- Is Your Shoulder Pain From Your Rotator Cuff?
- Rotator Cuff Syndrome
- What Rotator Cuff Injuries are Common?
- Where are your Rotator Cuff Muscles?
- What Causes a Rotator Cuff Injury?
- What are the Symptoms of Rotator Cuff Injury?
- How is a Rotator Cuff Injury Diagnosed?
- How to Treat a Rotator Cuff Injury?
- More Information about Rotator Cuff Injury
- Referred Pain
- Common Rotator Cuff Injury Treatments
- FAQs about Rotator Cuff Injury
- What Is My Rotator Cuff?
- Torn rotator cuff: Symptoms, diagnosis, and treatment
- Acute injury
- Chronic degeneration
- What Is a Rotator Cuff Tear?
- Key points about rotator cuff injury
- Rotator Cuff Injury: Treatments, Symptoms and Diagnosis
Is Your Shoulder Pain From Your Rotator Cuff?
Rotator cuff pain is most commonly caused by an inflamed tendon (tendinitis) or torn tendon. The quality of the pain may range from a dull, aching sensation to sharp pain that moves down the upper arm when reaching overhead or sleeping on the affected side.
Interestingly, the intensity of the pain does not necessarily correlate with the degree of the injury.
Less commonly, rotator cuff pain may from result from a condition called rotator cuff tendinosis—when the tendons become frayed or worn down as a result of increasing age and overuse.
The rotator cuff consists of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that surround your shoulder blade and attach to your upper arm (humerus) via their own tendon. These four tendons converge to form a “cuff” or covering over the head of the humerus, allowing you to lift and rotate your arm. Issues with any one of these can cause rotator cuff pain.
With both a rotator cuff tendinitis and tear, a person often experiences pain over the shoulder that worsens with activities, such as reaching overhead or throwing.
Illustration by Alexandra Gordon, Verywell
Rotator cuff issues may be anticipated possibilities for those who regularly engage in physical activity involving repetitive arm motion, baseball pitchers, but may come as a surprise to many others for which such issues are also common.
Rotator cuff tendinitis is most common in young athletes and middle-age people. It occurs when a normal, healthy rotator cuff tendon is injured or inflamed, often as a result of a repetitive overhead activity (for example, painting, tennis, swimming, baseball, volleyball, or weightlifting).
Certain chronic diseases are also associated with rotator cuff tendinitis. For example, diabetes and obesity may be a risk factor.
A rotator cuff tear (when the tendon is torn from the arm bone) is found primarily in middle- to older-age individuals. A tear may be caused by trauma to the shoulder (for example, a fall directly on the shoulder or direct blow to the shoulder), as well as chronic overuse of the rotator cuff muscles.
Obesity and smoking may also increase a person's chance of tearing their rotator cuff.
Rotator cuff tendinosis—a condition whereby the rotator cuff tendon degenerates—occurs as a result of increasing age.
This is because, as we get older, there is a decreased blood supply to the rotator cuff tendons. As a result, when the tendons become stressed or injured, they do not recover or heal as well.
These weakened or frayed tendons are then more vulnerable to inflammation and tearing.
Poor posture, smoking, repetitive overhead activity, and genes may also play a role in the development of rotator cuff tendinosis.
Sharp or aching pain and swelling from a rotator cuff tendinitis or tear are usually located over the front or lateral part of the shoulder and upper arm.
People often complain of difficulty performing activities such as combing their hair, clasping a bra behind their back, reaching behind their back, or sleeping on the affected shoulder.
Throbbing pain at night is also common in individuals with a rotator cuff tendinitis or tear. For some people, the shoulder pain may awaken them from sleep.
In addition, it's not uncommon for the pain of a rotator cuff tendinitis or tear to be felt further down the arm from the shoulder. This has to do with the location of the nerves that pass by the deeper parts of the shoulder.
More specifically, with rotator cuff tears, deficits in strength are very common. For instance, many people noticed they have a hard time putting dishes away in upper cabinets or reaching into the refrigerator to lift a carton of milk.
