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Rotator cuff issues

What is the rotator cuff?

The rotator cuff is a group of tendons that surround the shoulder joint. This group of tendons connects individually to muscles that start at the scapula, also called the shoulder blade. When these muscles contract, they pull the rotator cuff tendons and cause the shoulder to either rotate inward or outward and allow the arm to rise. 

What is shoulder impingement syndrome?

In a healthy shoulder, the uppermost tendon of the rotator cuff smoothly glides underneath the bone on the top of the shoulder. Repetitive movement of the arm above shoulder level squeezes the lubricating tissue and tendons. 

Impingement syndrome happens when the tendons and the tissue become inflamed and swollen. The space between the bony prominence at the top of the shoulder and the head of the upper arm bone can also be reduced by a down-growth of bone, which causes irritation. 

  • Symptoms

    Torn rotator cuff tendon

    A torn rotator cuff tendon is damage to one or more of the four tendons that cover the shoulder joint. These tendons connect the rotator cuff muscles to the upper arm bone (humerus), shoulder bone (scapula), and collarbone (clavicle).

    It takes great force to tear a healthy rotator cuff tendon. This may occur from a direct blow to or by stretching the tendon too much. Tears almost always occur in rotator cuffs that have been inflamed, scarred, or frayed. These types of tears can form slowly over time with no known injury. In less-active older adults, simple movements such as lifting an object can cause a tear.

    Symptoms of a torn tendon include a popping sound heard at the time of the tear. They also include weakness, stiffness, and difficulty raising or turning your arm. You may also have pain, especially when your arm pushes against something. Pain at night is common.

    Treatment for a torn rotator cuff is focused on relieving pain and inflammation, and on getting back shoulder motion, strength, flexibility, and function. It's also focused on preventing more injury and loss of strength and movement in the shoulder.

    Treatment for a torn tendon will vary depending on where the tear is and how severe it is. It also depends on the person's age and overall health. Nonsurgical treatment may include rest, ice, anti-inflammatory medicines, and physical therapy. A complete tear usually requires surgery.

  • Prevention

    How can you care for a rotator cuff injury?

    • Rest your shoulder as much as you can. If your doctor put your arm in a sling or shoulder immobilizer, wear it as directed. Do not take it off before your doctor tells you to. If it is too tight, loosen it.
    • Be safe with medicines. Read and follow all instructions on the label.
      • If the doctor gave you a prescription medicine for pain, take it as prescribed.
      • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
    • Put ice or a cold pack on your shoulder for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake). Put a thin cloth between the ice pack and your skin.
    • After 3 days, put a warm, wet towel on your shoulder. This is to relax the muscles and help blood flow.
    • While holding a warm, wet towel on your shoulder, lean forward so your arm hangs freely, and gently swing your arm back and forth like a pendulum. You also can do this standing under a warm shower.
    • Do not do anything that makes your pain worse.
    • Follow your doctor’s advice about whether you need physical therapy.
  • Risk factors

    What increases your risk for rotator cuff disorders?

    Things that may increase the risk of rotator cuff disorders include:

    • Aging.
    • Having long-standing rotator cuff tendinitis.
    • Holding or moving your arm overhead often. This may include painting, working as a waiter, or playing tennis, baseball, and other throwing sports.
    • Previous shoulder injuries. These may include dislocations and broken bones.
    • Having a rotator cuff tear in the other shoulder.
    • Irregularities of the muscles, tendons, and bones in the shoulder that increase wear on the rotator cuff tendons.
    • Having received multiple corticosteroid injections in the shoulder. This may weaken tendons and increase your risk.
    • Smoking. This decreases the blood supply and slows healing.
    • Shoulder instability.
  • Care

    How can you care for a rotator cuff injury?

    • Rest your shoulder as much as you can. If your doctor put your arm in a sling or shoulder immobilizer, wear it as directed. Do not take it off before your doctor tells you to. If it is too tight, loosen it.
    • Be safe with medicines. Read and follow all instructions on the label.
      • If the doctor gave you a prescription medicine for pain, take it as prescribed.
      • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
    • Put ice or a cold pack on your shoulder for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake). Put a thin cloth between the ice pack and your skin.
    • After 3 days, put a warm, wet towel on your shoulder. This is to relax the muscles and help blood flow.
    • While holding a warm, wet towel on your shoulder, lean forward so your arm hangs freely, and gently swing your arm back and forth like a pendulum. You also can do this standing under a warm shower.
    • Do not do anything that makes your pain worse.
    • Follow your doctor’s advice about whether you need physical therapy.
  • Treatment

    What is the initial treatment for rotator cuff impingement?

    For minor impingement or rotator cuff tendonitis, you can apply ice to the top and front of the shoulder for 20 minutes three to four times a day for some immediate relief. Oral medications, cortisone injections, physical therapy and rest may also help. We recommend that you refrain from the activities that cause pain until it has improved. 

    Rotator Cuff Surgery

    Using ice and heat on a rotator cuff injury

    People respond to heat and ice differently. Use whichever one makes you feel better. In some cases, heat feels good for a while but may make pain and stiffness worse after 1 to 2 hours. For a sudden injury, don't use heat for the first 48 hours.

    • At first, use ice to help relieve pain and reduce swelling.

      Try applying ice to your shoulder for the first 48 hours after discomfort begins:

      • To avoid harming your skin, place a thin towel between the ice pack and your body, or put a pillowcase over the ice pack.
      • Apply ice 2 or 3 times a day, up to 20 minutes at a time.
      • Apply an ice pack after exercising your shoulder, to help prevent swelling.
    • After 2 to 3 days, start moving your shoulder with the aid of moist heat.
      • Soak a towel in hot water, and wring it out. Fold the towel to about 8 in. (20 cm) square.
      • While holding the towel on your shoulder, relax your shoulder, lean forward so your arm hangs freely, and gently swing your arm back and forth like a pendulum.
      • You also can do this exercise while standing under a warm shower. Heat relaxes your muscles and tendons by increasing blood flow to them. When combined with gentle motion, heat can ease inflammation.
      • Repeat these steps 2 or 3 times a day to reduce the risk of permanent stiffness in the joint.

    How successful is rotator cuff surgery?

    Although we are experts at rotator cuff surgery, the outcome relies largely on your willingness and participation in rehabilitation, as prescribed by your surgeon and physical therapist. Surgical outcomes are generally very good. Even with severe injuries, our surgical techniques are able to relieve pain and improve strength without decreasing mobility. 


    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.