What to know about rotator cuff injuries

The rotator cuff is a group of muscles and tendons that come together at an area of the humerus (upper arm bone) called the greater tuberosity.

The main function of the rotator cuff is to keep your shoulder joint stable while it moves. It does this by balancing the forces around your shoulder in all directions, which helps the joint move smoothly and stay in place.

Rotator cuff injuries are common, affecting nearly two million people every year in the United States. If you have shoulder pain or trouble lifting your arm and think you might have a rotator cuff problem, it’s important to see an orthopaedic surgeon.

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Rotator Cuff Injury Causes

Rotator cuff problems are often caused by traumatic events, repetitive motions and aging.

Traumatic Events

In younger patients, a traumatic incident such as a fall, accident or a seizure, especially when that acute injury leads to a shoulder dislocation, can injure the rotator cuff.

Repetitive Motions

For middle-aged patients, rotator cuff tears are most common in people who perform heavy physical work, such as carpenters and painters. For example, overusing the shoulder can cause bone spurs in the joint that aggravate the rotator cuff. Symptoms tend to get worse over time because of long-term overuse.

Aging

For older people, rotator cuff problems are often simply a symptom of aging, because our tendon tissues tend to degenerate over time. For this reason, rotator cuff injuries are most common in people over 60. If you are in this age group, you may not even realize you have a small tear until you develop shoulder pain after playing golf, tennis or pickleball.

Rotator Cuff Injury Symptoms

The most common symptoms of rotator cuff tears are:

• Pain or weakness in the arm or shoulder, especially when reaching overhead
• Struggling to lift your arm or objects
• Shoulder pain that disrupts your sleep or prevents you from laying on one side
• Limited mobility or range of motion in the arm

If you are worried you may have injured your rotator cuff, make an appointment with your primary care physician or an orthopaedic surgeon as soon as possible.

Rotator Cuff Injury Diagnosis

Getting an accurate diagnosis is the first step to managing your shoulder pain. Diagnosing a rotator cuff injury typically involves:

• Getting your medical history
• A physical exam to test your strength, mobility and range of motion
• Imaging tests, such as an X-ray, ultrasound or magnetic resonance imaging (MRI) scan, to help your care team check for arthritis, bone spurs, torn tendons and other issues in your shoulders that could cause your pain

Rotator Cuff Injury Treatments

Not all rotator cuff injuries require surgery, particularly if they are chronic problems caused by aging or overuse.

How to Reduce Pain without Surgery

Some options to reduce shoulder pain flare-ups include:

• Rest: Take a break from physical activities that aggravate your shoulder.
• Ice and heat: Using ice packs for about 15 minutes every few hours can reduce swelling. Heating pads can improve blood flow and help reduce stiffness.
• Over-the-counter pain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can ease pain and swelling.
• Physical therapy (PT): PT can help improve your shoulder’s strength and range of motion. Strengthening exercises can help build your shoulder muscles, while other exercises can help reduce stiffness and improve your shoulder mobility.
• Cortisone shots: Steroid injections in the shoulder joint may provide pain relief that lasts for a few weeks or up to a few months.

When to Consider Surgery for Rotator Cuff Problems

If you have a sudden onset traumatic tear, surgery may be recommended to address your severe pain and disability. In such cases, your tissue quality is typically better, and if the repair is done promptly, it can lead to a more successful recovery.

Surgery may also be recommended in other cases, such as when nonsurgical options have failed to address your symptoms. Your doctor can help you determine if surgery is the best option for you based on:

• The cause and type of injury
• How long the injury has been present
• The number of tendons involved
• The quality of your shoulder muscle
• Your age
• Your activity level
• Your pain level
• How much your injury limits your range of motion and daily activities

How long does it take to recover from rotator cuff surgery?

Recovery time after a rotator cuff repair varies widely. For some patients, it can take as long as six months to one year to fully recover, especially in older patients with less healthy tissue.

You will typically go home the same day after having rotator cuff surgery, but you will be in an arm sling for up to six weeks. If the surgery was done on your dominant arm, you may need someone to drive you until the sling can be safely removed.

Unlike with joint replacements, where patients are typically encouraged to get moving as quickly as possible, recovering from rotator cuff repair requires a more cautious approach.

Because the surgery repairs torn tendons that need to heal to bone, those tissues need time to heal. So, while physical therapy is key to recovery, your first focus should be to rest and protect the repair.

If you had a small to mid-sized tear, you can start PT about three to four weeks after surgery. If you had a mid- to large-sized tear, you should postpone PT for about four to six weeks after surgery.

For the first few weeks, you may feel more comfortable sleeping upright. Before your surgery, you may want to consider renting or buying a reclining chair that is comfortable enough to sleep in.

How can you prevent rotator cuff injuries?

For younger people, overall core and upper body strength is important to prevent rotator cuff injuries. Keeping the muscles around your shoulders — called scapular stabilizers — strong can help support the overall biomechanics of the shoulder. This can help prevent you from overusing your rotator cuff and developing tendonitis, one of the most common causes of shoulder problems in people under age 60.

If you’re a competitive athlete or work in a highly physical job, you should pay particular attention to how you’re moving your body. Varying your exercise routine is also important to maintain balance and avoid overusing any one joint.