Rotator cuff injuries are the most frequent cause of shoulder pain in individuals 40 years old and above. The rotator cuff is a collection of muscles and tendons around the shoulder that ensures the top of the arm bone remains in the socket. The first sign of a rotator cuff injury is often a mild to moderate ache in the shoulder area. This occurs due to irritation in the shoulder tendons. Over time this ache becomes worse, turning into a burning pain especially when sleeping on the affected side. If the irritation does not remit the tissue of the tendon can begin to deteriorate leading to tendinitis. These types of injuries most commonly occur in individuals who have jobs or play sports which involve repetitive overhead motions. Poor posture can also contribute to the development of a rotator cuff injury.
Signs and Symptoms of Rotator Cuff Injuries
The most common signs of rotator cuff injuries and tears include:
- Moderate to severe pain that worsens when relaxing the muscles, resting and when at night when in bed
- Pain with movement that engages the muscles near the rotator cuff such as lifting and lowering the arm, reaching overhead or other specific movements of the arm
- Moderate to severe pain and weakness when attempting to lift the arm out to the side, specifically
- Inability to reach behind the body due to pain, limited mobility and weakness
- A feeling of weakness when moving your arm from the shoulder such as the inability to rotate it as much as previously or difficulty lifting the arm
- A popping of crackling sound when moving the arm from the shoulder or moving it into certain positions
- Intense pain that occurs suddenly as the result of a tear from a fall or injury such as a sports related injury causing trauma separating the tendon from the bone
- A snapping sound or feeling followed by sudden weakness in the arm due to an intense injury
- Pain that seems to move down the arm
According to the American Association of Orthopedic Medicine, it is better to prevent a rotator cuff injury than to cure it. Preventing these types of injuries involves stretching and strengthening muscles and tendons of the shoulder. Combined, strengthening and stretching will condition the rotator cuff and should joint. Even for those who do not have any problems with their shoulder currently should get in the habit of conditioning their rotator cuff. As we age, the possibility of injury to this important area of the body increases while the seriousness of the injury or force needed to produce a tear decreases making these injuries more likely. Getting in the habit of conditioning the shoulders will help insure healthy shoulder joints and rotator cuffs and avoidance of unnecessary pain.
The shoulder is a very important joint in our body. If it isn’t hurting, we often don’t think about it. However, when it is injured, we find that there is very little that we can do without using our shoulders.
The shoulder is a joint that moves easily in a lot of different directions. One of the ways that our bodies protect us from moving too far is to stabilize it with the muscles of the rotator cuff. The rotator cuff muscles also help to lift our arms overhead, as well as rotate the arm in and out.
What Is the Rotator Cuff?
There are four muscles that form the rotator cuff: the supraspinatus, the infraspinatus, the teres minor, and the subscapularis. These muscles attach to the shoulder blade, then come together to form a ‘cuff’ of tendons that attaches to the upper part of the humerus, or arm bone.
Of course, we’ve all heard of a rotator cuff tear. The muscle that is usually injured is the supraspinatus, but other muscles may be involved. Rotator cuff tears may be partial (some of the muscle fibers are torn) or full thickness tears (the muscle is torn completely through). The size of the tear can range from small (<1cm) to massive (>5 cm).
There are a couple of different ways to tear the rotator cuff. One is some kind of a trauma, such as a fall. This is usually the type of tear that occurs for someone that is younger than 35. Another way that the rotator cuff can be torn is through wear and tear, especially with using the arm overhead frequently. This usually occurs more with middle aged to elderly adults.
Another injury is rotator cuff tendinitis/tendinosis. This is usually due to repeated overuse. This may be due to something a person does frequently, or it may occur after a person is doing a new task doing more activity than they have done in a long time. For example, this can happen after someone had to rake the yard in the spring, after a winter of limited use of the shoulders. Another common way for this to occur is when someone begins a new exercise program, especially if they have not been doing many exercises previously.
Treatment of the Rotator Cuff
Treatment modality depends on the severity of the injury. Initially, treatment includes promoting tissue healing and avoiding further injury. Your physical therapist can teach you positions to use for sitting, standing, and sleeping to reach these goals. Other parts of the initial treatment include gentle exercises for range of motion, and teaching of appropriate ways to use heat and ice.
As the shoulder begins to heal, further strengthening can be done. This is gradually progressed as the muscles get stronger. If the muscle is not injured too severely, it may heal over time. However, a muscle that is completely torn will require surgery in order to regain full use of the shoulder.