Rotator Cuff Strain

The shoulder is a ball and socket joint that has great mobility at the cost of structural stability. The rotator cuff is a group of muscles that primarily functions to stabilize the shoulder while other muscles move it. Injury to the rotator cuff is the most common problem affecting the shoulder. (1) The continuum of injuries ranges from minor strains of a single tendon or muscle to multiple complete tears of multiple tendons and muscles. While strains and tears can come from singular incidents, more commonly, they occur from repetitive overuse injuries and age related overuse. (2-4) Functional impairments like upper cross syndrome and scapular dyskinesis contribute to rotator cuff injuries. Individuals who have repetitive overhead work or overhead athletes are more likely to have rotator cuff injuries. 


Individuals with rotator cuff injuries often report gradual pain and weakness with crunching or clicking. This pain is usually over the front and outside of the shoulder but can travel down the arm. Overhead activity makes the pain worse and the patient may even have difficulty raising their arm overhead. Pain is often worse at night, especially if the individual sleeps on that shoulder. 


Treatment for rotator cuff injuries starts with activity modification, pain relief and restoration of normal scapular mechanics. (5) However, with activity modification, immobilization should never be used since it promotes adhesion of the shoulder. Stretching and manual release techniques can be used for shortened soft tissues. Manipulation through the neck, mid back and into the shoulder can help decrease pain and improve mobility and function. (6) Rehabilitation should begin with exercises to increase and maintain the range of motion of the shoulder and progressively increase the strength of the stabilizer muscles. Normal scapular movement should also be restored. 


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  1. Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG. Indications for rotator cuff repair: a systematic review. Clin Orthop Relat Res 2007;455:52-63

  2. Kibler WB, Chandler TJ, Pace BK. Principles of rehabilitation after chronic tendon injuries. Clin Sports Med 1992;11:661–73

  3. Ozaki J, Fujimoto S, Nakagawa Y, Masuhara K, Tamai S. Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion: a study in cadavers. J Bone Joint Surg Am 1988;70:1224-30

  4. Kibler, WB. Rehabilitation of rotator cuff tendinopathy. Clin Sp Med. 2003;22(4):837-847.

  5. Hawk C. Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions. J Manipulative Physiol Ther 2017 Jun ;40(5):293-319.

  6. Walser RF, Meseve BB, Boucher TR. The Effectiveness of Thoracic Spine Manipulation for the Management of Musculoskeletal Conditions: A Systematice Review and Meta-Analysis of Randomized Controlled Trials. J Man Manip Ther. 2009; 17(4): 237-246.