rotator cuff syndrome

General information about rotator cuff syndrome

What is the rotator cuff?

The rotator cuff is a group of four muscles and their tendons that surround and stabilize the shoulder joint. These muscles — the supraspinatus, infraspinatus, teres minor, and subscapularis — work together to keep your upper arm head in the flat socket of the shoulder blade and allow controlled movements. As the only real ball joint in the body, the shoulder offers the greatest range of motion, but this comes at the expense of stability. The rotator cuff is therefore crucial for the balance between mobility and stability.

Rotator cuff syndrome describes various diseases and injuries to this important muscle-tendon unit. This includes irritation and inflammation (tendonitis), degenerative changes (tendinosis), partial tears or complete ruptures of the tendons. These issues may occur individually or in combination and may vary in severity.

The rotator cuff is exposed to particular loads because it must function in a relatively tight space under the roof of the shoulder (Acromion). Certain movements, particularly when lifting the arm over the shoulder, can cause mechanical friction, which can cause wear and damage over time. The supraspinatus in particular is frequently affected by injuries due to its location.

Understanding the anatomy and function of the rotator cuff is essential for the successful treatment and prevention of shoulder problems. A healthy, strong rotator cuff is crucial for pain-free movements and full functionality in everyday life and during sport.

Causes and risk factors

The development of rotator cuff syndrome is usually multifactorial and can be caused both by acute events and by long-term stress or age-related changes.

Overwork and repetitive microtrauma are common triggers. Jobs involving frequent overhead work, such as painters, electricians or nursing jobs, place continuous stress on the rotator cuff. Certain sports such as swimming, tennis, volleyball or throwing disciplines in athletics also pose a particular burden due to the repeated overhead movements. These repetitive movements can lead to microtraumas, which, if not properly regenerated, cause long-term structural damage.

Degenerative changes play an important role with increasing age. From the age of 40, blood flow to the tendons decreases, which reduces their ability to repair and elasticity. The tendon structures become more susceptible to wear and tear. Statistically, the incidence of rotator cuff lesions increases significantly with age — in people over 60 years of age, there are often changes in imaging techniques, even without symptoms.

Anatomical factors may increase the risk of rotator cuff syndrome. A hook-shaped form of acromion (type III according to Bigliani) or bone spurs on the shoulder roof constrict the subacromial space and lead to increased mechanical friction during movements. Shoulder joint instability can also lead to altered biomechanics and thus to excessive stress on the rotator cuff.

Acute injuries Such as falls on an outstretched arm, sudden severe tensile loads or direct trauma, can result in partial or complete rotator cuff tears. Especially in older people with pre-existing degenerative changes, even relatively minor trauma can be sufficient to cause a crack.

Muscular imbalances between the various muscle groups of the shoulder also contribute to the development of rotator cuff syndrome. An imbalance between the strong movement muscles (deltoid, pectoralis) and the smaller stabilizing muscles of the rotator cuff leads to unfavorable load conditions. Inadequate control of the shoulder blade due to weakness of the shoulder girdle muscles can also impair biomechanics.

Symptoms and course of the disease

The symptoms of rotator cuff syndrome can vary depending on the severity and structures involved, but follow typical patterns that are important for diagnosis.

In the early stages, pain often only occurs during certain movements, in particular when raising the arm between 60 and 120 degrees (painful arc”). These symptoms are often described as dull and pulling and can radiate into the upper arm. Nocturnal pain is also typical, especially when you lie on the affected shoulder.

As the course progresses, the pain can persist even at rest and significantly disturb sleep. The mobility of the arm is increasingly restricted, and both active and passive movements can be affected. Everyday activities such as dressing, combing hair or taking objects from high shelves become particularly demanding.

As rotator cuff damage increases, loss of strength may occur. This is particularly evident during specific movements such as external rotation of the arm or when raising the arm against resistance. In the case of larger cracks, the active lifting capacity of the arm may be severely limited or impossible, while passive movements are still possible.

