Siddha system of medicine is one of the traditional systems of medicine. There are 64types of medicine.32 ulmarunthu and 32 puramarunthu.Varma is one of the vast and most reliable methods in pura marunthu 32[1]. Rotator cuff syndrome is termed as kumbavatham in Siddha text. The aim of the study is to evaluate and to manage the rotator cuff lesion in an elderly male with varmam therapy. The patient reported a gradual onset of pain. There was no history of fall or trauma. Pain was present on the right shoulder and was sharp and deep on abduction and flexion of the left shoulder which reported a VAS of 8/10. The patient had tried all conservative treatments and was finally advised for surgery. patient were given varmam therapy for three months as per following the Siddha varma protocols. Within the treatment course the patient started to do normal daily activities slowly without pain. The uniqueness of this case is that it involves an elderly female who sustained multiple causative factors for rotator cufF