Rotator Cuff Injury

What is a rotator cuff injury?

A rotator cuff injury is a strain or tear in the group of tendons and muscles that hold your shoulder joint together and help move your shoulder.

How does it occur?

A rotator cuff injury may result from:

• poor head and shoulder posture, especially in older people
• using your arm to break a fall
• falling onto your arm
• lifting a heavy object
• normal wear and tear in an older person
• use of your shoulder in sports with a repetitive overhead movement, such as swimming, baseball (mainly pitchers), football, and tennis, which gradually strains the tendon
• manual labor such as painting, plastering, raking leaves, or housework.

What are the symptoms?

The symptoms of a torn rotator cuff are:

• arm and shoulder pain
• shoulder weakness
• shoulder tenderness
• loss of shoulder movement, especially overhead.

How is it diagnosed?

Your healthcare provider will examine you and check your shoulder for pain, tenderness, and loss of motion as you move your arm in all directions. Your provider will ask if your shoulder pain began suddenly or gradually. You may have an X-ray to make sure there are not any fractures or bone spurs.

Based on these results, you may have other tests or procedures right away or later, such as:

• magnetic resonance imaging (MRI), which creates images of your shoulder and surrounding structures with sound waves
• an arthrogram, which is an X-ray or MRI that is taken after a special dye has been injected into your shoulder joint to outline its soft structures
• arthroscopy, a surgical procedure in which a small instrument is inserted into your shoulder joint so your provider can look directly at your rotator cuff.

What is the treatment?

A tendon in your shoulder can be inflamed, partially torn, or completely torn. What is done about it depends on how torn it is and how much it hurts.

If your tear is a minor one, it can be left to heal by itself if it does not interfere with your everyday activities. Your treatment plan should include:

• proper sitting posture, in which your head and shoulders are balanced
• rest for your shoulder, which means avoiding strenuous activity or any overhead motion that causes pain
• ice packs at least once a day, and preferably 2 or 3 times a day
• doing the exercises your healthcare provider gives you
• anti-inflammatory drugs. Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days without their healthcare provider's approval.
• possibly physical therapy to help you learn exercises you can do at home to stretch or strengthen your shoulder.

If you have a bad tear, you may need to have it repaired by arthroscopy. Arthroscopy can be used to perform surgery on a joint as well as to see inside the joint. The rough edges of a torn tendon can be trimmed and left to heal. Larger tears can be stitched back together. After surgery, your treatment plan will include physical therapy to strengthen your shoulder as it heals.

How long will the effects last?

Full recovery depends on what is torn and how it is treated.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activities will be determined by how soon your shoulder recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your normal activities when:

• Your injured shoulder has full range of motion without pain.
• Your injured shoulder has regained normal strength compared to the uninjured shoulder.

What can be done to help prevent this from recurring?

The best way to prevent a recurrence is to strengthen your shoulder muscles and keep them in peak condition with shoulder exercises.