Depending on the severity, rotator cuff syndrome can be divided into different stages:

• Stage I: Mild irritation and inflammation, pain during certain movements, complete mobility, no or minimal restriction of strength.
• Stage II: Significant inflammation and incipient degenerative changes, pain during many activities, limited mobility, moderate strength restriction.
• Stage III: Partial tendon ruptures, severe pain even at rest, significantly limited mobility, noticeable limitation of strength.
• Stage IV: Complete ruptures of one or more tendons, variable pain (sometimes paradoxically pain reduction after complete rupture), severely limited active mobility, significant loss of function.

The progression can be gradual, lasting months or years, or acute following trauma. If left untreated, rotator cuff syndrome can lead to progressive worsening with increasing limitations. Older people in particular can experience so-called “rotator cuff arthropathy” — secondary osteoarthritis of the shoulder joint due to permanently impaired biomechanics.

Early diagnosis and treatment is crucial to interrupt this progressive process and maintain or restore shoulder function.

What can you do yourself?

Acute measures for shoulder pain

In the case of acute pain in the rotator cuff area, some immediate measures can provide relief and support the healing process:

Relieve your shoulder by temporarily avoiding pain-causing movements, particularly overhead activities. However, complete immobilization is not recommended as this can lead to stiffness and muscle atrophy. Make sure you move gently in the pain-free area.

Cooling applications may be helpful for acute inflammation. Wrap a cool pack in a thin towel and place it on the painful area for 15-20 minutes, several times a day. Cooling reduces swelling and relieves pain by slowing nerve conduction velocity.

Warmth can be beneficial for chronic symptoms. Heat treatments such as cherry pit pillows, heat patches or a warm shower relax muscles and promote blood circulation. Apply heat for about 20 minutes, preferably before light exercise.

Pendulum exercises are a gentle way to mobilize the shoulder and prevent sticking. Bend your upper body slightly forward, let the affected arm hang down loosely and make small circular or pendulum movements. This exercise promotes blood circulation and the removal of inflammatory substances.

A pain-relieving sleeping position can reduce nighttime symptoms. Avoid sleeping on the affected shoulder. A supine position with a flat pillow under the head or a lateral position on the healthy side with a pillow to support the affected arm are often more comfortable.

Over-the-counter pain relievers such as ibuprofen can reduce pain and inflammation in the short term. However, please note the recommended dosage and duration of use. If symptoms persist for a longer period of time, you should seek medical advice instead of continuing self-medication.

If the pain is very severe, occurs after an accident, is associated with significant movement restrictions or swelling, or persists for more than two weeks, a medical consultation is absolutely recommended.

Effective rotator cuff strengthening exercises

A targeted rotator cuff training program can alleviate discomfort and improve shoulder function. Start with simple exercises and gradually increase intensity and volume.

Isometric exercises are ideal for the initial phase, as they strengthen muscles without straining the joint:

1. External rotation against resistance: Stand sideways next to a wall. Bend your elbow at a 90-degree angle and press the outside of your hand against the wall. Hold the pressure for 5-10 seconds and repeat 10 times.
2. Internal rotation versus resistance: Same position, but press against the wall with the inside of your hand.
3. Abduction against resistance: Hang your arm down sideways and press it against a wall as if you wanted to lift it up. Hold the pressure for 5-10 seconds.

If these exercises are painless, you can light resistance exercises pass over:

1. External rotation with thera band: Attach a thera band to a fixed point at elbow height. Stand sideways, hold your elbow against your body at a 90-degree angle and pull the band outwards. Perform the movement slowly and keep the final position short. 3 sets of 10-15 repetitions each.
2. Internal rotation with Theraband: Same exercise, but pull the band towards the center of the body.
3. Lifting sideways with light weight: Stand upright with your arms on your side. Slowly raise your arms sideways up to shoulder height, keep them short and slowly lower them again. Make sure you don't shrug your shoulders. 3 sets of 10-12 reps each.

Die Y-T-W exercise is particularly effective for the entire rotator cuff:

1. Lie with your stomach on a bench or bed so that your head and arms extend over the edge.
2. Y position: Extend your arms diagonally up so that they form a “Y”. Lift it slightly and hold for 3-5 seconds.
3. T-position: Extend your arms sideways in a “T” shape. Lift it up slightly and hold.
4. W position: Angle your arms, elbows down, hands up. Raise your arms and hold.
5. Perform 2-3 sets of 5-8 repetitions of each position.

