Rotator Cuff

What is the rotator cuff?

The rotator cuff acts as a dynamic stabilizer of the glenohumeral joint, the shoulder joint. Its primary function is to hold the humeral head in place throughout the full range of motion. It is composed of four muscles: infraspinatus, teres minor, subscapularis, and supraspinatus.

What is a rotator cuff injury?

A rotator cuff injury is a strain or tear in the group of tendons and muscles mentioned above. Most tears involve the dominant arm and occur in men older than age 40 years.

How does it occur?

A rotator cuff injury may result from using your arm to break a fall, falling onto your arm, lifting a heavy object, use of your shoulder in sports with a repetitive overhead movement (swimming, baseball, football, tennis) which gradually strains the tendon, or manual labor such as painting, plastering, raking leaves, or housework. Patients with a history of recurrent rotator cuff tendonitis are also at an increased risk.

What are the symptoms?

The symptoms are arm and shoulder pain, shoulder weakness, shoulder tenderness, and loss of shoulder movement, especially overhead. The tear can be either acute, sudden or short duration, or chronic, occurring over a long period of time. With acute tears, the symptoms may be a sudden tearing sensation in the shoulder followed by a severe pain that radiates into the arm. Chronic tears account for about 90% of tears. Early findings of chronic tears include pain worse at night and interfering with sleep.

How is it diagnosed?

Your doctor will perform a physical exam and check your shoulder for pain, tenderness, and loss of motion as you move your arm in all directions. Your doctor will also ask whether your shoulder pain began suddenly or gradually. An x-ray will be done to rule out fractures. Based on the results, your doctor may order other tests such as magnetic resonance imaging (MRI), an arthogram, or arthroscopy. An MRI creates images of your shoulder. An arthogram consists of a dye being injected into your shoulder joint and an MRI or x-ray being taken after the injection. An arthroscopy is a surgical procedure in which a small instrument is inserted into your shoulder joint so your doctor can look directly at your rotator cuff.

How is it treated?

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 doesn’t interfere with everyday activities. Your treatment plan should include proper sitting posture, rest for shoulder (avoid strenuous activity and any overhead motion that causes pain), ice packs at least once a day but up to three times a day, exercises given by your doctor to strengthen the rotator cuff muscles, anti-inflammatory drugs, and physical therapy. A subacromial injection of corticosteroid is also an option. As injections are repeated, the results may last for shorter periods of time.

If you have a bad tear, you may need to have it repaired arthroscopically. 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.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of physical therapy is to return to your normal activities as soon as is safely possible.

What can be done to help prevent this from recurring?

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

Cassandra Haddox, DO