interfere with daily activities, it may be more than temporary aches or soreness. But could it be a sign of a rotator cuff injury that needs medical attention?

What Is the Rotator Cuff?

The shoulder’s ability to lift, reach, and rotate your arm in almost any direction comes from a specific coordination of bones, muscles, and tendons. At the centre of this movement system is the rotator cuff, which is a group of muscles and their tendons that hold the top of your upper arm bone securely positioned within the shoulder socket.

The rotator cuff:

• Maintains joint stability: Keeps the upper arm bone properly aligned within the shallow shoulder socket during motion.
• Controls movement: Allows the arm to lift, rotate, and reach across a wide range of positions with precision.
• Supports overhead activity: Provides strength and coordination for tasks that require lifting the arm above shoulder level.
• Protects soft tissue structures: Works alongside a fluid-filled sac called the bursa to reduce friction between muscle and bone.

When the rotator cuff is healthy, you rarely think about it. But when it’s injured, even the simplest movements can become limiting. So how do these injuries happen and how can you recognise when something isn’t quite right?

What Are the Common Causes of Rotator Cuff Injuries?

While rotator cuff injuries are sometimes the result of a single traumatic event, most develop gradually over time. Repetitive stress, age-related degeneration, and mechanical strain are among the key contributors.

Some of the common activities that cause rotator cuff injuries include:

• Sudden Trauma: Falling onto an outstretched arm or lifting something too heavy in one go can overstretch or tear the rotator cuff tendons. These acute injuries tend to affect younger individuals and are sometimes accompanied by shoulder dislocation or fractures.
• Repetitive Overhead Movements: Jobs or sports that require frequent arm elevation place ongoing strain on the shoulder. Over time, this can wear down the tendons and lead to tears or irritation.
• Age-Related Wear and Tear: As you age, the tendons in the shoulder naturally lose strength and elasticity. The blood supply to these tissues also decreases, reducing their ability to repair minor damage before it worsens. People over the age of 40 or 50 also tend to face a higher risk, especially if they rely heavily on their dominant arm.
• Lack of Recovery Time: Performing repeated shoulder motions without adequate rest limits the tendons’ chance to heal. This is especially relevant for athletes or manual workers who don’t allow for off days or recovery periods.
• Family History: In some cases, rotator cuff injuries appear to run in families. While the exact reason isn’t fully known, inherited tendon structure or shoulder anatomy could play a part.
• Previous Shoulder Damage: If there has been a prior tear, whether diagnosed or not, the likelihood of further injury increases. Even if the opposite shoulder currently feels fine, it may be vulnerable to the same degenerative changes over time.

Treatment Options

Once a rotator cuff injury has been identified, the next step often depends on the severity of the damage, your age, and how much it affects your ability to move or rest. While not all cases require surgery, most do benefit from some form of active management to restore function and reduce discomfort over time.

Non-surgical management is often recommended first, particularly for partial tears or mild degeneration.

These may include:

• Rest and activity modification: Avoiding heavy lifting or overhead movements helps reduce strain on the tendons and gives the shoulder time to heal.
• Use of a sling: Supports the arm and limits movement to prevent further irritation while the tissues recover.
• Physiotherapy and guided exercises: A structured programme focuses on strengthening surrounding muscles and aiding with flexibility and shoulder stability.
• Anti-inflammatory medication: Over-the-counter NSAIDs can help control pain and swelling, particularly during flare-ups or after activity.
• Corticosteroid injections: In cases of persistent inflammation, an injection from a medical professional may help reduce pain and improve mobility temporarily.

While these measures do not repair a torn tendon, they often support the restoration of comfort and shoulder function for many patients with partial tears. However, surgical options may be explored when conservative care no longer provides relief or when the tendon tear is complete. In such cases, a medical professional may recommend:

• Arthroscopic tendon repair: A minimally invasive approach that reattaches the torn tendon to the bone.
• Open or mini-open repair: Suitable for larger or complex tears, this allows the surgeon to restore the tendon and surrounding tissues.
• Reconstruction or replacement procedures: In severe or recurrent cases, a tendon graft or reverse shoulder replacement may be recommended to regain shoulder stability and motion.

Can a Rotator Cuff Tear be Prevented?

Conservative care may help manage symptoms, but prevention begins long before pain sets in. If your daily routine involves repetitive overhead movement or if you’re simply hoping to maintain shoulder strength as you age, incorporating shoulder-specific care into your routine can help reduce strain on the tendons and keep the shoulder functioning well.

Some proactive steps to consider to support long-term rotator cuff health:

• Strengthen the supporting muscles: Focused strengthening exercises help stabilise the shoulder joint and improve control during movement, making the tendons more resilient to daily stress.
• Maintain flexibility: Proper stretching after strengthening exercises helps restore range of motion and reduces stiffness. Keeping the muscles long and flexible also lowers the risk of overuse injuries.
• Take regular rest breaks: During prolonged or repetitive shoulder activity, pausing to rest allows the tendons to recover and prevents fatigue-related strain.
• Use proper technique: When lifting or reaching, ensure the shoulder moves within a comfortable range to prevent unnecessary pressure on the joint.

When Do You Need to Visit an Orthopaedic Clinic?

After managing symptoms through rest or strengthening, persistent shoulder pain or weakness may point to something significant, such as a rotator cuff injury.

Typical symptoms may include a dull ache deep in the shoulder that disrupts sleep or makes it hard to reach overhead or behind your back. Some people also notice a gradual loss of strength or find it increasingly difficult to perform daily tasks like lifting or combing their hair. Even without severe pain, reduced mobility or arm fatigue can still indicate an underlying tendon problem that requires medical attention.

As such, you should consider visiting an orthopaedic clinic if you experience:

• Persistent or worsening shoulder pain: Ongoing discomfort that does not ease with rest or medication may suggest tendon inflammation or partial tearing.
• Sudden arm weakness after an injury: Loss of strength following a fall or strain can be a sign of a complete rotator cuff tear that requires assessment.
• Difficulty lifting or rotating your arm: Limited range of motion during simple activities may reflect damage to the stabilising muscles of the shoulder.

For professional assessment and care, consult an orthopaedic specialist in Singapore. Whether you visit our orthopaedic specialist at Mount Alvernia or our Novena clinic, our team can help guide you through recovery with a tailored plan.