Overview

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. A rotator cuff injury can cause a dull ache in the shoulder, which often worsens with use of the arm away from the body.

Rotator cuff injuries are common and increase with age. These may occur earlier in people who have jobs that require repeatedly performing overhead motions. Examples include painters and carpenters.

Many people with rotator cuff disease can manage their symptoms and return to activities with physical therapy exercises that improve flexibility and strength of the muscles surrounding the shoulder joint.

Sometimes, rotator cuff tears may occur as a result of a single injury. In those circumstances, medical evaluation should be provided as soon as possible to discuss the role of surgery. Extensive rotator cuff tears may not be fixable, and transfer of alternative tendons or joint replacement may be possible.

Symptoms

The pain associated with a rotator cuff injury may:

• Be described as a dull ache deep in the shoulder
• Disturb sleep
• Make it difficult to comb your hair or reach behind your back
• Be accompanied by arm weakness

When to see a doctor

Shoulder pain that is short-lived may be evaluated by your family doctor. See your doctor right away if you have immediate weakness in your arm after an injury.

Causes

Rotator cuff disease may be the result of either a substantial injury to the shoulder or to progressive degeneration or wear and tear of the tendon tissue. Repetitive overhead activity or heavy lifting over a prolonged period of time may irritate or damage the tendon.

Risk factors

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

• Age. As you get older, your risk of a rotator cuff injury increases. Rotator cuff tears are most common in people older than 60.
• Construction jobs. Occupations such as carpentry or house painting require repetitive arm motions, often overhead, that can damage the rotator cuff over time.
• Family history. There may be a genetic component involved with rotator cuff injuries as they appear to occur more commonly in certain families.

Complications

Without treatment, rotator cuff problems may lead to permanent loss of motion or weakness, and may result in progressive degeneration of the shoulder joint. Although resting your shoulder is necessary for your recovery, keeping your shoulder immobilized for a prolonged time can cause the connective tissue enclosing the joint to become thickened and tight (frozen shoulder).

Prevention

If you are at risk of rotator cuff injuries or if you've had a rotator cuff injury in the past, daily shoulder strengthening exercises can help prevent future injury.

Most people exercise the front muscles of the chest, shoulder and upper arm, but it is equally important to strengthen the muscles in the back of the shoulder and around the shoulder blade to optimize shoulder muscle balance. Your doctor or a physical therapist can help you plan an exercise routine.

Diagnosis

During the physical exam, your doctor will press on different parts of your shoulder and move your arm into different positions. He or she will also test the strength of the muscles around your shoulder and in your arms.

In some cases, he or she may recommend imaging tests, such as:

• X-rays. Although a rotator cuff tear won't show up on an X-ray, this test can visualize bone spurs or other potential causes for your pain — such as arthritis.
• Ultrasound. This type of test uses sound waves to produce images of structures within your body, particularly soft tissues such as muscles and tendons. It allows dynamic testing, assessing the structures of your shoulder as they move. It also allows a quick comparison between the affected shoulder and the healthy shoulder.
• Magnetic resonance imaging (MRI). This technology uses radio waves and a strong magnet. The images obtained display all structures of the shoulder in great detail. The quality of the images depends greatly on the quality of the equipment used.

Treatment

Conservative treatments — such as rest, ice and physical therapy — sometimes are all that's needed to recover from a rotator cuff injury. If your injury is severe, you might need surgery.

Injections

If conservative treatments haven't reduced your pain, your doctor might recommend a steroid injection into your shoulder joint, especially if the pain is interfering with your sleep, daily activities or physical therapy. While such shots are often temporarily helpful, they should be used judiciously, as they can contribute to weakening of the tendon and may lower the success of surgery if this is eventually needed.

Therapy

Physical therapy is usually one of the first treatments your doctor may suggest. Exercises tailored to the specific location of your rotator cuff injury can help restore flexibility and strength to your shoulder. Physical therapy is also an important part of the recovery process after rotator cuff surgery.

Surgery

Many different types of surgeries are available for rotator cuff injuries, including:

• Arthroscopic tendon repair. In this procedure, surgeons insert a tiny camera (arthroscope) and tools through small incisions to reattach the torn tendon to the bone.
• Open tendon repair. In some situations, an open tendon repair may be a better option. In these types of surgeries, your surgeon works through a larger incision to reattach the damaged tendon to the bone.
• Tendon transfer. If the torn tendon is too damaged to be reattached to the arm bone, surgeons may decide to use a nearby tendon as a replacement.
• Shoulder replacement. Massive rotator cuff injuries may require shoulder replacement surgery. To improve the artificial joint's stability, an innovative procedure (reverse shoulder arthroplasty) installs the ball part of the artificial joint onto the shoulder blade and the socket part onto the arm bone.

Lifestyle and home remedies

The pain from a minor rotator cuff injury often diminishes on its own, with proper care. Stop doing what caused the pain and try to avoid painful movements. Limit heavy lifting or overhead activity until your shoulder pain subsides. Icing your shoulder may help it feel better. Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol, others) also may be helpful.

Preparing for an appointment

You'll probably start by seeing your family doctor or sports medicine physician. If your injury is severe, you might be referred to an orthopedic surgeon. If you've been treated for a similar problem in the past, you may need to bring past records and imaging studies with you to your appointment.

What you can do

Before the appointment, you might want to write a list that answers the following questions:

• When did you first begin experiencing shoulder pain?
• What movements and activities worsen your shoulder pain?
• Have you ever injured your shoulder?
• Have you experienced any symptoms in addition to shoulder pain?
• Does the pain travel down your arm below your elbow?
• Is the shoulder pain associated with any neck pain?
• Does your job or hobby aggravate your shoulder pain?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• Where exactly is the pain located?
• How severe is your pain?
• What movements and activities aggravate or relieve your shoulder pain?
• Do you have any weakness or numbness in your arm?