Rotator Cuff Injuries
The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. Rotator cuff injuries are common and increase with age. These injuries can cause a dull ache in the shoulder, which often worsens when you try to sleep on the affected side. Rotator cuff injuries range from mild inflammation and tendinitis to partial or complete tears of the tendon. Treatment depends on the severity of the injury but might include physical therapy, steroid injections, or surgery.
Causes
- Age-related degeneration - As you age, the risk of a rotator cuff injury increases. Rotator cuff tears are most common in people older than 40.
- Repetitive overhead arm motions - Athletes who regularly use overhead arm motions, such as baseball pitchers, archers, and tennis players, have a higher risk of rotator cuff injuries.
- Occupational overuse - Jobs that require repetitive overhead arm motions, such as carpentry or painting, can damage the rotator cuff over time.
- Heavy lifting - Regularly lifting heavy objects, especially overhead, can strain the rotator cuff muscles and tendons.
- Poor posture or technique - Incorrect posture or improper form when exercising can place extra stress on the rotator cuff.
- Sudden trauma - Falling on an outstretched arm or lifting something too heavy with a jerking motion can tear the rotator cuff.
- Bone spurs - As we age, bone spurs (bony projections) often develop on the underside of the acromion bone. When we lift our arms, these spurs rub on the rotator cuff tendon, weakening it and making it more susceptible to tears.
- Decreased blood supply - As we age, the blood supply to the rotator cuff tendons decreases, which can lead to slower healing and increased risk of degeneration.
- Genetic factors - Some people may have a genetic predisposition to rotator cuff injuries.
- Previous shoulder injuries - A history of shoulder dislocations or other shoulder injuries can increase the risk of rotator cuff injuries.
Signs and Symptoms
- Shoulder pain - Pain at the top and outer side of the shoulder, especially when reaching overhead or behind your back.
- Shoulder weakness - Difficulty lifting the arm or performing specific movements.
- Limited range of motion - Trouble raising or rotating your arm.
- Pain at rest and at night - Particularly when lying on the affected shoulder.
- Crackling sensation (crepitus) - A crackling feeling when moving your shoulder in certain positions.
- Arm weakness - Difficulty lifting objects or performing everyday tasks.
- Pain radiating down the arm - Not just localized to the shoulder area.
- Shoulder instability - Feeling like your shoulder might "pop out".
- Disturbed sleep - Discomfort that prevents you from sleeping on the affected side.
- Difficulty reaching behind your back - Such as when trying to zip up a dress or tuck in a shirt.
Diagnosis
Physical Examination
Your doctor will press on different parts of your shoulder and move your arm into various positions to check for pain, weakness, and range of motion.
X-rays
X-rays can't visualize soft tissues like the rotator cuff tendons, but they can show bone spurs or other potential causes for your pain such as arthritis.
Ultrasound
This test uses sound waves to produce images of structures within your body, particularly soft tissues like the rotator cuff tendons. It allows dynamic testing, showing the structures while they're moving.
Magnetic Resonance Imaging (MRI)
MRI uses radio waves and a strong magnetic field to create detailed images of the structures within your shoulder, including the rotator cuff tendons. It's the most effective way to confirm a rotator cuff tear and determine its size and location.
Arthrogram
In this test, a contrast dye is injected into your shoulder joint to make the structures more visible during an X-ray, ultrasound, or MRI. It can help identify small or partial rotator cuff tears.
Treatment Options
Rest and Activity Modification
Avoiding activities that cause shoulder pain, especially overhead movements and lifting, can allow the rotator cuff to heal. Your doctor might recommend limiting certain movements for a few days to weeks, depending on the severity of your injury.
Physical Therapy
Specific exercises can restore flexibility and strength to the shoulder muscles. A physical therapist can design an individualized program for your condition, which typically includes stretching and strengthening exercises for the rotator cuff and surrounding muscles.
Medications and Injections
Over-the-counter pain relievers like ibuprofen or naproxen sodium can reduce pain and swelling. For more severe pain, your doctor might prescribe stronger medications or recommend corticosteroid injections, which can provide temporary relief by reducing inflammation in the affected area.
Home Remedies
Ice Therapy
Applying ice to your shoulder for 15-20 minutes every few hours can help reduce pain and swelling, especially in the first 48 hours after an injury or during flare-ups.
Heat Therapy
After the initial inflammation has subsided (usually after 48-72 hours), applying heat to your shoulder can help relax tight muscles and increase blood flow to the area, which aids healing.
Gentle Stretching
Performing gentle shoulder stretches can help maintain range of motion and prevent stiffness. These should be done within a pain-free range and might include pendulum exercises and wall walks.
Activity Modification
Adjusting how you perform daily activities to avoid aggravating your shoulder. This might include using your unaffected arm for certain tasks, avoiding overhead activities, and taking frequent breaks during repetitive activities.
Over-the-counter Pain Relievers
Non-prescription anti-inflammatory medications like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help reduce pain and inflammation. Always follow the recommended dosage and consult with your doctor if you need to take these medications for more than a few days.
Preventive Care
- Maintain good shoulder strength and flexibility through regular exercise.
- Practice proper form and technique when performing activities that involve your shoulders.
- Avoid repetitive overhead activities when possible, or take frequent breaks if these activities are necessary.
- Strengthen the muscles surrounding your shoulder blade to improve overall shoulder stability.
- Maintain good posture to reduce strain on your shoulder muscles.
- Warm up properly before engaging in physical activities, especially those involving the upper body.
- Use proper equipment and techniques when playing sports or performing work tasks that stress the shoulders.
- Gradually increase the intensity and duration of shoulder exercises or activities to avoid overuse.
- Listen to your body and rest when you feel shoulder pain or fatigue.
- Maintain a healthy weight to reduce stress on all your joints, including your shoulders.
Surgical Options
Arthroscopic Tendon Repair
A minimally invasive procedure in which the surgeon inserts a small camera (arthroscope) and thin instruments through tiny incisions to reattach the torn tendon to the bone. This approach typically results in less pain and faster recovery compared to open surgery.
Learn More About This ProcedureOpen Tendon Repair
A traditional surgical approach involving a larger incision to access and repair the damaged tendon. This may be necessary for complex or large tears, or when additional reconstruction is required.
Learn More About This ProcedureTendon Transfer
For large, irreparable rotator cuff tears, a surgeon may use a nearby tendon as a replacement for the damaged tendon. This procedure is typically considered when the original tendon is too damaged to be repaired and the patient is experiencing significant weakness or disability.
Learn More About This ProcedureSchedule a Consultation
If you're experiencing symptoms of rotator cuff injuries, our expert team is here to help you find the right treatment approach for your specific needs.