Rotator Cuff Injuries

The rotator cuff is a group of four muscles and tendons that connect your shoulder blade (scapula) to your upper arm bone (humerus). The four muscles — supraspinatus, infraspinatus, teres minor and subscapularis — form a “cuff” around the shoulder joint. These muscles help you lift, rotate and move your arm.

A rotator cuff injury happens when the muscles and tendons are damaged. When these get hurt or torn, it can cause pain and make it harder to move your shoulder.

What are the types of rotator cuff injuries?

Rotator cuff injuries vary in severity, from mild strains to full tears: 

• Tendinitis (tendonitis): This occurs when the rotator cuff tendons become irritated and strained. It often results from repetitive motion or overuse.
• Bursitis in the shoulder joint: Inflammation of the bursa, a small fluid-filled sac that cushions the joints, can also happen. Bursitis often occurs alongside other rotator cuff problems and causes additional pain and stiffness.
• Shoulder impingement and rotator cuff pain: An impingement occurs when the rotator cuff tendons are pinched or squeezed between the bone in your shoulder. This can cause pain and swelling, making it harder to move your arm.
• Partial tears of the rotator cuff: A partial-thickness tear (or incomplete tear) occurs when one or more of the rotator cuff tendons is damaged but not completely torn. This type of tear still allows some movement but can cause pain and weakness in the shoulder. 
• Full-thickness rotator cuff tears: A full-thickness tear (or complete tear) involves the entire tendon insertion on the humerus. It means one or more tendons are torn all the way through. These tears are often classified by severity of the tear based on the number of tendons involved, size, and retraction of the tear.

Causes and risk factors for rotator cuff injuries

Several factors can lead to a rotator cuff injury or increase your risk of developing one:

Common causes of pain and injury in the rotator cuff include:

• Trauma: A sudden event or acute injury, such as falling on an outstretched arm or lifting something heavy, can cause an acute rotator cuff tear.
• Repetitive motion: Repeating the same arm motions, especially overhead movements, can wear down the muscles and tendons over time. Sports like tennis, baseball and swimming, as well as jobs like painting or carpentry, can lead to degenerative tears.
• Aging: With age, our tendons (like a rope) can become thinner and wear out eventually becoming a degenerative tear. 

The following factors may increase your risk for a rotator cuff injury:

• Age: The risk of an injury increases, especially in people older than 60. As tendons weaken over time, they become more likely to tear.
• Sports: Athletes who frequently use overhead arm movements can be more prone to injury.
• Poor posture: Slouching or having poor posture can put added stress on the shoulders, increasing the chance of injury.
• Medical conditions: Some inflammatory diseases such as rheumatoid arthritis or lupus can be associated with rotator cuff tears.
• Treatment: Repetitive steroid use has also been associated with rotator cuff tears.

One of the first signs of a rotator cuff problem is shoulder pain. The pain can be mild at first and worsen over time. You may feel more pain when you lift your arm or try to reach behind you. Some people describe the pain as a deep ache in the shoulder. 

Other common symptoms of rotator cuff tear or injury include:

• Pain when raising your arm
• Weakness or reduced strength in your shoulder or arm
• Joint pain that gets worse at night or while resting
• Trouble sleeping on the affected shoulder
• Clicking or grating sounds when moving your arm
• Tenderness of the shoulder or mild swelling

Causes and risk factors for rotator cuff injuries

Several factors can lead to a rotator cuff injury or increase your risk of developing one:

Common causes of pain and injury in the rotator cuff include:

• Trauma: A sudden event or acute injury, such as falling on an outstretched arm or lifting something heavy, can cause an acute rotator cuff tear.
• Repetitive motion: Repeating the same arm motions, especially overhead movements, can wear down the muscles and tendons over time. Sports like tennis, baseball and swimming, as well as jobs like painting or carpentry, can lead to degenerative tears.
• Aging: With age, our tendons (like a rope) can become thinner and wear out eventually becoming a degenerative tear. 

