Rotator Cuff Tear Treatment London | Private Ultrasound Diagnosis & Injections

Rotator Cuff Tears Explained

Anatomy of a Rotator Cuff Tear

The rotator cuff is a group of four muscles and tendons which originate from different areas of the shoulder blade (scapula):

Subscapularis tendon — from the front of the scapular.

Teres minor and infraspinatus tendon — from the back of the scapular.

Supraspinatus tendon — from the top of the scapular.

These muscles and tendons are critical for shoulder function, as they co-contract during all movements to stabilise the humeral head (ball of the shoulder) within the centre of the socket (glenoid fossa) of the shoulder joint.

The rotator cuff muscles, and particularly the supraspinatus tendon, are also critical for providing leverage and compressing the joint within the centre of the socket, allowing larger muscles such as the deltoid muscle to lift the arm and weights into overhead positions.

What Causes a Rotator Cuff Tear?

Due to the extremely heavy workload during everyday activity and sporting tasks, the rotator cuff tendons — particularly the supraspinatus tendon — are commonly the site of degenerative tears to the tendon, and sometimes acute tears to the tendon during sports-related overhead activities or trauma.

Diagnosing a Rotator Cuff Tear

Ultrasound diagnostic imaging for rotator cuff and supraspinatus tendon tears has become the gold standard. Ultrasound imaging can clearly define the characteristic beak shape of the supraspinatus tendon as it inserts onto the greater tuberosity of the humerus.

It is able to detect irregularity on the underside (articular surface) of the supraspinatus tendon, as well as any associated bony irregularity that may be present with a tear.

Ultrasound can also examine the tendon fibres to assess for any areas of degenerative tendinopathy. Additionally, it is able to visualise the subacromial-subdeltoid bursa overlying the tendon.

Ultrasound Guided Injections for Rotator Cuff Tears

What to Do After Your Rotator Cuff Injection

Needle Path & Post-Injection Pain
For rotator cuff–related pain, either a glenohumeral joint injection (administered from the back of the shoulder) or a subacromial bursal injection (administered at the side of the shoulder through the deltoid area) may be used to reduce inflammation around the rotator cuff. With both of these approaches, there are typically no significant concerns about pain from the needle path itself.

Very rarely, a post-injection flare may occur, causing increased pain for 2–3 days. This is thought to be related to the medication and injectate reacting with the synovial fluid in the joint, rather than the injection technique itself.

Wound Care & Infection Risk
As with all ultrasound-guided injections, avoid exposing the injection site to dirty or public water (such as swimming pools) for 2–3 days due to the small risk of infection. Monitor for redness, swelling, or discharge at the injection site and contact me if these occur.

Activity Guidance
After an injection for rotator cuff–related pain, it is best to rest the shoulder from heavy loading and overhead activity for one week. From one week onward, you can gradually increase exercise and loading on the rotator cuff. This is best done under the guidance of a qualified physiotherapist to ensure safe and optimal rehabilitation of the shoulder muscles and tendons.

Follow-Up
If you experience any unusual pain, swelling, redness, or other concerns following your injection, please contact me immediately.

Other Treatments for a Rotator Cuff Tear

Upper Body Flexibility Exercises for Rotator Cuff Tears

Scapular Strengthening Exercises for Rotator Cuff Tears

Progressive External Rotation Strengthening Exercises for Rotator Cuff Tears

Progressive Internal Rotation Strengthening Exercises for Rotator Cuff Tears

Progressive Deltoid Strengthening Exercises for Rotator Cuff Tears

Rotator Cuff Tear | Evidence base

Evidence supports a tiered approach to rotator cuff tears based on severity and patient factors. Numerous randomized controlled trials and systematic reviews show that conservative rehabilitation, including progressive tendon loading and scapular strengthening, can yield substantial functional improvements, particularly in degenerative and partial tears. Non-operative treatment is especially effective in older or less active individuals. Surgical repair tends to offer faster and more complete recovery in traumatic full-thickness tears, particularly in younger and more active patients. Delayed surgery following failed physiotherapy has been shown not to compromise outcomes in many cases. Injection therapy may be useful to manage pain during rehab, but does not appear to change long-term outcomes.

Questions about your shoulder pain?