Keep in mind, some people with rotator cuff tears do not experience any pain—and the severity of the tear (partial versus complete) does not correlate with the pain experience. In other words, a person with a partial tear may report severe pain while a person with a complete tear may report no pain at all.
a rotator cuff tear, rotator cuff tendinosis does not always cause pain, especially early on in the disease course. If pain is present, it's often described as a dull, aching pain that worsens at night and with certain shoulder movements, reaching out or behind the back.
Any severe shoulder pain and/or pain that comes on suddenly warrants medical attention, as does any significant swelling or bruising around the shoulder joint or signs of infection redness and warmth.
Seek medical attention, as well, if your shoulder pain is associated with other unusual symptoms trouble breathing, dizziness, or abdominal pain.
Other signs that warrant a doctor's visit include:
- An inability to lift your arm above your head or carry objects
- Any trauma or injury to the shoulder, especially if there is deformity to the joint
- Shoulder pain that is persistent or worsening
After reviewing your medical history, if your primary care doctor suspects a rotator cuff problem, they will perform a series of tests to evaluate the rotator cuff tendons. They will then order an imaging test of your shoulder if a rotator cuff tear is suspected.
Several tests are used to evaluate the rotator cuff, some of which can be performed at home prior to your appointment. If you are not comfortable, though, that's OK. Your doctor will repeat these tests during your visit.
A few of these at-home tests include:
The empty can test is used to assess the status of the supraspinatus, located on the upper part of your shoulder. This is a simple test to perform, and the motion involved mimics that of dumping out a soda can.
- Sit or stand comfortably with a friend present.
- Lift your painful arm out the side so it is parallel to the floor.
- Bring your arm forward about 30 to 45 degrees.
- Turn your hand over so your thumb is pointing toward the floor (as if you were trying to empty a can of soda).
- Have your friend gently push your arm down.
If pain or weakness prevents you from maintaining your arm in the “empty can” position, you may have a supraspinatus rotator cuff injury. If so, check in with your doctor to confirm the diagnosis.
The lift-off test is a shoulder test to determine if you have a tear in the subscapularis. This muscle is located on the underside of your shoulder blade and is responsible for rotating your shoulder inward. To perform the lift-off test:
- Stand up and place the back of your hand on the small of your back.
- Face the palm of your hand away from your back.
- Attempt to lift your hand away from your body.
If you are unable to lift your hand away from your low back, it is suspected that a subscapularis rotator cuff injury may be present.
One way of determining if a rotator cuff tear is possibly causing your shoulder pain is to perform manual strength testing of your rotator cuff muscles. To do this, follow a simple procedure:
- Sit comfortably in a chair.
- Bend your elbow 90 degrees and keep your elbow tucked into your side.
- Have someone push your hand in toward your belly.
If you are unable to hold this position and feel pain, you may have a rotator cuff tear.
The lidocaine injection test is sometimes used by some doctors (mostly orthopedic surgeons or sports medicine physicians) to help distinguish between a rotator cuff tendinitis and tear. Distinguishing between these two conditions is important because it affects the overall treatment plan.
During this test, lidocaine is injected into the shoulder joint. If a person has a rotator cuff tendonitis, the lidocaine will relieve the pain and muscle strength will remain normal. If a person has a rotator cuff tear, the pain will be relieved, but the muscle will remain weak.
If a large tear is found, your primary care doctor will refer you to an orthopedic surgeon, as you may require surgical repair.
It's important to understand that pain in the rotator cuff region may not actually be related to a compromised rotator cuff. Some other conditions that may mimic a rotator cuff injury include:
The good news is that these other conditions can be distinguished from one another through imaging tests—for example, an X-ray can show signs of osteoarthritis, while an MRI can be used to diagnose a labral tear.
Besides musculoskeletal issues, several other health conditions can also cause shoulder pain within the rotator cuff region, such as a heart attack or heart disease, gallbladder disease, or nerve compression in the neck.
