How to Diagnose and Treat Rotator Cuff Injuries

Complex Shoulder Structure Is Vulnerable to Injury

Rotator cuff injuries, including rotator cuff tears, can occur due to acute injury or as the result of progressive damage caused by repetitive movements—such as reaching overhead or swinging the arms. Progressive injuries are most often associated with work (such as painting or lifting) or sports (like tennis or swimming).

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Your rotator cuff is the group of muscles and tendons that wrap around the front, back, and top of your shoulder joint. It holds the head of your upper arm bone securely in the shallow socket of the shoulder.


Rotator cuff injuries range in severity from simple inflammation to the complete disruption of the shoulder joint.

The most common symptoms include:

  • Pain that feels like a dull ache, deep in the shoulder
  • Arm weakness
  • Difficulty reaching up and behind you
  • Difficulty sleeping on the affected shoulder

The symptoms may flare up occasionally, usually after strenuous activity or excessive use. In some cases, the shoulder may be entirely frozen and unable to move.

Possible Causes

The symptoms of a rotator cuff injury are largely dependent on the cause.

Among the two most common causes:

  • Impingement: This occurs when the rotator cuff muscles swell and cramp the space between the arm and shoulder bones. Muscle strain and overuse are the most common causes. Over time, impingement can lead to tendonitis (inflammation of the shoulder tendons) and bursitis (inflammation of the bursa). If left untreated, the tendons may thin and tear. The formation of bone spurs (osteophytes) is also common.
  • Tear: While less common, a rotator cuff tear can occur when a rotator cuff tendon or muscle is torn. Most tears do not require surgery unless the tissue is severely disrupted. With a small or moderate injury, you can have vague pain in your shoulder area, as well as a "catching" sensation as you move your arm. A complete tear would make it impossible to move the affected arm.

Treatment Options

If you have a rotator cuff injury due to an accident, immediate medical attention is necessary. If the damage was gradual, the focus of treatment may be placed on exercise and pain relief.

The vast majority of rotator cuff injuries can be treated with non-surgical methods. The aim is to allow the shoulder to heal on its own. This would be followed by exercises to strengthen the supporting muscles and restore the full range of movement.

Treatment would typically involve:

If these treatments fail to provide relief, some doctors will recommend cortisone (steroid) injections as a form of short-term relief.

If surgery is indicated, options include traditional open surgery or less-invasive arthroscopic surgery. Your doctor may recommend a joint repair, partial shoulder joint replacement, or total shoulder joint replacement.

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Article Sources
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  1. NIH MedlinePlus. Rotator cuff injuries. Updated October 21, 2019

  2. Harvard Health Publishing. Rotator cuff injury. Updated December 2018.

  3. OrthoInfo from the American Academy of Orthopaedic Surgeons. Shoulder impingement/rotator cuff tendinitis. Updated February 2011.

  4. UW Medicine Orthopaedics and Sports Medicine. Repair of rotator cuff tears.

  5. SSM Health. Rotator cuff injuries.

  6. UW Medicine Orthopaedics and Sports Medicine. Arthroscopic shoulder surgery for the treatment of rotator cuff tears.

Additional Reading
  • Ludewig, P. and Braman, J. "Shoulder Impingement: Biomechanical Considerations in Rehabilitation." Man Ther. 2011; 16(1):33-39. DOI:10.1016/j.math.2010.08.004.

  • Itoi, E. "Rotator cuff tear: physical examination and conservative treatment." J Orthop Sci. 2013; 18(2):197-204. DOI: 10.1007/s00776-012-0345-2.