Rotator Cuff Injuries

What is the rotator cuff?

The rotator cuff comprises four separate muscles that surround the top of the shoulder. These muscles stabilize the ball of the shoulder joint to keep it in the socket. The four muscles include the supraspinatus muscle, the infraspinatus muscle, the subscapularis muscle, and the teres minor muscle. The supraspinatus is the most commonly injured of the four muscles.

How is the rotator cuff usually injured?

In people under the age of 25, rotator cuff injury is usually caused by overuse or by activities that require repetitive shoulder motion, such as tennis, swimming, or baseball, and the pain generally occurs during the overhead portion of the activity. This injury, referred to as tendinitis, is common in young people and usually results from strain of the rotator cuff muscles.

In people between the ages of 25 and 45 years, rotator cuff problems usually occur from chronic overuse. These patients usually
have a history of persistent pain with any overhead activities. They may have "popping" in the shoulder and also may complain of pain, which continues even during rest and may wake them up from sleep. These symptoms may appear if someone has begun a new exercise or a new workout routine using the shoulder muscles. Weakness also is common in this age group.
In people from 45 to 65 years of age, shoulder pain may occur secondary to a structural problem. A small hook of bone can form and rub the top of the rotator cuff muscles, causing pain and inflammation of the rotator cuff. This is commonly referred to as
bursitis. If the shoulder movement is limited, the rotator cuff and also the biceps tendon may have been worn away by the bone spur. A common complaint is chronic pain and weakness, which is exacerbated by lifting anything. Theses people report a noticeable increase in pain at night. Some locking or catching in the shoulder also may occur.

In people over 65 years, rotator cuff tears are very common. Depending on a person's activity level, the symptoms may be less or more severe than those reported by someone in a younger age group. The pain can be debilitating, and if not treated properly, may lead to degenerative arthritis of the shoulder.

How is a rotator cuff tear diagnosed?

A clinical exam will identify the location of pain and tenderness during range of motion of the shoulder. People often have pain raising their shoulder actively above their head. Routine x-rays will not diagnoses a rotator cuff tear, but they will show bony overhang that catches on the rotator cuff. Sometimes a physical exam will not identify a rotator cuff problem and further diagnostic tests, such as an MRI, are needed to fully evaluate the rotator cuff muscles. Other problems such as biceps tendinitis or ganglions (fluid-filled cysts) in the shoulder can mimic rotator cuff tears. MRI can help to evaluate the cause of shoulder pain.

How is a torn rotator cuff treated?

Nonsteroidal anti-inflammatory medicines and physical therapy are necessary when a rotator cuff muscle is inflamed. The physical therapy regimen may include muscle strengthening and ultrasound treatment. Applying ice directly to the area that is most painful also can help to reduce swelling and relieve pain. A steroid injection can also relieve the pain and inflammation. This especially provides relief of tendinitis of the rotator cuff. However, when the rotator cuff is partially or completely torn, physical therapy and muscle strengthening is not always helpful. In these cases arthroscopic surgery is usually necessary to shave the undersurface of the bone that catches on the rotator cuff. Anything on the rotator cuff muscle that may be impinging on the undersurface of the bone can be removed at the same time. If the muscle is completely torn, then it is necessary to reattach the rotator cuff to bone. This can be done arthroscopically or through a small skin incision approximately two to three inches in length. The muscle is reattached to bone to relieve pain and improve shoulder function. Using advanced arthroscopic techniques, recovery is much faster, and less painful then with traditional open shoulder surgery.

How soon will a rotator cuff muscle heal?

If it is necessary to repair the rotator cuff muscle, it may take six weeks to two months for the tendon and muscles to completely heal. People who engage in activities that require overhead movement may need three to four months to heal, depending on the extent of the rotator cuff tear. If the muscle is only partially torn and is repaired at the time of surgery, recovery is much faster.

What is subacromial decompression?

Sometimes a small hook of bone can catch on the rotator cuff and cause pain and inflammation of the rotator cuff muscles. This is commonly referred to as bursitis and it will sometimes respond to an injection of steroids and local painkillers. However, if this treatment does not relieve the pain, it may be necessary to perform arthroscopic surgery to shave the undersurface of the bone. This is done through three small skin incisions. Recovery time from this type of surgery is very fast and people often are able to return to their activities by six weeks after the operation.

In addition, our surgeons also use an automatic pain pump after surgery, which gives pain medicine directly to the incision site for 48 hours after surgery. This helps your recovery after surgery to be comfortable and much less painful.

To see more information about the shoulder, including video animations of shoulder anatomy and other shoulder injuries and ways to treat them, please click here.