Rotator Cuff Injury
The rotator cuff is the group of four muscles and tendons that surround the shoulder joint. These muscles include the supraspinatus, infraspinatus, subscapularis, and teres minor. They help elevate and rotate the arm and provide strength and stability to the shoulder.
Above the rotator cuff is a bursa, a small sac of tissue that cushions and protects surfaces around the shoulder. When the rotator cuff is injured or damaged, the bursa can become inflamed, causing bursitis, pain, and loss of motion.
Causes
Rotator cuff injuries can result from trauma such as falls, sports injuries, or motor vehicle accidents. However, many injuries occur from natural tendon aging and gradual breakdown. Tendinosis is a process where microscopic changes develop in the tendon without inflammation. Over time, the weakened tendon may tear during routine activity.
Signs and Symptoms
Damage to the rotator cuff is often called a tear. Symptoms can vary depending on the size and location of the tear.
- Pain
- Weakness
- Limited motion
- Catching or locking
- Feeling that the shoulder is not stable
Symptoms may be worse when reaching backward, picking up an object from the back seat, lifting plates from a cupboard, pitching, throwing, playing tennis or racquetball, or weight lifting. Some rotator cuff tears cause no pain.
Diagnosis
Diagnosis begins with a history and physical exam. Not all shoulder pain comes from the shoulder; pain may also come from the neck or even the heart. X-rays may be used to look for bone spurs, arthritis, or other bony problems. If a rotator cuff tear is suspected, an MRI can show the location and size of a tear or inflammation.
MRI can help determine how many tendons are affected, whether there is tendinosis, whether a tear is partial or complete, how far a displaced tendon has moved, and whether the muscle has fatty tissue changes. Some surgeons may also recommend arthroscopy, a procedure that uses a small camera to view the shoulder joint.
Treatment
Treatment depends on the location and size of the tear and how long ago it occurred. Treatment often begins without surgery and may include activity changes, physical therapy, anti-inflammatory medication, and steroid injections.
Surgery may be considered when non-surgical treatment fails or when the tear is new and repair is more likely to succeed.
Arthroscopy may be used to remove scar tissue or loose bodies, debride the tendon, remove inflamed joint lining, release tight tissue, or repair rotator cuff tears. If a tendon has been detached from bone for too long, it may become harder or impossible to repair. Tendon transfer or joint replacement may be options in selected cases.
Rehabilitation
Therapy is a critical part of recovery after rotator cuff surgery. Depending on the procedure, therapy may last from three to 12 months and may require special slings or supports early after surgery. A coordinated effort between the patient, surgeon, and therapist is important for the best result.
This mobile-friendly version is adapted from patient education content originally provided by the American Society for Surgery of the Hand.