The rotator cuff is a vital part of the shoulder made up of the muscles and tendons surrounding the shoulder joint. It consists of the upper arm bone, shoulder blade, and collarbone. The muscles of the rotator cuff are supraspinatus, infraspinatus, subscapularis, and teres minor, which are connected by tendons.
Bursae are small sacs filled with synovial fluid that surround the shoulder joint, providing cushioning and lubrication. The rotator cuff keeps your arm socketed, giving you the stability and strength needed for a full range of motion. Rotator cuff tears and injury are more common in middle aged and older individuals. They also can be caused by acute injury. There is a large difference in the treatment of chronic rotator cuff tears, rotator cuff tendinosis and partial tears, versus acute rotator cuff tears. Acute tears are generally treated operatively, while others are treated with conservative measure such as exercise, physical therapy and occasional injections to decrease inflammation.
Rotator cuff injury symptoms
While rotator cuff injuries don't always hurt, pain is the most common sign you have an injured rotator cuff. Rotator cuff injury or tendinosis pain can start with a dull shoulder ache that worsens at night. The pain can also be on the side portion of the shoulder and between the elbow, in the large muscle called the deltoid. Pain can also worsen when you raise or lower your arm to the front or side above the shoulder level or reach behind your back. If you have pain when moving your arm below shoulder level, then you may have something called frozen shoulder. If you have chronic achy pain both at rest and with activity, it you could have arthritis.
Symptoms of an injured rotator cuff can include:
- Pain when playing sports or lifting heavy objects
- Pain when raising your arm
- Pain when lying down that keeps you awake at night
- Popping or cracking sounds when you move your arm
- Limited mobility and weakness in your shoulder and arm
Request an appointment with the Mass General Brigham sports medicine team for cutting-edge care, treatment, and rehabilitation of your shoulder injury.
Types of rotator cuff injuries
Rotator cuff injuries can range from minor inflammation to complete tendon tears.
A torn rotator cuff happens when a tendon in your shoulder partially tears or fully separates from the bone. Most commonly they are a supraspinatus tear, which can be caused by a high-impact injury like falling on your arm while playing sports. Rotator cuff tears can also be caused by wear over time.
Tendonitis is inflammation of the tendons that connect the rotator cuff muscles to your shoulder bones. Often, tendonitis can cause the tendons to pinch and become a chronic issue.
Repetitive motions can inflame the bursa sacs in your shoulder and cause them to fill with extra fluid, causing pain and swelling.
Risk factors and causes of rotator cuff injuries
Rotator cuff injuries most commonly impact people who work jobs requiring heavy lifting and athletes playing sports such as baseball and tennis. Repeatedly using your rotator cuff can wear down the tendon tissue over time, causing damage or irritation. Accidents or falls causing sudden trauma to your shoulder can also lead to rotator cuff injuries.
Common risk factors for a rotator cuff injury include:
- Age. As you get older, the more likely you are to suffer a rotator cuff tear
- Occupation. Any job that requires you to lift your arms over your head repeatedly
- Playing sports. Activities like baseball, tennis, and weightlifting can strain the shoulder
How are rotator cuff injuries diagnosed?
Most rotator cuff injuries have many of the same symptoms. To determine the type and extent of your injury, the doctor will examine your shoulder and ask questions about your injury. X-rays and MRIs might also be used to determine if there are bone issues, inflammation, or tearing.
How are rotator cuff injuries treated?
Rotator cuff injury treatment options vary depending on the specific condition, its severity, and your overall health. If you notice persistent shoulder pain, you should consult your physician, as continued use can worsen your injury.
Rotator cuff injuries typically do not require surgery to heal. Usually, the treatment options for a rotator cuff injury include:
- Resting your shoulder and refraining from activities
- Applying ice regularly
- Taking pain relievers and anti-inflammatories
- Undergoing physical therapy for rotator cuffs
- Getting corticosteroid shots if the pain is severe
More severe rotator cuff tears might require surgery. Torn rotator cuff surgery can repair partial or full tears with a minimally invasive arthroscopic procedure. Recovery from rotator cuff surgery typically takes four to six months before you can return to full activity. More severe tears can take even longer to fully recover.
Physical therapy for your rotator cuff after surgery can help with mobility by increasing your strength and flexibility. Your doctor or physical therapist can recommend daily exercises to help you regain your shoulder strength and range of motion.
Rotator cuff injuries most commonly affect athletes and active individuals, but nearly everyone faces some risk. Some options for preventing these shoulder injuries include:
- Strengthening your shoulders. People with weak shoulder muscles that perform repetitive motions with their shoulders can aggravate the muscles and tendons. The stronger your shoulder muscles are, the more resilient they are against physical stress and trauma.
- Avoiding overuse. If you play sports that require a lot of shoulder rotations, like swinging a tennis racket or throwing a baseball, give your body time off to recover afterwards.
- Working with a trainer. Whether it's weightlifting or pitching a softball, proper form is vital to maintaining healthy rotator cuffs. Consider using a professional trainer to ensure you are exercising and practicing safely.
If you need help recovering from and preventing future shoulder injuries, our sports medicine team can help you develop a rehabilitation plan that will allow you to regain maximum function and mobility. Our physical therapists design regimens using strength and stretching exercises to help you return to sports and other activities while minimizing your risk of injury. Request an appointment or call us at 617-726-0500 to learn more.
FAQs
The best indication you've hurt your rotator cuff is pain. Another sign your rotator cuff is damaged is a weakness and popping or cracking sounds when you move your arm.
Depending on how bad your injury is, rest is the best treatment. If you have a severe rotator cuff injury, you might need surgery to repair the damage in your shoulder. Physical therapy might also be recommended to strengthen your muscles and restore full range of motion.
Recovery times for a rotator cuff injury depend on factors such as age, your condition's severity, and your treatment plan. Mild injuries can heal on their own within a few weeks. Surgery might be necessary in more severe cases, leading to several months of recovery.
