Rotator cuff injuries are typically attributed to trauma, tissue degeneration, and shoulder impingement. Baseball pitchers have a distinctive throwing motion that puts them at a higher risk for rotator cuff problems. All four of these sources of injury are explained below.
The rotator cuff is the group of four muscles and tendons that surround the shoulder joint. The four muscles are called the supraspinatus, infraspinatus, subscapularis, and teres minor. The most common tendon to have a problem is the supraspinatus. On top of the rotator cuff is the deltoid muscle. The bones at the shoulder include the humerus, scapula (shoulder blade), and clavicle (collar bone). The rotator cuff muscles start on the shoulder blade and attach around the front, top, and back of the humerus.
They help to elevate the arm away from the body in forward, side, and backward motions. They also turn the arm in or out to rotate the shoulder. These muscles and tendons provide strength and stability to the shoulder joint.
Rotator cuff injuries can limit your range of motion and cause aggravating pain. Join Airrosti’s Casey Crisp, DC as he discusses the anatomy of the rotator cuff and demonstrates easy exercises to help prevent and relieve nagging shoulder pain.
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.
What Is A Rotator Cuff Injury?
The rotator cuff is made up of four muscles that help move and stabilize the shoulder joint. Most rotator cuff disorders are caused by a combination of normal wear and tear and overuse. Using your shoulder for many years slowly damages the rotator cuff.
The severity of injury may range from a mild strain and inflammation of the muscle or tendon, which will lead to no permanent damage, to a partial or complete tear of the muscle that might require surgery for repair. Both normal wear and tear and overuse can lead to impingement, when a tendon rubs against bone. This damages and irritates the tendon, which causes bleeding and inflammation.
The rotator cuff is prone to injuries. The injuries can be acute or chronic.
- Acute injuries are tears and strains to the rotator cuff that result from a one-time traumatic event, such holding out the arm to break a fall. With rest and proper treatment, these injuries may heal over time.
- Chronic injuries are injuries that result from overuse (fatigue) or entrapment (impingement) of the rotator cuff, or a combination of these factors. Athletes, such as baseball pitchers, and construction workers are especially prone to chronic rotator cuff injuries. These chronic conditions are ongoing, with symptoms lasting 6 weeks or longer.
Most rotator cuff injuries are treated with a combination of pain control, rest, and rehabilitation. More severe injuries may respond better with injections and possibly surgery.
Learn more about the symptoms of a rotator cuff injury, how a rotator cuff injury is diagnosed, and about potential treatments, including injections.
Types of Rotator Cuff Injuries
Rotator cuff injuries can be acute (traumatic) or chronic (ongoing) injuries that happen over time. These injuries include:
General Wear and Tear
As you get older or participate in repetitive movement activities, the general wear and tear on your shoulder can cause a rotator cuff injury.
Tendinitis
Tendinitis is inflammation of the tendons in your rotator cuff from overuse or overload. Shoulder tendinitis is a common repetitive motion injury for athletes who participate in overhead sports like swimming, tennis and volleyball.
Bursitis
Bursitis is inflammation or irritation of the fluid-filled sac (bursa) between your shoulder joint and rotator cuff tendons.
Tendon Strain or Tear
A partial or full tear can occur in the tendon connecting the muscle to the bone during an abrupt injury or as a result of repetitive motion. Untreated tendonitis can also lead to a tendon tear. A torn rotator cuff causes pain, weakness and inability to move the arm freely in full range of motion. It also tends to be painful when you try to lift and turn your arm during overhead activity.
Shoulder Impingement
Shoulder impingement, a common cause of shoulder pain, occurs when the rotator cuff rubs or catches on the bones in the shoulder. Shoulder impingement causes persistent pain as the tendons are injured and swell. Left untreated, shoulder impingement can lead to rotator cuff tears.
Symptoms Of Rotator Cuff Injuries
The most common symptoms of rotator cuff injuries are stiffness, weakness, loss of range of motion, and—most notably—shoulder pain.
