Rotator Cuff Injuries: Causes, Symptoms and Treatment

What the rotator cuff is

Your rotator cuff is part of the shoulder joint: a group of muscles and tendons that holds the top of your upper arm bone firmly in the shoulder socket, keeping the shoulder stable as you move your arm in any direction.

The injuries

Rotator cuff injuries are common. Most come from wear and tear — making the same arm movements over and over, especially reaching overhead — as the tissues gradually break down:

• Tendinitis — the tendons connecting the muscles to the shoulder bones become irritated and swollen from being pinched during movement.
• Bursitis — the bursa, a small fluid-filled sac cushioning the space between the rotator cuff and the shoulder bones, is rubbed too much by muscle and bone, swells with fluid and hurts.
• Tears — a tendon can tear gradually or suddenly from an injury, such as falling on an outstretched arm or lifting something heavy. A tear may go part way through the tendon (partial) or all the way (full).

Who's at risk

Anyone can injure the rotator cuff, but some people are more likely to:

• people over 40 — most injuries come from the wear of aging, and by 80 most adults have tears;
• athletes in sports with repeated shoulder movements, such as tennis, swimming and baseball — especially pitching;
• workers who reach overhead or lift heavy loads a lot, such as carpenters, construction workers and painters.

Symptoms

Rotator cuff injuries don't always hurt. When they do, the pain is often in the top of the arm or shoulder, and may be worse when you:

• lie down, especially on the injured side;
• raise or lower your arm to the front or side;
• reach behind your back.

A torn rotator cuff may also cause weakness in the arm and clicking or popping when you move it.

Diagnosis

Your health care provider will examine the shoulder — its range of motion and where it hurts — test your arm and shoulder strength, and may order x-rays, an ultrasound or an MRI.

Treatment

The best treatment depends on your age, how much the injury bothers you, and whether it came suddenly or from wear and tear. It often includes:

• rest, and ice or a cold pack on the sore spot;
• pain relievers such as ibuprofen or aspirin to ease pain and swelling;
• physical therapy exercises to strengthen the shoulder and improve movement;
• a corticosteroid injection into the joint if other treatments don't relieve the pain.

Tendinitis and bursitis may also be treated with ultrasound therapy, and a torn rotator cuff with heat or electrical nerve and muscle stimulation (transcutaneous electrical nerve stimulation, TENS). Surgery may be an option if the shoulder isn't better after 6 to 12 months, or for a large tear or one from a recent injury.

When to see a provider

If certain activities bother your shoulder, stop them and check with your provider — early treatment can keep a mild injury from becoming serious. If your arm feels weak right after a sudden injury, see your provider as soon as possible.

Sources

Based on "Rotator Cuff Injuries," MedlinePlus, National Library of Medicine; a work of the United States government in the public domain.