Patient education: Rotator cuff injury (The Basics)

What is a rotator cuff injury? — 

This is a condition that can cause shoulder pain. The rotator cuff is made up of 4 shoulder muscles and their tendons (figure 1). Tendons are strong bands of tissue that connect muscles to bones.

People can get different types of rotator cuff injuries. One common injury is "tendinopathy," which is a problem with 1 or more of the tendons. When a person has tendinopathy, the tendons are not inflamed or swollen. If they do get inflamed or swollen, it is called "tendinitis." Tendinopathy and tendinitis can happen if you:

●Do a job or activity that involves repeated use of your shoulder muscles (like window washing, painting, or construction)

●Do sports that involve throwing a lot (like pitching a baseball) or raising your arm over your head (like swimming)

●Do any exercises or activities that make some of your shoulder muscles stronger than others

●Have "calcific tendinopathy" – This is when small calcium deposits form on 1 or more of the tendons in the shoulder.

Another type of rotator cuff injury is a tear in a tendon or muscle. Tears can happen if you fall on your shoulder or move your shoulder too fast and with too much force. Tears can also happen as a tendon wears out over time. You might be more likely to have a tear as you age if other people in your family had this problem or if there are changes in the bones around your shoulder.

What are the symptoms of a rotator cuff injury? — 

Most people have pain in the front or side of the shoulder, down the outer part of the upper arm. The pain is usually worse when they try to move their arm over their head or lie on their shoulder.

People with a tear might also feel their shoulder is weaker than usual.

Will I need tests? — 

Maybe. Your doctor or nurse will talk with you and do an exam. If they suspect you have a tear, you might need an imaging test of your shoulder, such as an MRI scan, X-ray, or ultrasound. These create pictures of the inside of the body.

What can I do on my own to feel better? — 

You can:

●Rest – Avoid doing activities that cause pain or strain your shoulder, such as raising your arm over your head or reaching behind you. In general, try to keep your arm down, close to, and in front of your body. But you can move your shoulder gently if you need to. If sleeping on your shoulder is painful, try to avoid sleeping on that side.

●Apply ice – Put a cold gel pack, bag of ice, or bag of frozen vegetables on the injured area every 1 to 2 hours, for 15 minutes each time, as needed. Put a thin towel between the ice (or other cold object) and your skin. Ice can be especially helpful after you've been using your shoulder a lot for work, sports, or chores.

●Take pain medicines – Your doctor or nurse might recommend taking medicines such as acetaminophen (sample brand name: Tylenol), ibuprofen (sample brand names: Advil, Motrin), or naproxen (sample brand name: Aleve).

How is a rotator cuff injury treated? — 

Many rotator cuff injuries get better on their own, but they can take months to heal completely. Depending on your injury, you might be able to do specific exercises to help your shoulder feel better. Ask your doctor or nurse which exercises you should do, when to start them, and how often to do them. They might suggest working with a physical therapist (exercise expert).

Some exercises help keep your shoulder from getting too stiff. One example is pendulum exercises (figure 2). To do this exercise, let your arm relax and hang down. Move your arm back and forth, then side to side, and then around in small circles in both directions. Do this exercise for 5 minutes, 1 or 2 times a day.

Other exercises can help strengthen your shoulder muscles. Your doctor, nurse, or physical therapist can show you how to do these.

When you do shoulder exercises, it's important to:

●Warm up your shoulder first. You can do this by taking a hot shower or bath, putting a warm moist towel or heating pad on your shoulder, massaging the area, or doing gentle movements.

●Start slowly, and gradually make the exercises harder over time. Follow all instructions for how often to do the exercises and how many times to repeat each motion.

●Know that some soreness is normal. If you have sharp or tearing pain, stop what you're doing and tell your doctor or nurse.

Your doctor might suggest other treatments, such as getting a shot of medicine into your shoulder or surgery, if:

●Your injury is severe.

●You do not get better after resting and strengthening your shoulder.

●Your pain is from calcific tendinopathy – Other treatments might involve procedures to break up the calcium deposits.

How can I prevent injuring my rotator cuff again? — 

To reduce the chances of injuring your rotator cuff again:

●Try to take breaks if you are doing a repetitive activity, such as window washing, painting, construction, pitching a baseball, or swimming. Some people might need to completely avoid these activities for a time. If you are a pitcher, follow pitching guidelines for how to keep your shoulder healthy. For example, you might need to limit how many pitches you throw in a day and rest for a certain number of days between pitching.

●Do not ignore or try to work through shoulder pain.

●Do exercises to keep all the muscles in your shoulder strong. Warm up your muscles before exercising to help prevent injury.

●Try to practice good posture. To do this, sit up straight and keep your shoulders back.

When should I call the doctor? — 

Call your doctor or nurse if your:

●Pain does not get better or gets worse

●Shoulder feels stiffer or harder to move

●Shoulder feels weaker

●Hand or arm becomes weak or swollen

●Fingers are numb, tingly, blue, or gray

Get medical help right away if you have shoulder pain along with other concerning symptoms, like chest pain or shortness of breath.

More on this topic

Patient education: Rotator cuff repair (The Basics)
Patient education: Frozen shoulder (The Basics)
Patient education: Biceps tendinopathy (The Basics)
Patient education: Shoulder impingement (The Basics)
Patient education: Shoulder pain (The Basics)
Patient education: Shoulder arthroscopy (The Basics)
Patient education: Shoulder replacement (The Basics)
Patient education: How to use a shoulder sling (The Basics)

Patient education: Rotator cuff tendinitis and tear (Beyond the Basics)
Patient education: Frozen shoulder (Beyond the Basics)
Patient education: Biceps tendinitis or tendinopathy (Beyond the Basics)
Patient education: Shoulder impingement syndrome (Beyond the Basics)