When it comes to ruling out a heart attack, which is a medical emergency, in addition to a concise medical history and physical exam, your doctor may order cardiac enzymes (a blood test) and an ECG.
Gallbladder disease can generally be ruled out with a normal abdominal exam and ultrasound.
An MRI of the neck can help sort out whether a compressed nerve root is a culprit behind someone's shoulder pain.
In the end, the vast differential for shoulder pain is why it's important to not self-diagnose, but rather to see a healthcare professional for a comprehensive evaluation.
The treatment of your rotator cuff problem depends on whether or not you have a tendinitis, tendinosis, or tear, and if there is a tear, how severe it is.
The treatment of rotator cuff tendinitis and tendinosis is generally straightforward, encompassing six key strategies:
- Avoiding activities that aggravate the pain, overhead reaching or reaching behind the back
- Keep your arm down, in front of and close to your body (avoid an arm sling, as you risk the development of a frozen shoulder)
- Ice to reduce initial inflammation in tendonitis (apply a cold pack to shoulder for 15 to 20 minutes every four to six hours)
- Take an anti-inflammatory medication a nonsteroidal anti-inflammatory (NSAID)
- Apply heat and perform light shoulder massage prior to home exercise or physical therapy sessions
- See a physical therapist for stretching and range of motion exercises
After about two to three months of the above strategies, most people report an improvement in their pain. However, if pain persists, be sure to talk to your doctor. You may need an MRI to look for a rotator cuff tear.
The good news is, not every rotator cuff tear needs surgery. In fact, small rotator cuff tears are treated similarly to a rotator cuff tendinitis.
However, when surgery is the best treatment, it's often better to proceed sooner rather than later, as the rotator cuff muscle can weaken (atrophy) and retract (pull back) over time. This can make repair less successful or even impossible.
Therefore, it's good to discuss your treatment options with your orthopedic surgeon as soon as possible.
For people who choose nonsurgical treatment options, there are a number of ways to find relief of the shoulder pain caused by the rotator cuff tear. Often with physical therapy and a proper exercise program, people can improve the function of their shoulder joint to prevent pain that comes from a torn tendon of the rotator cuff.
There are a few things you can do to prevent the development of a rotator cuff problem. These self-care strategies include:
- Warming up before exercising
- Learning how to lift weights properly (for example, using your legs and maintaining a straight back)
- Engaging in stretching and strengthening shoulder exercises, such as those recommended by the American Academy of Orthopedic Surgeons
- Practicing good posture
- Avoiding smoking
- Maintaining a healthy body weight
A rotator cuff problem is a common condition, especially as people age. In fact, rotator cuff tears eventually become an expected finding, even in people who have little to no shoulder pain.
The good news is that often with simple measures avoiding certain activities and physical therapy, the majority of people get better.
Rotator Cuff Syndrome
Rotator cuff syndrome is very common shoulder injury. Your shoulder joint is a relatively unstable ball and socket joint that is moved and controlled by a small group of four muscles known as the rotator cuff.
The subscapularis, supraspinatus, infraspinatus and teres minor are your small rotator cuff muscles that stabilise and control your shoulder movement on your shoulder blade (scapula).
As the name suggests, the rotator cuff muscles are responsible for shoulder rotation and form a cuff around the head of the humerus (shoulder ball).
What Rotator Cuff Injuries are Common?
Your rotator cuff muscles and tendons are vulnerable to rotator cuff tears, rotator cuff tendonitis and rotator cuff impingement and related rotator cuff injuries.
Rotator cuff injuries vary from mild tendon inflammation ( rotator cuff tendonitis), shoulder bursitis (inflammed bursa), calcific tendonitis (bone forming within the rotator cuff tendon) through to partial and full thickness rotator cuff tears, which may require rotator cuff surgery.
Some shoulder rotator cuff injuries are more common than others.
Where are your Rotator Cuff Muscles?
