Rotator Cuff Injuries

What is a Rotator Cuff?

The rotator cuff plays an integral role in the movement of the shoulder, a ball and socket joint connecting the bone of the upper arm (humerus) with the shoulder blade (scapula). The rotator cuff helps stabilize your shoulder as you move your arm.

What Are the Four Muscles of the Rotator Cuff?

The four muscles of the rotator cuff are the supraspinatus, infraspinatus, teres minor and subscapularis. These muscles are attached by tendons from the scapula to the humerus that lie just outside the shoulder joint and its capsule. The muscles of the rotator cuff help stabilize the shoulder and enable you to lift your arm, reach overhead and perform sports activities such as throwing, swimming and swinging a bat, racket or golf club.

What is a Rotator Cuff Injury?

Rotator cuff injuries can take multiple forms, but commonly result in pain in the shoulder, especially during movement of the arm overhead or away from the body. A rotator cuff injury could result from age, overuse or an impact injury or trauma. Symptoms can include pain, tenderness, swelling, clicking, reduced mobility and stiffness. The rotator cuff can tear as part of an acute injury caused by lifting a heavy weight or falling on the shoulder. In these cases, the shoulder immediately becomes weak and exhibits pain when the arm is lifted.

What Are the Types of Rotator Cuff Injuries?

There are three common types of rotator cuff injuries.

• Tendonitis: This happens when the rotator cuff tendon becomes irritated or inflamed
• Bursitis: This occurs when the bursa, a fluid-filled sac that reduces a joint's internal friction, becomes inflamed due to compression
• Rotator cuff tears: The rotator cuff tendons may partially tear from overuse or fully tear from a sudden injury

Rotator Cuff Injury Symptoms

Rotator cuff injuries often cause pain during movement but can include other signs.

• Pain when raising or moving your arm
• Stiffness in the shoulder
• Tenderness of shoulder or mild swelling
• A clicking sound in the shoulder
• Reduced strength and mobility in the shoulder
• In extreme cases, pain may never fade and even wake you from sleep

How to Diagnose a Rotator Cuff Injury

A rotator cuff injury diagnosis often begins with a physical exam and discussion of recent injuries. A simple rotator cuff injury test is to check the strength of your shoulder and its mobility. Pain resulting from activities that require raising your arm overhead, away from the body or in a wrapping motion could indicate a potential tear. A doctor will likely use a physical exam and a review of medical history and recent injuries to make a diagnosis.

Rotator Cuff Tear Diagnosis

A rotator cuff tear means the tendons that make up the rotator cuff are not fully attached. Symptoms of a rotator cuff tear include shoulder pain that awakens you at night and weakness raising the arm. Cracking sounds when moving your arm, limited arm mobility and muscle weakness are also common symptoms.

A rotator cuff tear might require additional tests to diagnose.

• X-rays and MRIs are taken after dye is injected into the shoulder
• Arthrogram MRI or arthroscopy may be needed in cases of a small or partial tear

How to Treat a Rotator Cuff Injury

The severity of a rotator cuff injury will dictate the type of treatment. For minor injuries, rest, ice, medication and physical therapy may help heal the injury. More severe cases could require surgery.

Non-Surgical Rotator Cuff Injury Treatments

• Rest: Avoid activities that cause pain, especially if the pain is worse the next day. Avoid the activity that started the problem. Do not use the arm repeatedly out to the side of the body.
• Ice: Apply an ice bag (over a towel) to your shoulder at least twice a day for 20 minutes. Also apply ice after any activity that aggravates your shoulder pain.
• Medication: An anti-inflammatory pain medication (such as Advil, Aleve or aspirin) can relieve pain and inflammation.
• Physical therapy: Your orthopedic surgeon may refer you to a physical therapist for exercises or other therapy. Exercises to strengthen the shoulder may help to prevent a recurrence. Learn more about how the Sports Physical Therapy Service can help treat your shoulder injuries.

Surgical Repair of a Rotator Cuff

A tear of the rotator cuff is commonly treated with immediate surgical repair by reattaching the torn tendon(s) to the humerus. While not a major operation, the rehabilitation time for a rotator cuff surgery can be lengthy. Surgery may also be a treatment option for degenerative changes to the rotator cuff.

Rotator Cuff Surgery and Recovery

During surgery to repair a torn rotator cuff tendon, the deltoid muscle gets separated, and sutures are attached to the torn tendon(s). Tiny holes are made in the humerus where the tendons were attached, and the sutures are passed through the bone and tied, securing the rotator cuff tendons to the humerus. The tendons heal back to the bone over several months, reestablishing the normal tendon-to-bone connection. During this time, forceful use of the shoulder, such as weightlifting and raising the arm out to the side or overhead, should be avoided.

After surgery, you will probably use a sling for six weeks. You can remove the sling several times a day for gentle pendulum motion exercises. If the repair was quite large or difficult to fix, a large pillow that holds your arm out to the side of your body is needed for six weeks.

Learn more about how Mass General Brigham specialists diagnose and treat a full spectrum of shoulder injuries.

Risks & Results of Surgery

The success of surgery to repair the rotator cuff depends upon the size of the tear and how long ago the tear occurred. Usually, a small tear has a good chance for a full recovery. If the tear is large, the extent of recovery cannot be accurately predicted until the repair and rehabilitation are completed. If the tear occurred a long time ago (several months or longer), it can be difficult or sometimes impossible to repair. Most patients achieve good pain relief following repair regardless of the size of the tear unless the tear is massive.

Shoulder pain is usually worse than before surgery the first few weeks or even several months after surgery, but then gradually the pain lessens. It can take up to a full year to regain motion and function in the shoulder. Shoulder stiffness and loss of motion are potential complications after rotator cuff repair. Re-rupture of the repaired rotator cuff is possible if too much force is placed on the repaired tendon before it is fully healed. Nerve and muscle injury and infection are infrequent complications.

FAQs

What causes rotator cuff injuries?

A rotator cuff injury could occur because of overuse or a sudden injury. It can also be due to degeneration. Repetitive activities, such as throwing or swimming, can lead to injuries over time. Falls or hard hits may cause sudden injury. Aging can play a factor in rotator cuff degeneration.

How do I know if I have a rotator cuff strain vs a tear?

It may take medical imaging to accurately diagnose your rotator cuff injury. If you are experiencing sharp pains or if your shoulder has lost function and mobility suddenly, it is likely a tear. If you can trace your pain back to a specific collision, such as a sports injury, especially if you noticed a pop at the time of the hit, that could signify a rotator cuff tear. If the pain has come on gradually, that could signify a rotator cuff strain.

What doctor do you see for a rotator cuff injury?

An orthopedic surgeon has specialized knowledge of the rotator cuff and shoulder. The sooner you visit a doctor for rotator cuff injury treatment, the faster your recovery. If you have a rotator cuff injury, request an appointment with our Sports Medicine Service today.

What exercises should I avoid with a rotator cuff injury?

While a doctor or physical therapist may suggest exercises to rehabilitate your range of motion during a rotator cuff injury, you should avoid movements that place additional stress on the shoulder.

Exercises to avoid:

• Throwing a ball or swinging a racket over the head
• Swimming strokes that require an overhead reach
• Lifting weights above the head or away from the body, such as shoulder presses
• Lifting weights that pull the arm away from the shoulder, such as a deadlift or shrug

Find more exercises and rehabilitation protocols around rotator cuff repair.

Related Conditions and Treatments

• Shoulder tendonitis
• Shoulder instability
• FAQ shoulder injuries
• FAQ shoulder surgery