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Rotator Cuff Injuries: Common Causes and Treatments

The rotator cuff is made up of muscles and four separate tendons that fuse together to surround the shoulder joint. This network of muscles and tendons allow the arm to rotate. An injury or overuse can lead to a painful rotator cuff tear.

Diagram: normal shoulder and injured rotator cuff

Causes

Causes of a rotator cuff injury include:

  • Direct blow to the shoulder area
  • Falling on an outstretched arm
  • Chronic degenerative wear and tear on the tendons
    • Arthritis may decrease the space for the tendons
    • Chronic instability of the humerus may traumatize the tendons
  • Repetitive overhead motion of the arm such as in:
    • Swimming
    • Baseball (mainly pitching)
    • Tennis

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a rotator cuff injury include:

  • Age: 40 or older
  • Heavy lifting
  • Activities that involve repetitive overhead arm motion
  • Weakened shoulder muscles from inactivity

Symptoms

  • Recurrent, constant pain, particularly when reaching overhead
  • Pain at night that prevents you from sleeping
  • Shoulder muscle weakness, especially when lifting the arm
  • Popping or clicking sounds when the shoulder is moved
  • Limited range of motion in the shoulder joint

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will carefully examine your shoulder. You will be asked to move your shoulder in several directions.

Tests may include:

  • X-rays -to rule out fractures and bone spurs.
  • Arthrogram-dye is injected into the shoulder joint and then an x-ray or MRI is taken. The doctor will look for dye that leaks out of the joint, which may indicate a tendon tear.
  • MRI scan -a test that uses a strong magnetic field and radio waves to make pictures of the inside of the shoulder. This will show bones and tendons, and is an excellent way to determine either large or small tears of the cuff.
  • Arthroscopy -a thin, lighted tube is inserted through a small incision in the shoulder to look at the structures inside the shoulder. Arthroscopy can also be used for treatment.
  • Ultrasound -a test that uses sound waves to examine the rotator cuff for inflammation or tears.

Treatment

The treatment will depend on the extent of your injury, level of pain, and amount of immobility. The first step is usually a nonsurgical approach.

Non-surgical

  • Rest-to help the shoulder heal. The doctor may recommend that you wear an arm sling to help rest the shoulder area.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)-to help control the pain if there is inflammation
  • Topical pain medicines (eg, cream, patches) that are applied to the skin
  • Corticosteroid injections-to help reduce swelling and pain
  • Ice-to help reduce swelling and pain. Apply ice to shoulder area for 15 minutes, 3 to 4 times a day.
  • Physical therapy-to help strengthen and increase motion in the shoulder area

Surgical

  • Acromioplasty-This surgery on the bony structures that impinge the rotator cuff. It can be arthroscopic or open.
  • Arthroscopy -During an arthroscopy, a small instrument is inserted into the shoulder and used to remove bone spurs or degenerated portions of the rotator cuff tendons. Lesser tears can be repaired during arthroscopy as well.
  • Mini-Open Repair with Arthroscopy-This surgery combines arthroscopy with an incision in the shoulder joint. Through the incision, the doctor can suture larger tears in the tendons.
  • Open Surgery-This surgery is used to repair the injured tendon in more severe cases. A tissue transfer or a tendon graft can be done during surgery if the tear is too large to be closed together. In the most severe cases, a joint replacement may be necessary.

Depending on the extent of your injury, full recovery can take anywhere from 2 to 6 months, and sometimes longer. If you are diagnosed with a rotator cuff injury, follow your doctor's instructions.

Prevention

To reduce your chances of getting a rotator cuff injury:

  • Avoid overhead repetitive motion
  • Avoid heavy lifting
  • Exercise regularly to strengthen the muscles around the shoulder joint

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted March 2011

Contact Information

Sports Medicine & Shoulder Surgery
Carl J. Shapiro Department of Orthopaedics
Beth Israel Deaconess Medical Center
Carl J. Shapiro Clinical Center, 2nd Floor
330 Brookline Avenue
Boston, MA 02215
617-66-SPORT (667-7678)

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