Rotator Cuff Injury (Shoulder)

Rotator cuff tendons often become inflamed from overuse, aging, or a fall on an outstretched hand or another traumatic cause.

Sports or occupations requiring repetitive overhead motion or heavy lifting can also place a significant strain on rotator cuff muscles and tendons. Over time, as a function of aging, tendons become weaker and degenerate. Eventually, this degeneration can lead to complete tears of both muscles and tendons. These tears are surprisingly common. In fact, a tear of the rotator cuff is not necessarily an abnormal situation in older individuals if there is no significant pain or disability.

Fortunately, these tears do not lead to any pain or disability in most people. However, some individuals can develop very significant pain as a result of these tears and they may require treatment.

Signs and symptoms of rotator cuff injury

Typically, a person with a rotator cuff injury feels pain over the deltoid muscle at the top and outer side of the shoulder, especially when the arm is raised or extended out from the side of the body. Motions like those involved in getting dressed can be painful. The shoulder may feel weak, especially when trying to lift the arm into a horizontal position. A person may also feel or hear a click or pop when the shoulder is moved. Pain or weakness on outward or inward rotation of the arm may indicate a tear in a rotator cuff tendon. The patient also feels pain when lowering the arm to the side after the shoulder is moved backward and the arm is raised.

Diagnosis of rotator cuff injury

A doctor may detect weakness but may not be able to determine from a physical examination where the tear is located. X rays, if taken, may appear normal. An MRI or ultrasound can help detect a full tendon tear or a partial tendon tear.

Treatmentof rotator cuff injury

Doctors usually recommend that patients with a rotator cuff injury rest the shoulder, apply heat or cold to the sore area, and take medicine to relieve pain and inflammation. Other treatments might be added, such as electrical stimulation of muscles and nerves, ultrasound, or a cortisone injection near the inflamed area of the rotator cuff. If surgery is not an immediate consideration, exercises are added to the treatment program to build flexibility and strength and restore the shoulder’s function. If there is no improvement with these conservative treatments and functional impairment persists, the doctor may perform arthroscopic or open surgical repair of the torn rotator cuff.

Treatment for a torn rotator cuff usually depends on the severity of the injury, the age and health status of the patient, and the length of time a given patient may have had the condition. Patients with rotator cuff tendinitis or bursitis that does not include a complete tear of the tendon can usually be treated without surgery.

Nonsurgical treatments include the use of anti-inflammatory medication and occasional steroid injections into the area of the inflamed rotator cuff, followed by rehabilitative rotator cuff strengthening exercises. These treatments are best undertaken with the guidance of a health care professional such as a physical therapist, who works in conjunction with the treating physician.

Surgical Repair of Rotator Cuff Tears

Surgical repair of rotator cuff tears is best for:

  • younger patients, especially those with small tears. Surgery leads to a high degree of successful healing and reduces concerns about the tear getting worse over time.
  • individuals whose rotator cuff tears are caused by an acute, severe injury. These people should seek immediate treatment that includes surgical repair of the tendon.

Generally speaking, individuals who are older and have had shoulder pain for a longer period of time can be treated with nonoperative measures even in the presence of a complete rotator cuff tear. These people are often treated similarly to those who have pain, but do not have a rotator cuff tear. Again, anti-inflammatory medication, use of steroid injections, and rehabilitative exercises can be very effective. When treated surgically, rotator cuff tears can be repaired by either arthroscopic or traditional open surgical techniques.

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Last updated: 4/5/2022