Pacific Rim Orthopedic Surgeons

Rotator Cuff Injury

Injuries to the rotator cuff are fairly common due to how frequently it is used. The rotator cuff is typically engaged in most day-to-day activities, especially if a person has an active lifestyle or plays sports. There are several rotator cuff injury types, some occurring suddenly and others building up over time, each treatable with both conservative and more invasive techniques.

What is the Rotator Cuff?

The rotator cuff is in a small space between the humerus and the upper part of the shoulder blade, surrounding the shoulder and covering the head of the humerus. It is made up of four shoulder muscles which keep the shoulder and upper arm stable when they are moved and used, also allowing the shoulder to turn and be rotated.
Illustration of a torn rotator cuff.

Shoulder Muscles of the Rotator Cuff

Supraspinatus

This muscle stretches from the top of the scapula to the upper end of the humerus, allowing the arm to be lifted and rotated.

Subscapularis

The muscle attaches to the middle of the scapula and stretches to the lower part of the humeral head, allowing the arm to be outstretched away from the body.

Infraspinatus

The muscle reaches from the bottom of the scapular, connecting to the humerus behind the supraspinatus, allowing the arm to be rotated.

Teres Minor

This muscle also allows the arm to be turned and rotated, attaching to the outside edge of the scapula and attaches to the humerus beneath the infraspinatus.

Rotator Cuff Injuries

Rotator cuff injuries are very common, most being wear-and-tear injuries, but others can come on suddenly. There are several risk factors for a rotator cuff injury occurring, including:

  • Adults over 40: Most rotator cuff injuries are due to wear and tear, which begins to take a greater toll after the age of 40.
  • Sports Players: Athletes use repeated shoulder movements, increasing the risk of a rotator cuff injury, especially in sports like tennis, swimming, and baseball.
  • Jobs Requiring Frequent Overhead or Heavy Lifting: People who are carpenters, construction workers, painters, and other similar professions are more likely to develop rotator cuff problems.

These are the most common types of rotator cuff injuries:

Tendonitis or Shoulder Impingement Syndrome

Rotator cuff tendinitis is a sub-type of shoulder impingement syndrome and is the swelling or irritation of one of the four tendons that support the rotator cuff.

Bursitis

The bursa is a small, fluid-filled sac that acts as a cushion between joints, reducing their internal friction. The bursa can become inflamed (bursitis) due to repetitive motions or positions that put excess pressure on it or due to trauma from conditions like inflammatory arthritis, gout, or infection.

Rotator Cuff Tear

A rotator cuff tear can either be a partial or complete tear of one or more of the tendons, making it difficult to raise and move the arm. Tears are often due to an accident or trauma, such as a broken collarbone or dislocated shoulder, but can sometimes develop due to age ( a degenerative tear).

Diagnosing a Rotator Cuff Injury

No matter the rotator cuff injury, a proper diagnosis by a healthcare provider is needed where they’ll perform a physical exam and order some imaging tests such as an X-ray, MRI, or ultrasound. They’ll examine the shoulder and discuss the symptoms experienced, asking when the pain was first noticed and if any activities ease or worsen the symptoms.

Symptoms

Rotator cuff injury symptoms include:

  • Pain when raising or moving your arm
  • Stiffness in the shoulder
  • Tenderness of shoulder or mild swelling
  • A clicking sound in the shoulder
  • Reduced strength and mobility in the shoulder
  • In extreme cases, pain may be constant or chronic, even waking a person from sleep

Treatment Options

There are several treatments available for different kinds of rotator cuff injuries, ranging from conservative or non-surgical treatments to surgery:

  • Rest: Avoiding the activity that caused the injury
  • Icing: Using an ice pack wrapped in a thin towel, follow the healthcare provider’s recommendations on how often and for how long the shoulder should be iced.
  • Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs): These over-the-counter medications will help relieve pain and reduce inflammation.
  • Physical Therapy: To strengthen the shoulder muscles and help regain mobility, a physical therapist will teach specific exercises to encourage regaining strength and flexibility during recovery.
  • Cortisone Shots/Steroid Injections: Corticosteroids help reduce inflammation and are generally used to treat bursitis and rotator cuff tendinitis.
  • Surgery: If non-surgical approaches don’t provide relief or if a rotator cuff tear is severe, surgery to repair the tendons may be needed.

Preventing Injuries to the Rotator Cuff

The help reduce the risk of injuring the rotator cuff, a person should adopt methods to avoid overusing the shoulder:

Wearing the right equipment for sports and physical work

Warming up and cooling down before and after training or working out

Stopping exercise or physical activities as soon as pain is felt.

Schedule an appointment with a healthcare provider if pain or other symptoms in the shoulder develop.