Rotator cuff injury is the damage to the tissue around the shoulder joint. Read this article to know about it in detail.
The muscles and tendons that help in the movement of the shoulders are called the rotator cuff. Any injury to this group of muscles can cause a dull ache in the shoulder, which worsens with shoulder movement. This type of injury is commonly seen in athletes and people who repeatedly move their shoulders like painters and carpenters. However, most people recover from this injury with the help of physiotherapy.
Rotator cuff injury is caused by the wear and tear of the group of muscles and tendons (collectively called rotator cuff) that work together to stabilize and move the shoulder.
The muscles that make the rotator cuff are:
Supraspinatus Muscle - It keeps the upper arm stable and helps lift the arm.
Infraspinatus Muscle - It helps in shoulder rotating action.
Subscapularis Muscle - It connects the upper arm to the shoulder blade and helps rotate the shoulder.
Teres Minor Muscle - It is the smallest muscle and helps in rotation.
These tendons get injured easily as they move in a very tight space. When the shoulder is moved normally, these muscles move and help with the movement. But when the shoulder is stressed or strained beyond its capacity, these muscles rub against the bony process in the shoulder bone (acromion). This results in the muscles getting injured and inflamed.
The types of rotator cuff injuries include -
Wear and Tear - Repetitive movements, and advancing age can cause general wear and tear of these muscles.
Rotator Cuff Tendinitis - Overuse can cause inflammation of the tendons in the rotator cuff. This type of injury is commonly seen in athletes who swim or play tennis and volleyball.
Shoulder Bursitis - The inflammation of the bursa, the fluid-filled sac between the shoulder joint and rotator cuff tendons, is called shoulder bursitis.
Rotator Cuff Tear - The tendons, which are the fibers that connect the muscles to the bone, can tear fully or partially. It can occur from a sudden injury or due to repetitive motion. Untreated rotator cuff tendinitis can eventually lead to a tear. This causes shoulder pain, inability to move the shoulder fully, and shoulder weakness.
Shoulder Impingement - Shoulder impingement is when the muscles in the rotator cuff rub or impinge on the shoulder bones. It is the most common cause of shoulder pain and rotator cuff tear.
Symptoms are not seen with all types of rotator cuff injuries. Repetitive motions can gradually damage the muscles over the years.
The common symptoms include -
Shoulder pain while performing certain activities.
Inability to achieve a full range of shoulder motion.
Inability to sleep on the affected side.
Severe pain while lifting your hands overhead.
Throbbing pain at night.
If these symptoms persist for more than a week and the patient starts to lose sensation or function of the arm, they should consult a doctor immediately.
The following are the most common causes of rotator cuff injury -
Arthritis (inflammation or tenderness in joints) and patients with knee pain take support by putting excess force on their arm while sitting and rising from the chair. As their knees hurt, they take support from the chair handles. The shoulder joint is not built for this and leads to crushing and grinding of the rotator cuff tendons.
Shoulder injuries from falls, accidents, and sports collisions.
Repetitive activities like pushups, swimming, and painting a house can cause rotator cuff injury.
Sudden overhead arm movements commonly seen in athletes can result in rotator cuff tears.
The rotator cuff injuries are commonly seen in -
People older than 40 years.
Athletes who play contact sports.
People who play tennis, baseball, and archery.
Painters and carpenters.
Genetics, from parents to children.
The doctor will first do the physical examination by pressing the shoulders in different areas and telling the patient to perform various shoulder movements. Physical examination also tests for the strength of the rotator cuff muscles. If needed, the doctor might ask the patient to get the following tests -
X-ray - The shoulder radiographs will not show a rotator cuff tear, but it is used to rule out other conditions that can cause shoulder pain, like bone spurs or arthritis.
Ultrasound - Here, sound waves are used to produce images of muscles and tendons in the shoulder. Moreover, this procedure can also show stretching muscles with every movement.
Magnetic Resonance Imaging (MRI) - Strong radio waves magnets are used to obtain a detailed view of all hard and soft structures in the shoulder.
Most rotator cuff injuries get better with rest, ice compressions, and physical therapy. Surgery is indicated only in severe cases of rotator cuff tear. The various treatment options include -
1) Conservative Treatments - Rest the affected shoulder, apply ice, and consult a physiotherapist for physical therapies. The doctor will prescribe painkillers and anti-inflammatory medicines for pain.
2) Physical Therapy - Exercises specially designed for this type of shoulder injury will help reduce pain and restore flexibility and strength of the shoulder.
3) Injections - If the pain did not improve with physiotherapy, the doctor might recommend getting a steroid injection directly into the shoulder joint. It is indicated for people with pain that interferes with sleep and other activities. However, this only gives temporary relief.
4) Surgery - The surgeries that are done to treat rotator cuff injury include -
Arthroscopic Tendon Repair - Here, the surgeon inserts an arthroscope, a small tube with a camera, inside the shoulder joint through small incisions, and the torn tendon is reattached.
Open Tendon Repair - Here, the surgeon makes a larger incision to visualize the joint and then reattaches the damaged tendon.
Tendon Transfer - In case of a damaged tendon, a nearby tendon is used to replace the damaged one.
Shoulder Replacement - In severe cases, the shoulder might need replacement with an artificial joint.
For people at risk, performing shoulder stretches and strengthening exercises must be limited. Ask a fitness specialist how to perform these exercises correctly.
Rotator cuff injury is one of the common injuries to the shoulders. It can be easily treated with non-surgical methods. However, in severe cases of a rotator cuff tear, shoulder strength may not improve unless surgically corrected and the prognosis of rotator cuff injury depends upon the injury type.
Last reviewed at:
30 Sep 2022 - 5 min read
Query: Hello doctor,I have been suffering from a shoulder rotation and mobility issues when I play sport. When I throw a ball, my shoulder is not fully rotating. It is mostly external rotation of my shoulder. Read Full »
Query: Hello doctor,I cannot rotate my left side of the shoulder for five days and continues severe pain, which is not letting me sleep. Read Full »
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