Your rotator cuff muscles hold your arm (humerus) onto your shoulder blade (scapula). Most of the rotator cuff tendons are hidden under the bony point of your shoulder (acromion), which as well as protecting your rotator cuff can also impinge on your rotator cuff structures.
What Causes a Rotator Cuff Injury?
Your rotator cuff tendons are protected from simple knocks and bumps by bones (mainly the acromion) and ligaments that form a protective arch over the top of your shoulder.
In between the rotator cuff tendons and the bony arch is the subacromial bursa (a lubricating sack), which helps to protect the tendons from touching the bone and provide a smooth surface for the tendons to glide over.
However, nothing is fool-proof. Any of these structures can be injured – whether they be your bones, muscles, tendons, ligaments or bursas.
Rotator cuff impingement syndrome is a condition where your rotator cuff tendons are intermittently trapped and compressed during shoulder movements This causes injury to the shoulder tendons and bursa resulting in painful shoulder movements.
What are the Symptoms of Rotator Cuff Injury?
While each specific rotator cuff injury has its own specific symptoms and signs, you can suspect a rotator cuff injury if you have:
- an arc of shoulder pain or clicking when your arm is at shoulder height or when your arm is overhead.
- shoulder pain that can extend from the top of your shoulder to your elbow.
- shoulder pain when lying on your sore shoulder.
- shoulder pain at rest (with more severe rotator cuff injuries).
- shoulder muscle weakness or pain when attempting to reach or lift.
- shoulder pain when putting your hand behind your back or head.
- shoulder pain reaching for a seat-belt.
How is a Rotator Cuff Injury Diagnosed?
Your physiotherapist or sports doctor will suspect a rotator cuff injury your clinical history and the findings from a series of clinical tests.
A diagnostic ultrasound scan is the most accurate method to diagnose the specific rotator cuff injury pathology. MRI’s may show a rotator cuff injury but have also been known to miss them. X-rays are of little diagnostic value when a rotator cuff injury is suspected.
How to Treat a Rotator Cuff Injury?
Once you suspect a rotator cuff injury, it is important to confirm the exact type of your rotator cuff injury since treatment does vary depending on the specific or combination of rotator cuff injuries.
Your rotator cuff is an important group of control and stability muscles that maintain “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This prevents injuries such as impingement, subluxations and dislocations.
We also know that your rotator cuff provides subtle glides and slides off the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapula) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.
Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence.
- Early Injury Protection: Pain Relief & Anti-inflammatory Tips
- Regain Full Range of Motion
- Restore Scapular Control
- Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
- Restore Rotator Cuff Strength
- Restore High Speed, Power, Proprioception & Agility
- Return to Sport or Work
For more specific advice about your rotator cuff injury, please contact your PhysioWorks physiotherapist.
More Information about Rotator Cuff Injury
What is Rotator Cuff Impingement Syndrome?
What is Impingement Zone?
What Causes Rotator Cuff Impingement?
Your PhysioWorks physiotherapist is an expert in the assessment and correction of shoulder rotator cuff injuries. Any deficiencies that they detect during your assessment will be an important component of your rehabilitation.
Your physiotherapist will be able to guide you in the appropriate treatment and exercises for your rotator cuff injury after their thorough assessment.
- Neck Arm Pain
- Pinched Nerve
- Thoracic Outlet Syndrome
Common Rotator Cuff Injury Treatments
FAQs about Rotator Cuff Injury
What Is My Rotator Cuff?
Your shoulders do a lot of important things you might take for granted. They help you get something off a high shelf, comb your hair, or play a game of tennis or catch.
It’s a complicated process that your body makes look easy. And your rotator cuff is a big part of that. It protects your shoulder joint and lets you move your arms over your head. It’s especially important in sports baseball, swimming, or tennis.
© 2014 WebMD, LLC. All rights reserved.
Your rotator cuff is made up of muscles and tendons that keep the ball (head) of your upper-arm bone (humerus) in your shoulder socket. It also helps you raise and rotate your arm.
