The rotator cuff is a group of four muscles and tendons that help stabilize the shoulder. They also aid in movement. Each time you pull an item toward you or lift your arm over your head, you are using your rotator cuff.
The rotator cuff is a common spot for injuries. The most common are tears, strains, tendinitis, and bursitis.
Rotator cuff injuries can range from mild to severe. They tend to fall into one of three categories.
Tendinitis is an injury caused by overuse of the rotator cuff. This causes it to become inflamed. Tennis players who serve overhead and painters who reach upward to paint may commonly experience this injury.
Bursitis is another common rotator cuff injury. It is caused by inflammation of the bursa, which are fluid-filled sacs in the rotator cuff that aid in motion. This typically occurs after an injury or degenerative damage to the rotator cuff.
Rotator cuff strains or tears are caused by overuse or acute injury. The tendons that connect muscles to bones can overstretch (strain) or tear, partially or completely. The same can be true for rotator cuff muscles. For example, a baseball pitcher who frequently uses the rotator cuff to throw would experience this type of injury. Untreated tendinitis commonly causes these injuries (Mayo Clinic, 2010).
The rotator cuff can also strain or tear after a fall, a car accident, or another sudden injury. These injuries typically cause intense and immediate pain.
Rotator cuff injuries can be acute or degenerative.
Acute injuries are the result of previous injuries. These can be caused by lifting objects that are too heavy, falling, or breaking the collarbone. Young people are more likely to experience this type of rotator cuff injury (AAOS, 2011).
Degenerative injuries are due to long-term overuse. People most at risk for these injuries include:
- athletes, particularly tennis players, baseball players, rowers, and wrestlers
- people with jobs that require repetitive lifting, such as painters and carpenters
- people above 40 years of age (AAOS, 2011)
Not all rotator cuff injuries cause pain. Because some are the result of degenerative conditions, the rotator cuff could be damaged for months or years before symptoms start to appear.
Common rotator cuff injury symptoms include:
- avoiding certain activities because they cause pain
- difficulty achieving full range of shoulder motion
- difficulty sleeping on the affected shoulder
- pain or tenderness when reaching overhead
- pain in the shoulder, especially at night
- progressive weakness of the shoulder
- trouble reaching behind the back
If you have been experiencing shoulder symptoms for longer than a week or lose function in your arm, see your doctor.
Doctors use a medical history, a physical exam, and imaging scans to diagnose rotator cuff injuries. They may ask about physical activities at the workplace. These questions determine whether a patient has an increased risk for a degenerative condition.
The doctor also tests the arm’s range of motion and strength. He or she will also rule out similar conditions, such as a pinched nerve or arthritis.
Imaging scans, such as an X-ray, can identify any bone spurs. These small bone growths can rub against the rotator cuff tendon. They cause weakening and inflammation.
Magnetic resonance imaging (MRI) or ultrasound scans can also be used. These tools examine soft tissues, including the tendons and muscles. They can help identify tears, as well as show how large and old the tears are.
Treatments range from resting the affected arm to surgery. Tendinitis can progress to a rotator cuff tear, and a rotator cuff tear can enlarge. Seeking treatment as quickly as possible helps keep the injury from getting worse.
Nonsurgical treatments improve symptoms in about 50 percent of people with a rotator cuff injury (AAOS, 2011).
These treatments include:
- applying hot or cold packs to the affected shoulder to reduce swelling
- exercises to restore strength and range of motion
- injecting the affected area with cortisone, a steroid that helps to reduce inflammation
- resting the affected arm and wearing a sling to isolate arm motions
- over-the-counter anti-inflammatory medications, such as ibuprofen and naproxen
According to the AAOS, no research indicates that timing of surgery affects outcomes (2011). This means if you have a rotator cuff injury, your doctor is likely to first try nonsurgical methods.
Pain is different for each person. A shoulder injury that lasts longer than six months indicates a very large tear or significant loss of function and strength in the arm. These cases usually require surgery.
A variety of surgical approaches are available.
The prognosis for a rotator cuff injury depends upon the injury type. According to the Mayo Clinic, half of those with a rotator cuff injury recover using exercise and at-home care (2010). These interventions reduce pain and encourage range of motion.
In the case of a more severe rotator cuff tear, shoulder strength may not improve unless the injury is surgically corrected (AAOS, 2011).
Athletes and people with occupations that require using the shoulder should take frequent rest breaks. This can reduce the load on the shoulder. Exercises to strengthen the shoulder and encourage range of motion also can help. Examples include stretching a straight arm across the chest or stretching the arms over the head.
In the case of shoulder pain, icing the affected area can help reduce swelling. Apply ice in a cloth-covered pack for no more than 10 minutes at a time.
These activities can also help prevent re-injury.