Rotator cuff related shoulder pain diagram

What is Rotator Cuff Related Shoulder Pain?

The shoulder complex has many muscles which help move the shoulder through a wide range of movement. There are 17 muscles that attach to the shoulder blade. There is an arch over the top of the ball and socket joint (glenohumeral joint) consisting of the acromion (end of the shoulder blade) and the collar bone or clavicle.

The space underneath this arch is called the subacromial space. Within this, lie the four rotator cuff tendons which wrap around the head of the arm bone (humerus). The terms rotator cuff related shoulder pain (RCRSP) and Sub-acromial Pain Syndrome (SAPS) are used to describe a problem with the structure(s) within the sub-acromial space.


There are many possible causes of rotator cuff related pain, including:

  • Injury or trauma however can come on ‘out of the blue’.
  • Instability of the shoulder – this can be related to poor muscle control.
  • Altered movement of the shoulder due to muscles and other structures around the shoulder becoming tight
  • Stiffness in the upper spine can affect the way your shoulder moves.
  • Muscle control of the shoulder blade.
  • Factors relating to posture for example a slumped posture can cause changes to shoulder function and result in pain.
  • Other conditions such as obesity, high blood pressure and diabetes may be related to shoulder pain.


  • Pain felt from RCRSP is normally on the outside of the upper arm. It can radiate as far as the elbow and occasionally  into the lower arm.
  • Often patients with RCRSP will also experience pain in the neck muscles on top of the shoulder.
  • There is often a dull ache at rest as well as sharp pain associated with certain positions e.g. sudden forward movement of the arm.


There is increasing evidence that conservative (non-surgical) management is very effective at managing this condition.

Activity modification

  • Initially, it is best to rest from painful activities and modify your activities.
  • It is always important to keep moving, however resting from painful activities in the short term can ease strain on the shoulder allowing it to recover. Once pain has settled, you can gradually return to normal activities.
  • This condition is normally worse when the arm is lifted forward or sideways to shoulder height or reaching behind your back. Modifying these positions will help the shoulder improve. If you need to lift an object, consider bending your elbow first, or reducing the amount you are lifting. Where possible you should avoid lifting objects to shoulder height.

Pain relief

  • Using a heat pack or something similar on a painful knee might help to relieve the pain and stiffness of osteoarthritis.
  • An ice pack can also help but be careful not to put ice or heat packs or hot water bottles directly on your skin – wrap them with a tea towel or cover.
  • Over the counter painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. A short course of anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist or GP, especially if you have any underlying health conditions.


Aim to do all exercises 2-3 times daily as your pain allows.

Pendulum Swings

Stand with your feet hip width apart and leaning forward onto your good arm. Make sure your free arm is fully relaxed. Slowly swing your affected arm forwards and backwards in a comfortable range 10-15 times.

Wall Press

Stand or sit with your elbow bent to halfway with a pillow under your arm and your forearm against the wall. Push your arm into the wall as hard as you can comfortably. Hold 5-10 sec and repeat 10 times. As this becomes easier you can complete this with your arm further away from your body.

Shoulder Blade Movements

Stand with your feet hip width apart with your hands on the wall in front of you and your elbows straight. Keeping your elbows straight push your shoulder blades forward and backwards. Repeat 10-15 times.


Spinal and shoulder posture can have a significant effect on how your shoulders move. Though, it is important to remember that there is no ‘perfect posture’, you should move and change positions often throughout the day.

Try to focus on achieving a relaxed, comfortable posture and moving or changing position once every 30-45 minutes.

When to seek help?

Following the above advice, symptoms should gradually settle over 6-12 weeks, though full recovery may take several months.

If symptoms fail to improve in this time or become more painful, further treatment or investigation may be required.

If your symptoms continue after trying conservative management, you should discuss further treatment options with your healthcare practitioner.

Your healthcare practitioner may refer you to a physiotherapist for a tailored treatment programme.

Alternative treatment options may include local injections and surgical management.

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