The following applies to all exercises: They should be painless or can be performed with only minimal discomfort. Only increase the intensity slowly and focus on quality over quantity. Perform the movements in a controlled manner and avoid sudden or rapid movements.

Regular training, ideally 3-4 times a week, can significantly improve the stability and function of the rotator cuff and reduce discomfort.

Stretching and mobilizing the shoulder

Good shoulder mobility is crucial for the rotator cuff to function. Regular stretching and mobilization exercises can relieve tension and improve shoulder function.

Die Chest stretch at the door is important because shortened chest muscles pull the shoulders forward and thus have a negative effect on the biomechanics of the shoulder:

1. Stand in a door frame and place your forearms on the side of the frame, elbows at shoulder height.
2. Take a small step forward and feel the stretch in your chest muscles.
3. Hold this position for 20-30 seconds and repeat the exercise 3 times.

Die Stretching the posterior shoulder capsule is important because this area is often shortened and can result in limited internal rotation:

1. Place one arm across your chest.
2. Support your elbow with your other hand and gently pull your arm toward your body.
3. Hold the stretch for 20-30 seconds and repeat on the other side.
4. Perform 3 repetitions per side.

shoulder circles is a simple yet effective mobilization exercise:

1. Stand up straight, arms loose at the sides.
2. Make slow, large circular movements with your shoulders—forward, up, back, and down.
3. Perform 10-15 circles in each direction.
4. Vary the exercise by doing the circles with outstretched arms.

Die Towel stretch improves the internal and external rotation of the shoulder:

1. Hold a towel behind your back with one hand and over your shoulder with the other hand.
2. Gently pull the towel to create a stretch.
3. Hold for 15-20 seconds and then change arm position.
4. Do 3 stretches per side.

Die Mobilization of the thoracic spine is important because a stiff thoracic spine often leads to compensatory movements in the shoulder:

1. Sit on a chair and fold your arms over your chest.
2. Slowly rotate your upper body from side to side, initiating the movement from the spine.
3. Perform 10-15 turns to each side.

These exercises should be done without pain. A slight feeling of stretching is normal, but severe pain should be avoided. Perform the stretches slowly and in a controlled manner, without making springs or jerky movements. Breathe calmly and evenly during exercises.

Performing these stretching and mobilization exercises regularly, ideally daily, can significantly improve shoulder mobility and help relieve the rotator cuff.

Ergonomics and everyday tips

The right ergonomics and conscious behavioral changes in everyday life can make a decisive contribution to relieving your rotator cuff and supporting the healing process.

Optimize your workplace:

• Set your screen at eye level to promote an upright posture.
• Position your keyboard and mouse so that your elbows form a 90-degree angle and stay close to your body.
• Look for an ergonomic chair that supports your natural spine curvature.
• For longer phone calls, use a headset instead of clamping the handset between head and shoulder.
• Place frequently used items within easy reach to avoid excessive stretching or overhead grasping.

Correct posture in everyday life:

• Avoid a forward tilted head position that often occurs when using a smartphone or reading. This “forward head position” places considerable strain on the neck and shoulder muscles.
• Practice an upright posture regularly with your shoulder blades pulled back and your abdominal muscles slightly tight.
• Check your posture several times a day and correct it as needed — especially during extended periods of sitting.
• Change your position regularly if you have to sit or stand for longer periods of time. Short exercise breaks every 30 minutes are ideal.

Shoulder-friendly techniques for everyday activities:

• When lifting heavy objects: Kneel down instead of bending over, keep the load close to your body and use your leg muscles instead of your arms to lift.
• When carrying: Spread heavy loads evenly over both arms or use a backpack with wide, padded straps instead of a shoulder bag.
• When tidying high shelves: Use a sturdy step instead of stretching yourself or place frequently needed items on lower levels.
• For household tasks: Alternate between different activities to avoid unilateral burdens. Plan breaks and divide strenuous tasks over several days.

Sleep hygiene for the shoulder:

• Find a comfortable sleeping position that relieves your shoulders. The supine position with a flat pillow under your head is often ideal.
• If you sleep on your side, avoid lying on the affected shoulder. A pillow between your arms can provide extra support.
• Make sure you have a suitable mattress and pillow that provides enough support for your neck without overstretching it.

