An Overview of Rotator Cuff Injuries

The rotator cuff is the group of four tendons and muscles that surround the shoulder joint. When the rotator cuff is injured, it's usually the tendons that connect the rotator cuff muscles to the bone that are affected. When the tendons are inflamed or torn, they cannot function properly. 

The rotator cuff is important for shoulder strength, lifting, and maintaining normal stability and mechanics of the shoulder. Without a properly functioning rotator cuff, mobility and movement of the shoulder can be impaired.

Man with a hurt shoulder
Jan-Otto / istock 

There are other causes of shoulder pain besides a rotator cuff injury, such as a frozen shoulder or labral tear. An accurate diagnosis will help direct your treatment to the actual problem.

Rotator cuff tears are uncommon among people in their 20s, 30s, and 40s. As we get older, they become extremely common due to wear and tear. In fact, by the time someone is in their 70s or 80s, rotator cuff tears are actually expected.

Almost all rotator cuff tears will improve with nonsurgical treatment. While surgery can play an important and necessary role in the treatment of some types of these injuries, this is typically not the first treatment of a rotator cuff injury. The vast majority of people with a rotator cuff tear can resume normal, active lifestyles and never need surgical intervention.

Signs of Injury

Most people with a torn rotator cuff don't even realize they have a problem, as most have no injury at the time of onset, and the tear results in minimal limitations in function. Pain, which is typically over the top of the shoulder and arm, is the most common symptom of a rotator cuff problem. Sometimes the pain can descend down the outside of the arm to the elbow. 

Other common symptoms of a rotator cuff tear include:

  • Weakness of the shoulder: This can cause difficulty lifting the arm up overhead or difficulty with activities such as reaching, getting dressed, or carrying objects. 
  • Stiffness in the shoulder: Sometimes, if there is significant inflammation associated with a rotator cuff injury, you can have a limitation of shoulder motion.
  • Numbness in the arm: Inflammation can cause nerve irritation, with numbness and tingling going down the arm. 
  • Inflammation of the shoulder: In acute injuries, inflammation or swelling around the shoulder joint can sometimes occur.

Treatment Options

Most rotator cuff tears can be treated without surgery. In fact, few people with a rotator cuff injury end up having surgery for a rotator cuff tear. 

Non-surgical rotator cuff treatments may include:

  • Physical therapy: Physical therapy is the most important treatment for a rotator cuff injury. By optimizing muscle and tendon function, and training other muscles to compensate for damage, many people find relief.
  • Anti-inflammatory medications: Inflammation is commonly associated with discomfort in rotator cuff injuries. A variety of modalities can be used to reduce inflammation, including oral medications. Oral anti-inflammatory medications do have possible side effects, so you should check with your doctor before beginning any new medication regimen for the treatment of your rotator cuff problem.
  • Ice: Ice application is commonly used to help control pain and inflammation. While the results are transient and certainly do not lead to long-standing improvement, it can be a helpful way to control the discomfort associated with a rotator cuff injury.
  • Cortisone injections: Cortisone injections do not heal damaged rotator cuffs, but they do help control inflammation. One of the benefits of a cortisone injection over oral anti-inflammatory medications is that the medication is delivered exactly to the location of the inflammation, with fewer systemic side effects. That said, too much cortisone can be harmful to the tissues, but the benefits of a one-time cortisone injection generally outweigh the risks.

The goal of these treatments is to reduce inflammation and strengthen the muscles that surround your shoulder. Physical therapy is often helpful for improving the mobility and mechanics of the shoulder joint, without placing excessive stress on the damaged muscles and tendons. Even people who participate in athletic activities can find dramatic relief with the guidance of a physical therapist.

Surgery

In some situations, surgery may be recommended to repair the torn tendons. Determining when surgery may be appropriate involves consideration of factors like the type of rotator cuff tear, your activity level, and the treatments that have already been used.

While surgery is often the best treatment to attempt to restore normal function of the shoulder if other methods have failed, there are some reasons people opt not to have surgery. First, most people do not need to have full shoulder function to do all the activities they want to do. Many people can continue to participate in sports, housework, and their jobs with rotator cuff tears. Second, rehab after surgery can be long and difficult. Many patients have symptoms for six months to a year following surgery.

There are several surgical options for the treatment of a rotator cuff tear. The exact type of surgery that's best for you may depend on the size and location of your tear and the activities you want to be able to return to after surgery. Your surgeon will discuss the type of surgery that's recommended for your specific condition.

Rehab After Surgery

Healing after surgery for a rotator cuff tear requires avoiding activities that could injure your healing tendons and also depends on your ability to participate in rehabilitation. Rehab after rotator cuff surgery varies, but follows some general principles.

Rehab following rotator cuff surgery can be long and difficult. Many patients take a year to get back to normal. If you have minimally invasive surgery, that could speed your recovery and make rehab less painful. But be prepared for a recovery that may be longer than you would want, even after a minimally invasive procedure. The good news is, the vast number of patients are back to their day-to-day activities within several months of surgery, and most are eventually able to return to their normal activities.

A Word From Verywell

A rotator cuff problem, like any injury, is never something anyone welcomes. On a positive note, most people with this type of injury can resume their usual activities after treatment, often without surgery.

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