What are rotator cuff disorders?
The rotator cuff is a group of tough, flexible fibers (tendons) and muscles in the
shoulder. Rotator cuff disorders occur when tissues in
the shoulder get irritated or damaged. Rotator cuff disorders include:
- Inflammation of
the tendons (tendinitis) or of a bursa (bursitis). In
the shoulder, a bursa is a small, fluid-filled sac that serves as a cushion
between the tendons and the bones.
- Impingement, in which a tendon
is squeezed and rubs against bone.
- Calcium buildup in the tendons,
which causes a painful condition called calcific tendinitis.
Partial or complete tears of the rotator cuff tendons.
How does the shoulder work, and what does the rotator cuff do?
The shoulder is a joint with three
main bones: the upper arm bone (humerus), the collarbone (clavicle), and the
shoulder blade (scapula). The bones are held together by muscles, tendons, and
ligaments. The rotator cuff keeps the upper arm bone
in the shoulder socket and lets you raise and twist your arm.
shoulder is a ball-and-socket
joint. The ball at the top of the upper arm bone fits
into the socket of the shoulder blade. This socket is shallow, which lets you
move your arm in a wide range of motion. But it also means that the muscles and
tendons of the rotator cuff have to work hard to hold the bones in place. As a
result, they are easy to injure and are prone to wear and tear.
What causes rotator cuff disorders?
Most rotator cuff disorders are caused by a combination of:
- Normal wear and tear. Using your shoulder for
many years slowly damages the rotator cuff. As you age, everyday activities can
lead to changes in the rotator cuff, such as thinning and fraying of the
tendons and reduced blood supply.
- Overuse. Activities in which you
use your arms above your head a lot—such as tennis, swimming, or house
painting—can lead to rotator cuff problems. Even normal motions made often over
a long period can stress or injure the rotator cuff.
Both normal wear and tear and overuse can lead to
impingement, when a tendon rubs against bone. This damages and irritates the
tendon, which causes bleeding and inflammation. Over time, damage to the tendon may build up, so the tendon is more easily
It takes great force to tear a healthy rotator cuff
tendon. This can happen during sports, an accident, or a severe fall. But even
a simple movement like lifting a suitcase can cause a rotator cuff tear in an
older adult or someone whose shoulder is already damaged.
What are the symptoms?
Symptoms of a rotator cuff
disorder include pain and weakness in the shoulder. Most often, the pain is on
the side and front of the upper arm and shoulder. It may hurt or be impossible
to do everyday things, such as comb your hair, tuck in your shirt, or reach for
something. You may have pain during the night and trouble sleeping.
How are rotator cuff disorders diagnosed?
To diagnose a rotator cuff disorder, doctors ask about any shoulder
injuries or past shoulder pain. They also do a physical exam to see how well
the shoulder works and to find painful areas or activities. Moving your arm in
certain ways can help a doctor learn about the condition of the rotator cuff.
You may have an
X-ray to check the bones of the shoulder. If the
diagnosis is still unclear, the doctor may order an imaging test, such as an
MRI or an
How are they treated?
It is important to treat a rotator cuff problem.
Without treatment, your shoulder may get weaker and you may not be able to lift
up your arm.
For most rotator cuff disorders, doctors recommend
these steps first:
- Rest the shoulder. Use the arm, but do so
carefully. Don't keep the shoulder still with a sling or brace. This can lead
to stiffness or even a frozen shoulder (adhesive capsulitis).
- Use ice or heat on
the shoulder, whichever feels better.
- Take anti-inflammatory drugs (NSAIDs) to relieve pain and
reduce swelling and inflammation. Examples include ibuprofen (such as
Advil) and naproxen (such as Aleve). Or try acetaminophen (such as Tylenol). It can help with pain but will not reduce swelling or inflammation.
- Avoid positions and
activities that are uncomfortable, such as lifting or reaching overhead. Stop
any activity that hurts the shoulder.
The doctor may also suggest
physical therapy. Physical therapy can reduce pain and
help make your shoulder stronger and more flexible. In physical therapy, you
learn exercises to stretch and strengthen your shoulder. After you learn the
exercises, you can do them at home.
It is important to give
treatment time to work. It may take from a couple of weeks to several months to
get good results.
If other treatments don't help, your doctor may
give you shots of steroid medicine in the shoulder. The shots probably don't
cure rotator cuff disorders. But they can help relieve pain and inflammation so
you are able to do exercises to strengthen the shoulder. The shots may also
help your doctor find out if your shoulder pain is from your rotator cuff. If a
steroid shot near the rotator cuff relieves your pain, even if the pain comes
back later, it means the rotator cuff—not some other shoulder problem—is
causing the pain.
Most rotator cuff disorders aren't treated with
surgery. But doctors may do surgery if a rotator cuff tendon is torn or if
several months of other treatments have not helped.
- Surgery may be a good choice if you are young
and your rotator cuff has been in good shape. Surgery may not work as well if
your tendons are weak and frayed.
- Surgery is not a substitute for
physical therapy. Even after surgery, you may need months of physical therapy
to have a full recovery.
Frequently Asked Questions