The following factors may increase your risk for a rotator cuff injury:

• Age: The risk of an injury increases, especially in people older than 60. As tendons weaken over time, they become more likely to tear.
• Sports: Athletes who frequently use overhead arm movements can be more prone to injury.
• Poor posture: Slouching or having poor posture can put added stress on the shoulders, increasing the chance of injury.
• Medical conditions: Some inflammatory diseases such as rheumatoid arthritis or lupus can be associated with rotator cuff tears.
• Treatment: Repetitive steroid use has also been associated with rotator cuff tears.

Your health care provider will ask you about your symptoms and do a physical exam. You may also need imaging tests like:

• X-rays: These are used to check for bone issues, such as bone spurs, arthritis or fractures.
• MRI or ultrasound: These tests provide a clear view of the muscles and tendons, helping to diagnose a cuff injury or rotator cuff tear. 

If you have a rotator cuff injury, your provider will refer you to an orthopedic surgeon or specialist for further treatment.

Several treatment options are available for rotator cuff injuries. The right choice depends on the severity of the injury, your symptoms and your overall health.

Nonsurgical treatments for rotator cuff injuries

Most people with a rotator cuff problem will start with simple measures, including:

• Rest: Give your shoulder time to heal. Avoid activities that worsen your symptoms.
• Ice and heat therapy: Apply ice packs to reduce swelling and pain and use heat to relax the muscles. 
• Physical therapy: A key part of rotator cuff treatment, physical therapy helps restore strength and improve range of motion. Your therapist will show you exercises to stretch and strengthen the muscles around your shoulder joint. They will guide you to make sure you don’t do too much too soon and risk reinjuring your shoulder.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) and other over-the-counter (OTC) pain relievers such as ibuprofen or acetaminophen can help reduce pain and swelling.
• Steroid injections: If rest, medication and physical therapy don't help with shoulder pain, your health care provider may recommend a limited amount of corticosteroid shots (injections).

Surgical treatments for rotator cuff injuries

If nonsurgical treatments don’t work, or if you have a severe or complete tear, surgery may be needed to repair the shoulder. There are different types of rotator cuff surgery:

• Arthroscopic surgery: Arthroscopic tendon repair is a minimally invasive surgery where a surgeon makes small incisions (cuts) and uses a camera to guide the repair. This option can help reduce recovery time. 
• Open surgery: In some cases, a more traditional surgical approach may be needed to repair the torn tendon. In this type of surgery, a surgeon works through a larger incision to reattach the tendon to the bone.
• Tendon transfer: If the rotator cuff is too damaged to be repaired, the surgeon may use a tendon from another muscle, like the back, to help stabilize the shoulder and improve movement.
• Reverse shoulder replacement: This specialized procedure is often used for severe rotator cuff injuries and arthritis. It reverses the positions of the ball and socket, allowing the deltoid muscle to lift the arm when the rotator cuff is not functioning properly.
• Stem cell therapy: While still considered experimental, this treatment involves using stem cells to help repair damaged tissues. It may not be suitable for everyone, but it is an option being explored for some people.   

When considering surgery, talk to your health care provider or orthopedic specialist. They can evaluate your injury and recommend the best treatment based on your condition, age, activity level and overall health.

Most people see improvements with both nonsurgical and surgical treatments. However, recovery requires time as the body needs to heal properly.

Many people who undergo surgery for a torn rotator cuff regain improved motion after surgery. However, the same tendon could be torn again. If a re-tear leads to pain or limited joint movement, surgery may be necessary again. 

Regardless of your treatment, shoulder rehabilitation is an important part of recovery and preventing another injury.

While some factors, like aging, can't be controlled, there are steps you can take to reduce your risk of a rotator cuff injury:

• Strengthen your shoulder muscles: Regular strength training can help keep your muscles and tendons strong.
• Improve flexibility: Stretching your shoulder and improving your range of motion can reduce your risk of injury.
• Use proper technique: Proper form can help protect your shoulders, whether playing sports or lifting heavy objects.
• Rest and recover: If you're involved in activities that put stress on your shoulders, rest and recover to avoid overuse injuries.

Shoulder injuries can interfere with daily life, but expert care can make all the difference. At Banner Health, we understand that shoulder pain can limit your life. Our orthopedic specialists and surgeons offer expert diagnosis and treatment options.