The rotator cuff is the group of four tendons that stabilize the shoulder joint and help to lift the arms overhead. The tendons connect to the four muscles that move the shoulder. Rotator cuff damage can occur from an acute injury or as a result of repetitive strains and wear and tear to the tendons. This happens more often in people who do work or play sports that involve repetitive, overhead movements, such as tennis. Minor strain injuries can progress to a partial tear of the tendons or a complete rupture of the muscles with loss of shoulder joint function. However, a complete tear can also occur without symptoms; this often occurs in older adults who are less active.

Gradual Onset of Pain

Pain from a rotator cuff injury can develop gradually, beginning at the time of the injury or days afterward. Over time, the pain will continue to grow in intensity until moving the shoulder joint at all causes extreme discomfort.


Short, Sharp Pain in Shoulder and Arm

Pain from a rotator cuff injury will be felt in the front and side of the shoulder, not surprisingly. The sensation often intensifies when the individual lifts their arms above their shoulders or up to the side and may be most noticeable during activities such as swimming or playing golf or tennis. Sometimes, the pain will spread from the shoulder to affect the upper arm and possibly the elbow as well.


Difficulty Lifting the Arm and Decreased Arm Mobility

People with rotator cuff disease usually find it difficult to lift the arm overhead or away from the body, thus decreasing the arm's full range of motion. If rotator cuff disease involves severe tears of the rotator cuff tendons, an individual may find it impossible to hold their arm up. Generally, he or she will be able to lift the arm slightly, but not as high as the shoulder. Simple tasks such as brushing the hair or reaching for an object on a high shelf may become difficult or impossible.



Some people with rotator cuff injuries hear loud clicking, popping, or cracking sounds when lifting their affected arm. This sound, called crepitus, may become worse over time and are more pronounced when moving the arm or shoulder into certain positions.


Pain at Night

The pain from rotator cuff disease often worsens in the evening and can be most severe at night when resting or lying on the affected shoulder. Later stages of the disease can cause pain so severe that individuals require painkillers to sleep.


Stiffness and Tenderness

Over time, rotator cuff disease can cause the shoulder to become stiffer due to inflammation and the continued lack of movement. Some people develop frozen shoulder, which can last for months or years even after the rotator cuff injury is addressed. Most people with frozen shoulder feel moderate to severe pain for the first two to nine months. Then, the pain diminishes somewhat. However, increasing stiffness follows this stage, and may also involve tenderness around the injured tendons. Physical therapy is important for recovering full mobility of the affected shoulder.


Bruising and Weakened Shoulders

This symptom is uncommon but may develop in people with severe rotator cuff disease, most commonly a tear in the rotator cuff. The shoulder and connecting tissue begin to bruise and become swollen. These symptoms exacerbate the muscle weakness that can become worse over time, especially if the shoulder continues to be too painful or stiff to complete its full range of motion.


Asymptomatic Injuries

Though a rotator cuff injury can cause many symptoms, sometimes the condition is asymptomatic. In these cases, a person may not be aware they have injured their shoulder until they require medical imaging or another diagnostic procedure for minor issues or another problem entirely. Even mild shoulder pain should be examined by a physician if it does not ease or resolve within a few weeks.


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