Rotator Cuff Injuries
Rotator cuff tears can be career-ending for professional athletes and are one of the most common causes of shoulder pain for everyday folks. So, what is a rotator cuff and how can it tear?
Shoulder Anatomy: The Rotator Cuff
The rotator cuff refers to a group of four tendons and muscles that form a "cuff" to stabilize the shoulder joint and keep the arm in the shoulder socket, while allowing it to move in different directions.
The shoulder joint is stable because of the rotator cuff, but it is also relatively weak. Acute injuries or repetitive stress and strain on the joint can cause swelling and tears in the tendons.
What Are the Causes?
Most of the time, rotator cuff injuries are caused by repetitive stress on the rotator cuff or degeneration caused by aging. Such repetitive stress can include injuries sustained from sports, particularly those that require a lot of shoulder movement such as baseball, tennis, swimming, weightlifting, and football.
As we age, reduced blood supply to the rotator cuff tendons means damage does not repair itself as well, and bone spurs (bony overgrowths) can also weaken the tendon and lead to tears.
Acute injuries caused by falling, using an arm to break a fall, or lifting heavy items with a jerking motion can also lead to rotator cuff tears.
Acute Rotator Cuff Tear
An acute rotator cuff tear occurs when there is excessive force exerted on the rotator cuff tendons. The amount of force needed to tear a rotator cuff tendon varies from person to person and the condition of their rotator cuff tendons prior to trauma. In a person with healthy tendons, it could require the stress of a fall, landing on an outstretched arm to tear a tendon. But if a tendon has pre-existing degeneration, the force require for it to tear may be modest, such as lifting a moderately heavy object.
Chronic rotator cuff tears are commonly seen in people whose occupations or sports require them to reach their arms overhead frequently, such as baseball pitchers, tennis players, or even painters. Use of the arm in such a position causes repetitive trauma to the rotator cuff muscles and tendons.
As we age, the blood supply to the tendons is reduced, which can lead to longer healing times after injury. In addition, muscles degenerate. All this can lead to tendinitis (tendon inflammation), which can make a person more prone to a rotator cuff tear and rotator cuff injuries.
What Are the Symptoms?
Symptoms of rotator cuff injuries are due to inflammation and swelling in the rotator cuff and include:
- Pain in the shoulder and arm. Pain is felt often at night when lying on the affected shoulder.
- Pain may also be felt when moving the arm in certain ways. The pain stops before the elbow.
- If the injury is acute (sudden) pain will be intense and immediate.
- If the injury is degenerative (damage occurs over time) the pain may be mild at first.
- Weakness or loss of motion in the arm or shoulder.
- A grating or snapping sensation or cracking sound when moving the shoulder.
When to See the Doctor
Any time you have an acute shoulder injury, or chronic shoulder or arm pain, you should see a doctor for a diagnosis and treatment. If your shoulder pain persists despite rest, ice, and anti-inflammatory medications, if you can no longer perform your daily activities, if you cannot reach overhead, or you can no longer participate in a sport you used to, see a doctor. Early diagnosis of a rotator cuff tear can make a big difference in recovery and prevent loss of strength and motion.
Should You Go to the ER?
If your injury is acute (sudden) such as from a severe fall or accident, go to a hospital's emergency department. If you suspect a bone is broken, if you have an open wound or a bone protruding from the wound, if you experience any numbness in the arm or hand, or if you cannot move your shoulder, go to an emergency department.
Exams & Diagnosis
A rotator cuff injury is diagnosed first with a physical exam in which a doctor will move your arm in different directions to assess your pain levels and range of motion. Other tests to diagnose a torn rotator cuff include:
- MRI (magnetic resonance imaging)
- Arthrogram - a special type of X-ray that uses dye injected into a joint to more clearly see detail in the tendons and muscles
The first line of treatment for rotator cuff injuries that are mild to moderate includes rest, ice, and anti-inflammatory medications such as NSAIDs including ibuprofen (Advil, Motrin). Avoid using the shoulder if it hurts.
Physical therapy for rotator cuff injuries is used to make the shoulder stronger and more flexible. In some cases, steroid injections such as cortisone may be used to relieve pain and inflammation.
Most of the time, surgery is not needed to repair a rotator cuff injury, except in severe cases where the tendon may be completely torn, the injury is acute, or the pain is chronic and has not been helped by other treatments. Following surgery, physical therapy is still needed.
