The rotator cuff is a group of four muscles and associated tendons, located where your humerus, or upper arm bone, meets your scapula, or shoulder blade, and clavicle, or collarbone. The rotator cuff helps hold the arm and shoulder together, while facilitating a wide range of limb motions. An estimated two million Americans experience rotator cuff problems every year. Common issues include bursitis, tendinitis, and tears. These conditions tend to worsen with age, especially in persons whose jobs require overhead arm motions.

Many rotator cuff injuries can be managed with ice, rest, the use of NSAIDS, and physical therapy. More serious cases may call for surgery. Your Baptist Health medical team can help you diagnose and treat a rotator cuff injury.

What Are the Symptoms of a Rotator Cuff Injury?

Rotator cuff injuries are marked by pain and some degree of immobility. You may experience:

• A sustained ache in the shoulder
• Arm weakness or fatigue
• Difficulty in accomplishing certain tasks, such as putting on clothes, reaching an overhead light switch, or scratching your back
• Acute pain when sleeping on your damaged joint
• A cracking or popping sensation when moving your arm in certain directions

Feelings of shoulder discomfort often build slowly over time, to the point that pain medications are no longer effective. If these conditions persist, see your physician.

What Causes Rotator Cuff Injuries?

Rotator cuff injuries can happen abruptly or develop gradually, thanks to lifelong wear and tear on the shoulder joints. Two common conditions are:

• Acute tears: Acute or “all at once” tears often result from accidental injury, such as lifting heavy objects or falling on an arm or shoulder. 
• Degenerative tears: Chronic and degenerative tears are the natural consequence of aging and related joint decline. Repetitive-stress motions, bone spurs, and a diminished blood supply can all accelerate the process of degeneration.
• Chronic stress: Repetitive motions, such as throwing or lifting objects over one’s head, can cause overuse of a tendon.  These motions are common in several sports or hobbies enjoyed by all ages. An overused tendon may lead to small micro tears (tendinitis), but if left untreated can lead to a more serious tear or rupture.

Risk Factors for Rotator Cuff Injury

Several factors increase the likelihood of sustaining a rotator cuff injury:

• Family history: Data suggest that there is a degree of genetics in rotator cuff problems, meaning that some people are more genetically predisposed to injury than others.
• Age: Joints, muscles, and tendons gradually deteriorate over time (especially in those that are not active). Persons age 40 years and older are more likely to have issues with their rotator cuffs than are young people.
• Athletic activity: There is a strong correlation between certain types of athletic activity and rotator cuff injuries. Particularly susceptible are baseball and softball pitchers, football quarterbacks, swimmers, boxers, power lifters, bowlers, and tennis players, among others.
• Job characteristics: Any job or profession that requires overhead or swinging arm motions incurs a greater risk of rotator cuff injury. These run the gamut from firefighters, carpenters, painters, and construction workers to cheerleaders, drummers, and musical conductors.

How Do I Prevent a Rotator Cuff Injury?

You cannot do anything about aging or family history, but you can limit the activities that are correlated with higher incidences of rotator cuff injury. If that is not possible – and if your risk factors are job-related – then exercises that stretch and strengthen the shoulder and upper body muscles are a good preventive.

How Are Rotator Cuff Injuries Diagnosed?

The diagnosis of a rotator cuff injury typically involves:

• Documentation of your health and medical history
• A write up of your symptoms
• A physical examination of your shoulder joint, with an eye to deformities, swelling, and/or sources of pain
• Range-of-motion and strength tests for your arm
• X-ray, MRI, or ultrasound scans of the shoulder complex looking for evidence of old or new tears, as well as associated growths, such as bone spurs

How Are Rotator Cuff Injuries Treated?

The treatment of a rotator cuff emphasizes reductions in pain and restoration of movement. Medical researchers have found no advantage in taking a “surgery-first” approach, emphasizing less intensive, non-surgical treatments instead. Four out of five patients report improvements in health based on:

• Minimizing behaviors that resulted in injury
• Rest with applications of ice
• Use of nonsteroidal ant-inflammatory drugs (NSAIDs) such naproxen and ibuprofen to lessen pain and swelling
• Strength exercises
• Physical therapy
• Steroid injections
• Platelet Rich Plasma Treatment

There are, however, some cases where surgery may be warranted, for example, if pain persists for more than six months or the tear is greater than an inch in length. There are two major types of surgery for rotator cuff injuries:

• Open surgery: Open surgery is the traditional method for repairing a large or complex tear in the muscles or tendons of the rotator cuff. Open surgery typically requires hospitalization.
• Arthroscopic surgery: In recent years, a less invasive form of surgery, called arthroscopic surgery, has replaced open procedures in some cases. Muscle and tendon repair is conducted by the surgeon using long, thin tools, including a miniature camera, inserted through a small incision or incisions in your shoulder. Arthroscopic surgery is often performed on an outpatient basis.

The majority of patients report positive outcomes from rotator cuff surgery. You should expect some pain after your procedure, as well as a period of rehabilitation and recuperation.

Complications

In a few cases, patients receiving surgical treatment for a rotator cuff injury experience:

• Stiffness
• Infection
• Nerve injuries
• Muscle detachment
• Repeat tears

Following your physician’s rehabilitation plan is one key to capitalizing on the medical treatment you receive. Advanced age and smoking can also have a detrimental effect on recovery.