How to Diagnose and Treat Rotator Cuff Injuries

Complex Shoulder Structure Is Vulnerable to Injury

A rotator cuff is a group of muscles and tendons that wrap around the front, back, and top of the shoulder joint. Its function is to hold the head of your upper arm bone securely in the shallow socket of the shoulder.

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Rotator cuff injuries occur either because of an acute injury or progressive damage caused by repetitive movements, such as reaching overhead and swinging the arms. Progressive injuries are most often associated with work (such as painting or lifting) or sports (like tennis or swimming) where the shoulder is routinely stressed.


Rotator cuff injuries range in severity from simple inflammation to the complete disruption of the shoulder joint. The most common symptoms include:

  • A dull ache deep in the shoulder
  • Arm weakness
  • Difficulty reaching up and behind you
  • Difficulty sleeping on the affected shoulder

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

Possible Causes

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

If the injury was the result of an accident, immediate medical attention would be sought. In cases where the structure of the shoulder has been gradually worn down, the focus may be placed more on exercise and pain relief. Among the two most common causes:

  • An impingement is a condition where the rotator cuff muscles swell and cramp the space between the arm and shoulder bones. Muscle strain and overuse are most common causes. Over time, an impingement can lead to the inflammation of the shoulder tendons (tendinitis) and bursa (bursitis). If left untreated, it can cause tendons to thin and tear. The formation of bone spurs (osteophytes) is also common.
  • While less common, a rotator cuff tear occurs when a rotator cuff tendon or muscle is torn. Most tears so not require surgery unless the tissue is severely disrupted. A complete tear would make it impossible to move the affected arm. In less severe cases, there may be a vague pain in the shoulder area as well as "catching" sensation as you move your arm.

Treatment Options

The vast majority of rotator cuff injuries can be treated with non-surgical methods. The aim would be 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, less-invasive arthroscopic surgery, or 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.