Torn rotator cuff surgery may be recommended in severe cases. If pain does not improve with medical treatment and rest, or if you are an athlete or use your arms and shoulders a lot for work you may need surgery. Surgical options include an open repair, which involves a traditional surgical incision. This method is used for large or complex tears. Arthroscopic repair is less invasive and involves a smaller incision in which the surgeon inserts a small camera (an arthroscope) into the shoulder joint allowing the surgeon to see the shoulder anatomy and to guide surgical instruments.
Either type of surgery involves an extensive rehabilitation period. This consists of immobilization of the shoulder joint, such as with a sling, for four to six weeks. Once the sling is off, physical therapy begins with passive exercises in which a physical therapist will move the arm and shoulder for you. Beginning 8 to 12 weeks post-op you may start doing active physical therapy exercises to strengthen the arm.
Can Rotator Cuff Injuries Be Prevented?
You may not be able to prevent all causes of rotator cuff injuries. Accidents happen, and muscles and tendons degenerate with age. But there are some things you can do to decrease the likelihood of a rotator cuff tear. Torn rotator cuff prevention includes:
- Proper warm-ups before sports or other tasks involving the shoulder joint can keep it flexible and may prevent injury.
- Exercise the shoulder to maintain strength.
- Avoid lifting heavy objects over your head.
- If you are using your arms and shoulders a lot, take frequent breaks.
Recovery & Prognosis
The prognosis for torn rotator cuff varies. In about half of patients with rotator cuff injuries, nonsurgical treatment is sufficient to relieve pain and restore shoulder function and movement. Conservative treatment generally consists of a minimum of six weeks of physical therapy and sometimes cortisone injections.
If surgery is required, the recovery time is longer. The shoulder will need to be immobilized for four to six weeks, followed by physical therapy. It is usually necessary to wait about three months before using the shoulder for light activities above shoulder height, and about six months to return to vigorous activities.
Rotator Cuff Tear: Exercises, Symptoms, Tests, and Surgery
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What are 2 special tests for the rotator cuff? ›
The special tests described in this review evaluate specific tendons of the rotator cuff. The Jobe's test and drop arm test evaluate the supraspintus whereas the lift-off test, passive lift-off, and external rotation lag signs assess the infraspinatus and teres minor.Which test is used to confirm a torn rotator cuff? ›
Your doctor uses imaging tests to help diagnose a rotator cuff injury. An X-ray helps to rule out bone spurs or osteoarthritis as a cause of your symptoms. An MRI scan enables your doctor to see the soft tissue in the shoulder and determine if you have a rotator cuff tear and whether it is partial or full thickness.How do I know if I need rotator cuff surgery? ›
At what point does a rotator cuff tear require surgery to fix it? Surgery is recommended: If you have persistent pain or weakness in your shoulder that does not improve with nonsurgical treatment. Frequently, patients who require surgery will report pain at night and difficulty using the arm for lifting and reaching.What is the best exercise for rotator cuff surgery? ›
Bend forward 90° at the waist, placing your uninvolved hand on a table for support. Rock your body in a circular pattern to move your arm clockwise 10 times, then counterclockwise 10 times. Keep your arm relaxed during the exercise. The circle your hand is making should be about 1 to 2 feet wide.How can I test for rotator cuff tear at home? ›
In this test you begin by placing the injured arm behind your back, with the back of your hand resting on you lower back. Now try to raise your arm off of your back.. If you feel pain or weakness when trying to lift your hand off of your back, that is a sign that there could possibly be rotator cuff injury involved.Does a torn rotator cuff hurt all the time? ›
Rotator cuff tendon tears often cause pain at night. The pain may even wake you. During the day, the pain is more tolerable, and usually only hurts with certain movements, such as overhead or reaching toward the back. Over time, the symptoms become much worse and are not relieved by medicines, rest, or exercise.What is the strongest predictor of a rotator cuff tear? ›
The researchers developed a multivariate model using 191 patients, finding that the best predictors of rotator cuff injury were age older than 65 years, night pain, and weakness with external rotation.What exercises aggravate rotator cuff? ›
- Deadlifts. “These heavy weights are basically pulling your arm out of your socket,” says Kinsey. ...
- Shrugs. Another example of weight pulling down on your shoulder.
- Squatting. Resting the bar across your shoulders and your arm positioning stresses the rotator cuff.
A partial or complete rotator cuff tear makes it difficult to raise and move your arm. You may have shoulder pain and arm weakness. Rotator cuff injuries are common, especially as you get older. Rest, pain relievers and physical therapy can help.What indicates rotator cuff surgery? ›
Reasons rotator cuff repair may be done include: You have shoulder pain when you rest or at night, and it has not improved with exercises over 3 to 4 months. You are active and use your shoulder for sports or work. You have weakness and are unable to do everyday activities.
