Rotator cuff injury

Your rotator cuff is made up of the muscles and tendons in your shoulder. These muscles and tendons connect your upper arm bone (humerus) with your shoulder blade. They also help hold the ball of your upper arm bone firmly in your shoulder socket, as though holding a golf ball on a tee. The combination results in the greatest range of motion of any joint in your body.

Rotator cuff injuries are fairly common. Causes of the injury may include poor posture, falling, lifting and repetitive overhead arm activities. These activities may include throwing a baseball, reaching up to work on a car on a rack or placing items on shelves above your head. The injury is also common among people whose jobs or hobbies include heavy demands on their shoulders, such as athletes and people in the construction trades. As you get older, your risk of a rotator cuff injury increases.

Most of the time, treatment involves self-care measures or exercise therapy. Other treatments are steroid injections and surgery.

Signs and symptoms

Signs and symptoms of a rotator cuff injury may include:

bulletPain and tenderness in your shoulder, especially when reaching overhead or when sleeping on the affected side
bulletShoulder weakness
bulletLoss of shoulder movement
bulletDesire to keep your shoulder inactive

The most common symptom is pain. You may experience it when you reach up to comb your hair, bend your arm back to put on a jacket or carry something heavy. Lying or sleeping on the affected shoulder also can be painful. If you have a severe injury, such as a large tear, you may experience continuous pain and muscle weakness.

Causes

A rotator cuff injury involves any type of irritation or damage to your rotator cuff muscles or tendons, including:

bulletTendonitis. Tendons in your rotator cuff can become inflamed due to overuse or overload, especially in athletes who perform a lot of overhead activities, such as tennis or racquetball players. In some people, the space where the rotator cuff resides can be narrowed due to the shape of different shoulder bones, including the outside end of the collarbone or shoulder blade.
bulletBursitis. The fluid-filled sac (bursa) between your shoulder joint and rotator cuff tendons can become irritated and inflamed.
bulletStrain or tear. Left untreated, tendonitis can weaken a tendon and lead to a tendon tear. Stress from overuse also can cause a shoulder tendon or muscle to tear.

Common causes of rotator cuff injuries include:

bulletNormal wear and tear. Increasingly after age 40, normal wear and tear on your rotator cuff can cause a breakdown of fibrous protein (collagen) in the cuff's tendons and muscles. This makes them more prone to degeneration and injury. With age, you may also develop calcium deposits within the cuff or arthritic bone spurs that can pinch or irritate your rotator cuff.
bulletPoor posture. When you slouch your neck and shoulders forward, the space where the rotator cuff muscles reside can become smaller. This can allow a rotator cuff muscle or tendon to become pinched under some of your shoulder bones, including the outside end of your collarbone.
bulletFalling. Using your arm to break a fall or falling on your arm can bruise or tear a rotator cuff tendon or muscle.
bulletLifting. Lifting something that's too heavy or lifting improperly — especially heavy overhead lifting — can strain or tear your tendons or muscles.
bulletRepetitive stress. Repetitive overhead movement of your arms can stress your rotator cuff muscles and tendons, causing inflammation and eventually tearing. This occurs often in athletes, especially baseball pitchers and tennis players. It's also common among people in the building trades, such as painters and carpenters.

When to seek medical advice

See your doctor as soon as possible if you have severe shoulder pain or you're unable to use your arm. Call your doctor if you've had shoulder pain that has lasted for more than a week.

Screening and diagnosis

If your injury appears to be severe or your doctor can't determine the cause of your pain through physical examination, he or she may recommend diagnostic imaging tests to better delineate your shoulder joint, muscles and tendons. These may include:

bulletX-rays
bulletA magnetic resonance imaging (MRI) scan
bulletAn ultrasound
bulletAn arthrogram, a special type of X-ray in which dye is injected into the shoulder joint before the X-ray is taken in order to enhance the image of the joint

Treatment

Most of the time, treatment for rotator cuff injuries involves exercise therapy. Your doctor or a physical therapist will talk with you about specific exercises designed to help heal your injury, improve the flexibility of your rotator cuff and shoulder muscles and provide balanced shoulder muscle strength. Depending on the severity of your injury, physical therapy may take from three weeks to several months.

Other treatments may include:

bulletSteroid injections. Of the many different steroids, doctors commonly use corticosteroids by injection to relieve inflammation and pain.
bulletSurgery. If you have a large tear in your rotator cuff, you may need surgery to repair the tear. Sometimes during this kind of surgery, doctors may also remove a bone spur or calcium deposits.

Self-care

A minor injury often heals on its own, if you take care of it. If you think you've injured your rotator cuff, try these steps:

bulletRest your shoulder. Stop doing what caused the pain and try to avoid painful movements. Limit heavy lifting or overhead activity for four to seven days until your shoulder starts to feel better.
bulletApply ice and heat. Putting ice on your shoulder helps reduce inflammation and pain. Use a cold pack, a bag of frozen vegetables or a towel filled with ice cubes for 15 to 20 minutes at a time. Do this every couple of hours the first day or two. After about two or three days, when the pain and inflammation have improved, hot packs or a heating pad may help relax tightened and sore muscles. Limit heat applications to 20 minutes.
bulletTake pain relievers. Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve), may help reduce pain. Acetaminophen (Tylenol, others) may also help relieve pain. Follow label directions and stop taking the drugs when the pain improves.
bulletKeep your muscles limber. After one or two days, do some gentle exercises to keep your shoulder muscles limber. Total inactivity can cause stiff joints. In addition, favoring your shoulder for a long period of time can lead to frozen shoulder, a condition in which your shoulder becomes so stiff you can barely move it. Once your injury heals and you have good range of motion in your shoulder, continue exercising. Daily shoulder stretches and a balanced shoulder-strengthening program can help prevent a recurrence of your injury. In addition, daily exercises can help prevent an injury if you use your rotator cuff often. Your doctor or a physical therapist can help you plan an exercise routine.