In about 70% of cases, pain on lifting the arm is rotator cuff impingement — and 80% of these resolve with structured physiotherapy in 12 weeks.
📍 Sector 69, SAS Nagar (Mohali), Punjab · Serving Chandigarh Tri-City
Dr. Harjoban Singh — the only FIFA-approved orthopaedic surgeon in the Chandigarh Tricity — sees patients with this condition regularly. Most cases are treated without surgery first.
The rotator cuff is a group of four small muscles that keep the ball of the shoulder centred in the socket. Above the cuff sits a bony arch (the acromion) with a small space underneath through which the cuff and a fluid-filled bursa pass.
When you lift your arm, the cuff tendons must glide through that space. If the space is narrowed (by bone spurs, swelling, or poor scapular control), the tendons get pinched against the bone — impingement. Repeated impingement leads to bursitis, then partial tendon tears, then full tears.
The classic symptom: a painful arc between roughly 60° and 120° of arm elevation. Pain reaching behind to fasten a bra or get a wallet from a back pocket. Night pain when rolling onto the affected side.
Step 1: Physiotherapy (6–12 weeks). Scapular stabilisation, posterior capsule stretching, rotator cuff strengthening (especially external rotators). 80% of impingement resolves at this step.
Step 2: Subacromial cortisone injection. If symptoms persist after 6 weeks of physio. Image-guided for accuracy. One injection is diagnostic and therapeutic; if it doesn't help, the diagnosis is probably wrong.
Step 3: Arthroscopic subacromial decompression. If no improvement after 3 months of structured non-surgical care. Day-care procedure, shaves the bone spur, removes inflamed bursa.
Step 4: Rotator cuff repair. When MRI confirms a significant tear — especially full-thickness tears in active patients.
Partial thickness tears. Tendon fibres are damaged but not all the way through. Many can be managed without surgery, especially in older lower-demand patients. Surgery considered if symptoms persist after 6 months or the tear progresses.
Full thickness tears. Complete defect through the tendon. Without repair, the tear typically enlarges over time and becomes irreparable. Repair within 6–12 months gives the best results in active patients < 65.
Massive irreparable tears. Treatment options include superior capsule reconstruction, tendon transfers, or reverse shoulder replacement — more complex, less standard.
Frozen shoulder (adhesive capsulitis) presents as gradual onset stiffness AND pain in all directions — not just lifting. Loss of external rotation is the diagnostic finding.
Common in: women 40–60, diabetics (3× risk), thyroid disease.
Treatment: physiotherapy, intra-articular cortisone, hydrodilatation. Resolves spontaneously over 12–24 months in most cases. Manipulation under anaesthesia or arthroscopic capsular release for resistant cases.
Critical: do NOT inject and aggressively mobilise a rotator cuff tear thinking it's frozen shoulder — you can complete a partial tear. Get the diagnosis right first.
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