When should you consider shoulder surgery? ›
Signs that you might need shoulder surgery
A frozen shoulder that hasn't improved despite six months or more of treatment. A rotator cuff disorder that hasn't improved despite three to six months of treatment (depending on the severity of your pain and rotator cuff problem) A complete tear of your rotator cuff.
Patients with single shoulder surgery have to sleep at an incline for 4 to 6 weeks after surgery. The best position for most people with shoulder surgery is the reclined position because it reduces tension in the shoulder joint and the surrounding soft tissue.What is the best position to sleep after rotator cuff surgery? ›
Sleep at an Angle
The best position for sleeping after shoulder surgery is on an incline, rather than flat on your back. For the first few days, you'll probably be most comfortable upright on a recliner.
The O'Brien test is a simple procedure that healthcare professionals use to assess shoulder pain. It can detect a cartilage (labral) tear or an acromioclavicular (AC) joint problem. It's also called the active compression test.What are red flags for shoulder pain? ›
Look for the following red flags that indicate the need for urgent investigations and/or referral to secondary care: acute presentation with a history of trauma (especially if pain restricts all passive and active movements); systemic symptoms such as fever, night sweats, weight loss, or new respiratory symptoms; ...What is jerk test for shoulder? ›
The arm is moved horizontally across the body. A positive result is indicated by a sudden clunk as the humeral head slides off the back of the glenoid. When the arm is returned to the original position, a second jerk may be observed, that of the humeral head returning to the glenoid.Where is rotator cuff pain felt? ›
Rotator cuff injuries often result in a dull ache that can be felt deep in the shoulder. It can occur due to specific movements, such as lifting or lowering the arm. Some people experience discomfort during rest as well. Sleeping is often disturbed by pain, especially when lying on the affected shoulder.Where do you feel pain if you have a torn rotator cuff? ›
Rotator cuff injuries don't always cause pain. But when they do, the pain is often in the top part of your arm or shoulder. You may feel more pain when you: Lie down, especially on the injured shoulder.Does rotator cuff injury cause neck pain? ›
The rotator cuff is a set of muscles that keeps the arm in its socket. If it becomes damaged or torn completely, moving the arm becomes extremely difficult and painful. The ache associated with a torn rotator cuff can extend from the shoulder down to the elbow and sometimes cause neck pain and headaches.How painful is rotator cuff surgery? ›
Patients who are recovering from rotator cuff surgery know all too well that surgery on the shoulder is often painful. Some patients have very little pain after shoulder surgery, but most have significant pain for a few days to a few weeks.
Does a torn rotator cuff cause pain down the arm? ›
Can a rotator cuff injury cause pain in your arm and hand, too? Yes. Typically, the pain starts as a dull aching pain in your shoulder. As the injury progresses, it can cause radiating pain down the arm and into your hands.How long does it take for a torn rotator cuff to stop hurting? ›
Return to activities — Most people with rotator cuff tendinitis see improvement in pain and function after 6 to 12 weeks of rehabilitation. If shoulder pain does not improve after several weeks of physical therapy exercises, most clinicians will recommend further evaluation.How big does a rotator cuff tear have to be for surgery? ›
If you are very active and use your arms for overhead work or sports, your doctor may also suggest surgery. Other signs that surgery may be a good option for you include: Your symptoms have lasted 6 to 12 months. You have a large tear (more than 3 cm) and the quality of the surrounding tendon tissue is good.What muscles are most likely affected by a rotator cuff tear? ›
Generally, the supraspinatus muscle is located superiorly, the infraspinatus and teres minor are located posteriorly, while the subscapularis muscle is anterior in position. In 95% of rotator cuff tears, the supraspinatus tendon is involved.Which muscle is most often affected in a rotator cuff tear? ›
The most commonly injured rotator cuff muscle is the supraspinatus. This is in part because this muscle's tendon passes through a very narrow space between the top of the upper arm bone and the underside of the shoulder's top (acromion). Learn more about shoulder anatomy.What should I avoid with rotator cuff? ›
Avoid sleeping on your side with your arm stretched overhead. Try not to lie on your shoulder while you sleep. Don't smoke as it decreases blood flow to the rotator cuff. Avoid activities with repetitive overhead arm action.How do you speed up rotator cuff healing? ›
- Wear a sling. To speed recovery, it is important to keep your shoulder immobilized initially after surgery so your tendon can heal. ...
