Rotator Cuff Injuries

WHAT IS A ROTATOR CUFF?

A rotator cuff is a group of muscles and tendons that hold the arm in the shoulder socket and allow the arm to rotate and reach overhead.1 These muscles move the uppermost portion of the arm and the tendons connect the muscles to bones. The rotator cuff consists of four muscles, the supraspinatus, subscapularis, infraspinatus, and teres minor. These muscles allow for the following actions: abduction (reaching overhead), internal rotation (placing a hand over the heart), and external rotation (opening a door).1

HOW CAN YOU INJURE THE ROTATOR CUFF?

The rotator cuff can be injured directly or from long-term wear and tear. Direct injury to the rotator cuff can occur from falling on the shoulder, car wrecks, or dislocations.2 Wear and tear occurs naturally as people age. Repetitive motions from weightlifting and overhead activities like painting and carpentry can increase the risk of rotator-cuff injury.2 Athletes are prone to injury from repetitively using the muscles as frequently seen with tennis players and baseball pitchers.2

COMMON SIGNS AND SYMPTOMS

• Decreased strength in overhead task
• Difficulty brushing hair or reaching for a glass
• Pain or deep ache in the shoulder joint
• Bruising
• Swelling
• Cracking and popping sensation when moving arm in certain positions

WHAT SHOULD I DO?

Make an appointment with your doctor. A rotator-cuff injury can range from a mild/partial tear to a more severe full tear.2 The doctor perform a physical exam and may order imaging. The imaging may include an MRI, which visualizes the soft tissue and tendons to diagnose the specific type of injury.1

COMPLICATIONS OF NOT SEEKING TREATMENT

Adhesive capsulitis (frozen shoulder): Patients with rotator-cuff injuries may stop moving their shoulder to alleviate pain.4 Without movement, the shoulder joint can stiffen and develop decreased range of motion.

Tendinitis: A rotator-cuff injury can trigger long-term inflammation that may lead to lasting pain and further breakdown of the tendons.1 This can cause weakness and tears that require surgery.

Arthropathy: If a mild rotator-cuff injury is left untreated, it can become more severe and lead to bone erosion, called cuff tear arthropathy.3 This causes permanent loss of range of motion in the shoulder.

TREATMENT OPTIONS2-4

Treatment options depend on the exact injury to the rotator cuff, but some options include:

• Activity modification and rest
• Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections to reduce inflammation and pain
• Physical therapy to increase strength and improve range of motion
• Surgery to clear and repair the damaged tissue

It is important to talk with your doctor when you are having pain in your shoulder/rotator-cuff area. With a treatment plan, patients can expect the recovery to take several months, but will likely get back to regular activities with reduced or no pain.

SOURCES

1. Yang S, Kim TU, Kim DH, Chang MC. Understanding the physical examination of the shoulder: a narrative review: Ann Palliat Med. 2021;10(2):2293–2303. doi: 10.21037/apm-20-1808

2. Weber S, Chahal J. Management of rotator cuff injuries. J Am Acad Orthop Surg. 2020;28(5):e192–e201. doi: 10.5435/JAAOS-D-19-00463

3. Sambandam SN, Khanna V, Gul A, Mounasamy V. Rotator cuff tears: an evidence based approach. World J Orthop. 2015;6(11):902–918. doi: 10.5312/wjo.v6.i11.902

4. Ewald A. Adhesive capsulitis: a review. Am Fam Physician. 2011;83(4):417–422.

5. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The human shoulder joint. 2013. Wikimedia Commons. Accessed July 7, 2023. https:// upload.wikimedia.org/wikipedia/commons/f/fc/Shoulder_joint.svg