Conscious break planning:

• Incorporate short “micro-breaks” into your daily routine, during which you relax your shoulders.
• During these breaks, do simple mobilization exercises, such as shoulder circles or gentle stretches.
• Breathe in and out consciously to release tension.

Consistent implementation of these ergonomic principles and behavioral adjustments can significantly reduce the load on your rotator cuff and promote the healing process.

What does physiotherapy do?

Differentiated diagnostics and findings collection

At our physiotherapy practice, we start with a thorough examination to determine the exact causes and extent of your rotator cuff syndrome. This precise diagnosis is the basis for an effective treatment plan.

Die detailed anamnesis includes questions about your symptoms, their onset and course, triggering factors, previous treatments and your level of professional and sporting activity. We also record your hand habits and particular burdens in everyday life to get a complete picture of your situation.

At the clinical examination Let's assess the active and passive mobility of your shoulder in all directions of movement. Specific tests such as the Jobe Test, Hawkins-Kennedy Test, Neer Test or Empty-Can Test help us to narrow down the exact location and type of damage. These tests specifically provoke specific structures and provide us with important diagnostic information based on your pain response.

Die Force testing The individual muscles of the rotator cuff provide information about functional deficiencies. We test strength during external and internal rotation, arm lifting, and specific resistance tests to assess the function of each individual rotator cuff muscle.

Die posture analysis provides information about possible biomechanical factors that could contribute to your symptoms. We examine your shoulder blade position, spine posture, and head position, as these factors influence the load on the rotator cuff.

Die Examination of shoulder blade mobility and control is an important part of the examination, as impaired shoulder blade guidance can lead to incorrect loads on the rotator cuff. We observe the interplay between shoulder blade and upper arm during various movements.

If necessary, we work closely with doctors to ensure a precise diagnosis using imaging techniques such as ultrasound or MRI. These tests can provide information about structural changes such as tendon ruptures, thickening or inflammation.

Based on the results of this comprehensive diagnosis, we develop an individualized treatment plan that is tailored to your specific needs, the severity of your illness and your personal goals.

Manual therapy and physical measures

Manual therapy is a central component in the treatment of rotator cuff syndrome. With targeted hand movements and physical treatments, we can alleviate pain, improve mobility and support the healing process.

joint mobilization: Through gentle mobilization techniques, we improve the mobility of the shoulder joint and release blockages. Depending on the findings, various techniques are used, from gentle oscillating movements to specific traction and gliding techniques. These measures can normalize joint function and reduce pressure on the rotator cuff.

Myofascial techniques: With special hand movements, we work on tensions and adhesions in muscle and fascial tissue. In doing so, we focus not only on the directly affected structures, but also on functionally connected areas such as the neck, chest and back muscles. These techniques promote blood flow, release adhesions, and improve tissue elasticity.

trigger point treatment: Painful hardening in the muscles (trigger points) can cause radiating pain and movement restrictions. Through targeted pressure or special grip techniques, we can release these trigger points and thus reduce pain and improve muscle function.

neuromobilization: In case of irritation or compression of the nerves in the shoulder-arm area, we use special techniques to mobilize these structures. Through gentle, targeted movements, we improve the lubricity of the nerves and reduce nerve tension, which can lead to significant pain relief.

Physical therapy: Depending on the stage and type of symptoms, various physical measures are used:

• cryotherapy: In acute inflammation, cold can reduce pain and swelling.
• Heat applications: For chronic complaints, heat promotes blood circulation and relaxes muscles.
• ultrasound: Deep heat improves blood circulation and promotes tissue healing processes.
• electrotherapy: Various forms of current can be used to reduce pain, reduce inflammation and stimulate muscles.

shockwave therapy: Extracorporeal shock wave therapy (ESWT) can be effective for chronic tendon problems. The acoustic impulses stimulate blood circulation, release calcifications and stimulate the body's own repair mechanisms. This non-invasive treatment has proven particularly effective for persistent complaints.

Dry Needling: We use special needle techniques for muscular tensions and trigger points. By specifically inserting thin needles into tense muscle areas, a local relaxation reflex is triggered and blood circulation is improved.

All these measures are individually tailored to your needs and the current condition of your shoulder. By combining different techniques, we can achieve optimal results and speed up the healing process.