Each one of these muscles is part of the rotator cuff and plays an important role:
- Supraspinatus. This holds your humerus in place and keeps your upper arm stable. And helps lift your arm.
- Infraspinatus. This is the main muscle that lets you rotate and extend your shoulder.
- Teres Minor. This is the smallest rotator cuff muscle. Its main job is to assist with rotation of the arm away from the body.
- Subscapularis. This holds your upper arm bone to your shoulder blade and helps you rotate your arm, hold it straight out and lower it.
A rotator cuff tear is often the result of wear and tear from daily use.
You’re more ly to have this if you have a job where you need to move your arm a certain way over and over, a painter or a carpenter, or you play sports tennis and baseball.
It also can happen suddenly if you fall on your arm or try to lift something heavy. It’s usually treated with physical therapy and medication, or you may need surgery.
Tendinitis is inflammation or irritation of a tendon that attaches to a bone. It causes pain in the area just outside the joint. Common types of tendinitis include pitcher’s and swimmer’s shoulder.
Bursitis is when the bursa (a small sac filled with fluid that protects your rotator cuff) gets irritated. That can happen when you repeat the same motion over and over again, throwing a baseball or lifting something over your head. It also can be caused by an infection.
Tendinitis and bursitis can get better with rest, a combination of ice and heat, and over-the-counter pain relievers aspirin, naproxen, and ibuprofen.
Tendinitis and bursitis usually get better over time. Treatments include:
- Avoiding repetitive motions or overhead sports (tennis, baseball, volleyball, swimming and others)
- A combination of ice and heat
- Over-the-counter pain relievers
- Stretching and exercises to increase mobility
Call your doctor if the pain lasts more than a few weeks or keeps you from doing daily activities.
Comparative Effectiveness Reviews: “Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears.”
Sports Injury Clinic: “Suprasinitus.” “Infraspinatus,” “Teres Minor.”
University of Washington Department of Radiology: “Subscapularis.”
Mayo Clinic: “Bursitis,” “Rotator Cuff Injuries.”
Cleveland Clinic: “Shoulder Tendinitis.”
© 2019 WebMD, LLC. All rights reserved. Rotator Cuff Tear
Torn rotator cuff: Symptoms, diagnosis, and treatment
A torn rotator cuff is a common injury that affects a person’s ability to lift and rotate their arm.
According to the American Academy of Orthopaedic Surgeons, an estimated 2 million people in the United States will visit a doctor for a rotator cuff problem each year.
The rotator cuff is four muscles connected by tendons to the humerus, or upper portion of the shoulder.
When a rotator cuff tear occurs, one or more of the tendons detaches from the humerus. The tear may be complete or partial and can cause significant pain and restrict movement.
Both surgical and nonsurgical treatments are available when a person tears their rotator cuff.
Rotator cuff injury causes tend to fall in one of two categories — an acute injury or chronic degeneration.
A person can tear their rotator cuff performing a variety of activities. Examples of these types of injuries include:
- trauma, such as breaking a collarbone or dislocating a shoulder
- falling onto an outstretched arm
- lifting something in a sudden, jerking motion
- lifting something that is too heavy
These are just some of the common activities that can cause a rotator cuff tear.
A person’s tendons naturally wear down as they age. This degeneration is especially true for a person’s dominant arm.
Some of the potential contributors to chronic degeneration include:
- Affected blood supply: Blood supply to the tendons lessens with age, which increases the risk of tearing a rotator cuff. This means injuries are more common after 40 years of age.
- Bone spurs: Bone spurs are overgrowths of bone that can occur from repetitive movements. A person may notice that the pain worsens when they lift their arm if the bone spur presses on the rotator cuff.
- Repetitive movements: Athletes and people who work with their hands are prone to rotator cuff injuries. Examples of activities that increase the risk include baseball, rowing, and weightlifting. Common occupations where a person is prone to a rotator cuff tear include carpentry and decorating.