- Sleep carefully. ...
- Ask for help. ...
- Watch for complications. ...
- Do the physical therapy. ...
- Keep comfortable. ...
- Be mindful of your movement. ...
- Pace yourself.
We'd say that the best option to avoid pain when sleeping with rotator cuff pain is to rest on your back. When you sleep on your back, your shoulders are placed under less pressure.Are you awake during rotator cuff surgery? ›
The surgeon will sew the torn rotator cuff tendon back to the bone. You will awake from anesthesia while still in the operating room, although due to the effects of the anesthesia medications, most patients are still groggy for at least another 20-30 minutes.Can you live with a fully torn rotator cuff? ›
You may not need surgery if: Your shoulder gets better with physiotherapy. You have a torn rotator cuff but you are not in pain. You can do your daily activities.
Can you have full range of motion with a torn rotator cuff? ›
Tendon Strain or Tear
A rotator cuff tear causes weakness, pain and inability to freely move your arm in a complete range of motion. It can also be painful during overhead activity for you to lift and turn your arm.
Most rotator cuff tears don't require surgery to heal. This is because most people with rotor cuff tears don't have any problem with their shoulders. Even if the torn rotator cuff causes shoulder pain, you can get relief without surgical treatment.Which 2 special tests are used to evaluate for instability in the shoulder? ›
The relocation test. With the patient in the supine position, the shoulder is abducted and externally rotated, using the edge of the table as a fulcrum. The test is positive for anterior instability if the patient demonstrates apprehension. The drawer test is similar to the supine load-and-shift test (Figure 4).What does O Brien's test for? ›
The O'Brien test is a simple procedure that healthcare professionals use to assess shoulder pain. It can detect a cartilage (labral) tear or an acromioclavicular (AC) joint problem. It's also called the active compression test.How many rotator cuff special tests are used in the shoulder exam sequence? ›
The aim was to assess diagnostic accuracy of 15 shoulder special tests for rotator cuff tears.What is a positive Hawkins test in the shoulder? ›
The examiner places the patient's arm shoulder in 90 degrees of shoulder flexion with the elbow flexed to 90 degrees and then internally rotates the arm. The test is considered to be positive if the patient experiences pain with internal rotation.What is the shoulder flex test? ›
The Apley scratch test is a shoulder flexibility test used to evaluate the flexibility and mobility of your shoulder joint. The test can also be used to assess the range of motion (ROM) of your shoulder, including flexion and extension.What is Jobe's test for shoulder? ›
Jobe's test is a physical exam test that is used to detect anterior shoulder instability. It is used to distinguish between anterior instability and primary shoulder impingement. This test should be performed after the Apprehension test.What is a lift off test? ›
Lift-off Sign. To test for a lesion of the subscapularis muscle and scapular instability. The patient stands and places the dorsum of the hand against mid-lumbar spine. The patient then lifts his hand away from the back. An inability to perform this action indicates a lesion of the subscapularis muscle.How do you test for a torn shoulder labrum? ›
Diagnosing a labrum tear involves a physical examination and most likely an MRI, CT scan and/or arthroscopy of the shoulder. Treatment varies depending on type, severity and location of the labrum tear.
What is the gold standard for rotator cuff tears? ›
Magnetic resonance imaging (MRI) is the gold standard for evaluating rotator cuff tears (RCTs), providing information that is often not diagnosed on clinical examination and other complementary shoulder exams such as ultrasonography; however, the reliability of the diagnosis and the classification of some lesions ...How long do I have to wear a sling after rotator cuff surgery? ›
Patients are often advised to wear a sling or brace for the first 4–6 weeks after rotator cuff repair surgery to prevent them from performing any physical activities involving the affected shoulder (3).What is a positive drop arm test? ›
It is a positive test if there is a sudden dropping of the arm or weakness in maintaining arm position during the eccentric part of abduction, there may also be pain present while lowering the arm, suggesting a full thickness tear to the supraspinatus.What is a positive supraspinatus test? ›
Empty Can/ Supraspinatus Test. A positive test indicates a tear to the supraspinatus tendon or muscle and can also indicate a neuropathy of the suprascapular nerve. The patient actively abducts the arm to 90 degrees with the thumbs up which makes the full can position.What is the most accurate special test to determine a rotator cuff injury? ›
A doctor might request one of several imaging tests to diagnosis your torn rotator's cuff such as an x-ray, ultrasound, or magnetic resonance imaging(MRI).