- Shoulder pain. People with rotator cuff injuries complain about pain, especially at night. Pain may also be felt during over-the-head motions or reaching behind the back.
- Stiffness. The shoulder may feel most stiff when getting out of bed in the morning.
- Muscle weakness. Lifting the arm overhead or holding the arm away from the body may be difficult. The muscles at the back of the shoulder may appear smaller on the injured side than on the unaffected side.
- Loss of active range of motion. A person with an injured rotator cuff may not be able to move the arm through a normal range of motion. However, sometimes the arm can still be passively moved, meaning that someone else can lift the affected arm and rotate it through a complete range of motion.
- Swelling and tenderness. The front of the shoulder is often swollen and tender.
- Crepitus (shoulder popping). Cracking and popping sensations in the shoulder are also common, and may indicate the shoulder’s ball and socket joint is not tracking properly.
Rotator Cuff Injuries: Causes
Rotator cuff injuries may be grouped into two major areas: traumatic injuries and degenerative injuries. While traumatic injuries are one-time events—often unforeseeable accidents—degeneration occurs over time.
People with degenerative rotator cuff injuries tend to have one or more of the following risk factors:
- Overuse. Degenerative rotator cuff injuries are more common in people who engage in repetitive overhead shoulder motions, such as hammering, painting, swimming, playing tennis, or pitching a baseball.
- Shoulder arthritis. People with shoulder arthritis are more likely to develop shoulder instability, muscle weakness, and bony cysts, called osteophytes. All of these factors can put more stress on the rotator cuff, making it more prone to injury.
- Older age. Degenerative rotator cuff injuries tend to occur in people over 401 and become increasingly more common as people age. Experts estimate that 15% to 30% or more of people over age 70 have rotator cuff tears.2,3 These injuries do not always cause symptoms and may not require treatment.
Diagnosis
uring 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 Of Rotator Cuff Injuries
The type of treatment you need depends on the type of injury you have, and how severe it is. Your doctor will discuss your options with you and advise you which is best for you.
Self-help
There are some things that you can do to help yourself. Rest your shoulder as much as you can – try not to lift heavy weights or do activities that involve lifting your arm over your head. There are some gentle stretches you can do that may help. See the section on Physiotherapy (below) for more information.
You might find it helps to use an ice pack to help relieve pain. Wrap the ice pack in a towel or dishcloth before using it. Never put an ice pack directly on to your skin as it may cause damage or give you a burn.
If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. If these don’t work well enough, your GP may suggest taking paracetamol with codeine. You can buy this from a pharmacy. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Physiotherapy
Your GP may refer you to a physiotherapist. They’ll show you some rotator cuff stretches and exercises that you can do at home to help improve the strength and movement of your shoulder. The type of exercise and how long you will need to do them will depend on the type of injury you have.
Steroid injection
If the treatments above don’t work or your pain is severe or your movement limited, you may need to have a steroid injection. This is an injection into the area around your shoulder joint. It can help to reduce swelling, pain and stiffness. This will ease your symptoms and make physiotherapy exercises more comfortable. However, steroid injections can have side-effects. For example, you may find your pain initially gets worse or you get facial flushes. Talk to your doctor for more information.
Surgery
If other treatments haven’t worked for you or if you have a large tear, your doctor may suggest you have an operation.
An operation can be done either as open surgery, mini-open repair or keyhole surgery. Open surgery is usually for large tears and involves making a large cut in your skin to do the operation. In mini-open repair, your surgeon will do the operation through a small cut. They’ll use arthroscopy as part of the operation too. Keyhole surgery (arthroscopy), involves using a thin, flexible camera and special instruments to look inside and treat your shoulder joint.
Your surgeon will give you advice on which type of surgery is best for you. Treatment for a rotator cuff injury aims to ease your pain and to give you as much movement in your shoulder as possible. But recovering from a rotator cuff injury can be a slow process. You may need to take several weeks off work, particularly if you have an operation to repair a tear.