Rotator cuff tears may not immediately cause pain, although they can in acute injuries. Sometimes, a person may hear a distinct snapping sound with weakness in the upper arm afterward.
Other symptoms doctors associate with a rotator cuff tear include:
- popping sensations when a person moves their arm
- cracking sensations, known as crepitus, when moving the shoulder
- pain in the shoulder even at rest
- pain when lifting the arm or when throwing overhead
- shoulder locking into place
- weakness in the arm and hand
Sometimes, rotator cuff injury symptoms occur not only from the injury itself but also due to inflammation.
This inflammation is typically in the protective bursa sacs in the rotator cuff. Doctors call this condition bursitis.
A doctor will ask about a person’s symptoms, how the injury occurred, and if anything makes the pain better or worse.
They will also do a physical examination to determine a person’s range of motion and listen for any cracking or popping when they move their shoulder.
A doctor can also arrange imaging studies of the arm and shoulder, such as:
- X-ray: This type of imaging will look for signs of bone calcifications, arthritis, or other injuries.
- Magnetic resonance imaging (MRI): This method of imaging uses a magnetic field to generate images of soft tissue. A doctor can identify areas of inflammation and potential tearing.
Depending on the nature of the injury, a doctor may perform other tests to determine if the rotator cuff is torn or if symptoms are due to another problem.
The treatment for a rotator cuff repair often depends on the tear’s severity, and how much it is affecting the individual.
A doctor will usually recommend conservative methods over surgical treatment whenever possible.
Examples of conservative treatments for rotator cuff injuries include:
- Rest: Resting the affected shoulder and wearing a sling for a few days following the injury can help reduce inflammation and pain. A doctor may also recommend avoiding certain activities to reduce strain on the shoulder.
- Physical and occupational therapy: Therapy exercises to stretch and strengthen the muscles around the shoulder can help reduce the demands on the injured rotator cuff.
- Over-the-counter medications: Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain. Examples of these include ibuprofen and naproxen sodium.
- Injections: A doctor may recommend corticosteroid injections into the shoulder to reduce inflammation and improve mobility.
It is possible for a rotator cuff tear to worsen or persist over time, even with at-home treatments.
If the rotator cuff does not heal with conservative methods, a doctor may recommend surgical treatment. Surgery may also be necessary for a tear greater than 3 centimeters.
A doctor will discuss the lihood of the repair being successful, and the range of motion a person can expect after the surgery.
A 2015 meta-analysis covered studies on rotator cuff surgery versus conservative treatment. The evidence from this investigation suggests that surgery is not necessarily more effective than conservative treatments.
The authors concluded that more research is necessary, although current evidence does not suggest surgery is a guaranteed success for rotator cuff tears.
The surgical approach to a rotator cuff tear depends upon the tear’s severity and position. Sometimes, a surgeon will treat it by reattaching the tendon to its original attachment point.
Another approach involves trimming the injured tendon or smoothing the affected area. A doctor can do this by inserting small instruments into the shoulder and using other special tools to manipulate and repair the tendon.
Other surgical approaches include an open repair where a surgeon makes a larger incision.
Share on PinterestA person should discuss the risks and benefits of surgery with a doctor.
After surgery, the recovery process often requires physical therapy or occupational therapy to restore the full range of motion in the shoulder.
Shoulder movement may return to normal in 4 to 6 months after the surgery.
As with any surgical procedure, there are risks the surgery will be ineffective, or symptoms will worsen. A surgeon will discuss these risks with a person who has a rotator cuff injury.
Examples of potential postsurgical complications include:
- detachment of the deltoid muscle at the shoulder, which can affect mobility
- injury to surrounding nerves
- shoulder stiffness and pain with movement
- surgical site infection
A person can also reinjure a repaired rotator cuff tendon at a later time.
According to the authors of a 2015 meta-analysis, most recreational athletes can return to the same level of play they were at before their injury occurred. However, among professional and competitive athletes, the study found only 50 percent returned to their same competitive level after their surgery.
