The rotator cuff provides the rounded appearance of the shoulder and allows free movement at the shoulder joint. Two bones come together at the shoulder joint: the upper arm bone (called the humerus) and the shoulder blade (called the scapula). The subscapularis, supraspinatus, infraspinatus, and teres minor are the four major muscles that connect the two bones and coordinate various movements in the joint. At the points where they insert into the bones, the muscles are flattened to form tendons which connect the muscles to the bones. Together, the bones and muscles form the rotator cuff of the shoulder joint. At the points of friction between the rotator cuff and the joint, there are cushions of small fluid-filled sacs called bursae.

Pain in the shoulder can be the result of a problem in the muscles, bones, bursae, or the joint itself. Any trauma to or inflammation of these structures in the rotator cuff can cause shoulder pain. Inflammation in the tendons is called tendinitis, and it is referred to as bursitis if the bursae are inflamed. The tendons may also become strained or even torn due to injury, causing pain and severely limited joint movements in the shoulder.

Any person can suffer an injury to the rotator cuff. It is common in athletes like baseball pitchers, swimmers, tennis players, or competitors in other racket sports. All of these sports subject the rotator cuff to repeated stress during overhead arm movements. These injuries also frequently occur due to occupational stress in jobs which involve a great deal of lifting or pulling, which over time can injure the rotator cuff.

Falling on the arm or using the arm as a support to prevent a fall can also strain or rupture the tendons or muscles in the shoulder. Poor posture involving slouching of the neck and shoulders can restrict the space where the rotator cuff muscles sit, which increases the risk of these muscles getting pinched underneath the shoulder. The rotator cuff is also affected by the usual degeneration that comes with the aging process. The fibers of the tendons and muscles become weaker over time, making them more prone to injury. Another consequence of aging is the formation of calcium deposits in the rotator cuff, which can cause irritation in the shoulder.

Shoulder pain is the most common symptom of a damaged rotator cuff. This pain tends to occur while lifting the arm overhead, trying to reach behind the back, throwing something forcefully, or pulling an object. Normal activities like combing the hair, putting on a jacket, and reaching for containers on a shelf may become painful; and the discomfort is also aggravated by sleeping on the affected side. Typically, the pain is most noticeable in the range of 60 to 120 degrees of motion in the arm (often called the painful arc of motion). In addition to pain, the shoulder feels weak and may be limited in its ability to move.

It is important to see a doctor if the shoulder pain is severe or lasts more than a week. A medical visit is also necessary if the shoulder becomes weak or immobilized.

Minor injuries of the rotator cuff will often need no treatment to heal. Over-the-counter medicines like aspirin, ibuprofen, naproxen, or acetaminophen may be taken for pain relief.

In addition to medications, the injured shoulder may be supported in a sling and rest and ice pack applications may be recommended in order to facilitate healing. With severe rotator cuff injuries, steroid medications may need to be injected directly into the joint to relieve pain and reduce inflammation.

Exercises

Exercise therapy is generally the first approach in treating rotator cuff injuries. This type of therapy helps to regain strength and increase flexibility in the muscles. Exercises may be assigned by a physician for home completion, or the patient can be assisted by a physiotherapist. The exercise regimen may last a few weeks or several months depending upon the severity of the injury.

The best way to ensure proper healing without compromising mobility is to avoid both over activity and inactivity, as complete and prolonged rest can cause shoulder stiffness. All exercises should be performed in a pain-free range of motion. Weights for strength training and stretches may be incorporated into an exercise regimen if recommended by a physiotherapist. These exercises should be continued even after a full range of motion has been regained.

Surgery

Surgery may be required if exercise and medical therapy fail to relieve the shoulder pain and restore motion in the arm. Sometimes, surgery becomes the initial treatment option in cases of a tear that is large, is caused by a sudden or severe injury, or produces profound weakness in the arm.

In the most common surgical procedure, the torn tendon is manually repaired. The physician may use one of three different surgical approaches: the open repair (where a large incision is made), the mini-open repair (where a small incision is made), or the arthroscopic repair (where tiny incisions are made and a camera that is inserted into the joint is used to guide the surgical instruments). The choice and outcome of a chosen technique are largely governed by the expertise of the surgeon.

Chronic non-healing tears or extremely severe injuries that may damage surrounding bones may necessitate a partial or total shoulder joint replacement called an arthroplasty.

Regular shoulder exercises can help to prevent any recurrence of shoulder pain. An exercise regimen advised by a physiotherapist or health care provider should be followed closely and faithfully. These exercises help to strengthen various muscles around the shoulder and chest.

If the risk of rotator cuff injury is caused by a specific occupation, activity, or hobby, then the person should take frequent breaks when the shoulder is being used repetitively in positions which could adversely affect the rotator cuff. If the individual does start to feel pain, it can often be relieved by a heating pad or an ice pack.

Outlook

Rotator cuff injuries can be painful and significantly restrict a person’s activity. But sticking to an exercise regimen can keep the muscles and tendons around the rotator cuff flexible and strong. This will drastically diminish the chances of suffering from shoulder pain.