A rotator cuff tear can significantly impair shoulder and arm movements. While conservative methods can treat most injuries, some people may require surgery to reduce pain and improve their range of motion.
If a person thinks they may have injured their rotator cuff or their injury seems to be getting worse, it is best to speak to a doctor.
What Is a Rotator Cuff Tear?
A rotator cuff tear is a common injury, especially in sports baseball or tennis, or in jobs painting or cleaning windows. It usually happens over time from normal wear and tear, or if you repeat the same arm motion over and over. But it also can happen suddenly if you fall on your arm or lift something heavy.
Your rotator cuff is a group of four muscles and tendons that stabilize your shoulder joint and let you lift and rotate your arms.
There are two kinds of rotator cuff tears. A partial tear is when one of the muscles that form the rotator cuff is frayed or damaged. The other is a complete tear. That’s one that goes all the way through the tendon or pulls the tendon off the bone.
You can’t always feel a torn rotator cuff. But in some cases, you might:
- Have trouble raising your arm
- Feel pain when you move your arm in certain ways or lie on it
- Have weakness in your shoulder
- Be unable to lift things you normally do
- Hear clicking or popping when you move your arm
See your doctor if you have any of these signs. If you don’t do anything about a torn rotator cuff, you can have more serious problems over time. You can end up with a frozen shoulder or arthritis that is harder to treat.
To find out if you have a torn rotator cuff, your doctor will start with a history of the injury and a physical examination of the shoulder. During the exam, he’ll check your range of motion and muscle strength. He’ll also see what movements make your shoulder hurt.
In addition, your doctor may use one of the following:
- MRI. This uses radio waves and a powerful magnet to make detailed pictures of your shoulder.
- X-rays to see if the top of your arm bone (humeral head) is pushing into your rotator cuff space.
- Ultrasound to see the soft tissues (tendons and muscles and the bursas) in your shoulder.
Your doctor is ly to start with a combination of physical therapy to make your shoulder muscles stronger, and medications acetaminophen and anti-inflammatory drugs to help with pain and swelling. Surgery may be required in some cases.
You also may get exercises to do at home and suggestions that help you use your shoulder in safer, more comfortable ways in your day-to-day life.
If those don’t work, you may need surgery, especially if you have a complete tear. It’s ly your doctor will need to stitch together the torn area or reattach the tendon to the bone.
In some cases, he might need to take out small pieces of tendon or bone that are stuck in your shoulder joint or remove small areas of bone or tissue to give your tendon more room to move.
There are three types of rotator cuff surgery:
- Arthroscopic: Your doctor will make a small cut in your shoulder then use an arthroscope — a tube with a small camera and tiny instruments — to fix the tear. This means your recovery time will ly be shorter than it would with another type of surgery.
- Open: Your doctor uses larger instruments to go in to the muscles of your shoulder and fix the tear.
- Mini-Open: This uses both arthroscopic and open methods. Your doctor starts with the arthroscope and finishes with larger instruments.
After surgery, you’ll wear a sling for 4 to 6 weeks. Your doctor probably will tell you to do the following to speed along your recovery:
- Take the sling off several times a day and move your elbow, wrist, and hand to get better blood flow in those areas.
- If you have pain and swelling in your shoulder, use an ice pack for about 20 minutes at a time.
- Most important: Do not lift your arm at the shoulder until your doctor says it’s OK.
How your recovery goes will depend a lot on the size of the tear and how long your rotator cuff was torn. The smaller and more recent the tear, the better your chances of being pain-free and having a full range of motion.
Be patient. Recovery is a gradual process. It can take up to a year for you to have full use of your shoulder again.
Alberta Evidence-based Practice Center: “Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears.”
Massachusetts General Hospital, Orthopaedics, Sports Medicine: “Shoulder — Torn Rotator Cuff.”
American Society for Surgery of the Hand: “Rotator Cuff Injuries.”
OrthoInfo: “Rotator Cuff Tears.”
© 2019 WebMD, LLC. All rights reserved. Physical Therapy for Rotator Cuff Tear
ABOUT CAUSES DIAGNOSIS TREATMENT
Your rotator cuff consists of muscles and tendons that hold your shoulder in place. It is one of the most important parts of your shoulder.
Your rotator cuff allows you to lift your arms and reach up Each year, millions of people in the U.S. go to their healthcare providers because of a rotator cuff problem. A rotator cuff tear is a common cause of pain and disability among adults.
There are 2 main causes of rotator cuff tears: injury and degeneration. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand. It may also develop over time due to repetitive activities. Rotator cuff tears may also happen due to aging, with degeneration of the tissues.
Symptoms may be a bit different for each person. Symptoms may include:
- Pain that keeps coming back, especially when doing certain things such as lifting over your head
- Pain that prevents you from sleeping on your injured side
- Grating or cracking sounds when moving your arm
- Limited ability to move your arm
- Muscle weakness
The symptoms of a rotator cuff tear may seem other conditions or health problems. Always talk with your healthcare provider for a diagnosis.
Your healthcare provider will take a complete health history and do a physical exam. You may also have diagnostic tests such as:
- X-ray. This test uses invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film.
- MRI. This test uses a combination of large magnets, radiofrequencies, and a computer to make detailed images of organs and structures within the body.
A rotator cuff may tear partly or fully. Partial-thickness tears do not completely remove the tendon from the shoulder.
Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.
Treatment may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Strengthening and stretching exercises
- Ultrasound therapy
- Corticosteroid shot (injection)
- Surgery (for severe injuries or tears)
Call your healthcare provider if:
- Your pain gets worse or starts to interfere with your normal activities or ability to sleep well
- You can’t use your shoulder as much as you were able to previously
Key points about rotator cuff injury
- Your rotator cuff is one of the most important parts of your shoulder. It allows you to lift your arms and reach up.
- There are 2 main causes of rotator cuff tears: injury and degeneration.
- Symptoms may include pain that keeps coming back, muscle weakness, limited ability to move your arm, and grating or cracking sounds when moving your arm.
- Treatment may include rest, medicine, strengthening and stretching exercises, and surgery.
- Call your healthcare provider if pain gets worse or you can't use your arm you used to.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
Rotator Cuff Injury: Treatments, Symptoms and Diagnosis
The rotator cuff is a group of four muscles and tendons that help stabilize the shoulder. They also aid in movement. Every time you move your shoulder, you are using your rotator cuff to stabilize and help move the joint.
The rotator cuff is a commonly injured area. The most common injuries are 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 use an overhead serve and painters who have to reach upward to do their jobs commonly experience this injury.
Bursitis is another common rotator cuff injury. It’s caused by inflammation of the bursa. These are fluid-filled sacs that sit between the rotator cuff tendons and the underlying bone.
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 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.
Not all rotator cuff injuries cause pain. Some are the result of degenerative conditions, meaning 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’ve been experiencing any of these symptoms for longer than a week or lose function in your arm, see your doctor.
Rotator cuff injuries can be acute or degenerative.
Acute injuries usually occur from one particular incident. These can be caused by lifting objects that are too heavy, falling, or having the shoulder forced into an awkward position. Young people are more ly to experience this type of rotator cuff injury.
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
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.
Your doctor will also test the arm’s range of motion and strength. They 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 and cause pain 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 severe the tears have become.
Treatments range from resting the affected arm to surgery. Tendinitis can progress to a rotator cuff tear, and that injury can get worse with time. Seeking treatment as quickly as possible helps keep the injury from progressing.
Nonsurgical treatments improve symptoms in about 50 percent of people with a rotator cuff injury. These kinds of 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
Try this: Easy exercises to treat rotator cuff pain »
Research indicates that the timing of surgery doesn’t affect outcomes. This means if you have a rotator cuff injury, your doctor is ly to first try nonsurgical methods.
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. 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.
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. Ask your physical therapist for stretches and strengthening exercise to improve the function of your rotator cuff.
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.