Rotator Cuff Injuries: What They Are, Symptoms, Types, Causes & Treatment

The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, providing stability and enabling a wide range of shoulder movements. These muscles work together to keep the head of the humerus firmly within the shallow socket of the shoulder, allowing for smooth and controlled arm movements. A rotator cuff tear is a common injury affecting the shoulder, involving a tear in one or more of the tendons that comprise the rotator cuff.

Rotator cuff injuries feel like a dull ache deep in the shoulder, and they may disturb sleep. Other symptoms may include:

• Weakness: Difficulty lifting the arm or performing overhead activities.

• Limited range of motion: Stiffness and reduced ability to move the shoulder.

• Cracking sensation: A popping or clicking sound when moving the shoulder.

• Difficulty with daily activities: Challenges performing routine tasks like combing hair or reaching behind the back.

Rotator cuff tears can be classified based on their cause and extent:

• Partial tear: Involves damage to some of the tendon fibers but not complete severance.

• Full-thickness (complete) tear: The tendon is completely severed or pulled off from the bone.

• Acute tear: Occurs suddenly, often due to injury or trauma.

• Chronic tear: Develops over time due to repetitive stress or degenerative changes.

Some of the causes of a rotator cuff injury may include:

• Acute injury: Sudden injuries from falls, lifting heavy objects or accidents.

• Degenerative wear and tear: Gradual degeneration due to aging, repetitive shoulder motions (common in athletes and certain occupations) and reduced blood supply to the tendons.

• Bone spurs: Overgrowths on the shoulder bones can rub against the rotator cuff tendons, leading to tears over time.

Treatment depends on the severity of the tear and the patient’s age, activity level and overall health.

Nonsurgical treatments

• Rest: Avoiding activities that exacerbate symptoms.

• Physical therapy: Exercises to improve strength and flexibility.

• Medications: Anti-inflammatory drugs (such as nonsteroidal anti-inflammatory drugs, or NSAIDs) to reduce pain and swelling.

• Steroid injections: Corticosteroid injections to alleviate severe pain.

• Cold and heat therapy: Applying ice packs or heat to manage pain and inflammation.

Surgical treatments

Surgery may be recommended if nonsurgical treatments fail or in cases of significant tears.

• Arthroscopic repair: Minimally invasive procedure using small incisions and a camera to repair the tear.

• Open repair: Traditional surgery involving a larger incision to access and repair the tendon.

• Mini-open repair: Combines arthroscopy and open surgery techniques.

• Tendon transfer: In cases where the tendon is too damaged, a nearby tendon may be used to replace it.

• Shoulder replacement: For massive, irreparable tears accompanied by arthritis.

Recovery for rotator cuff injuries can vary depending on the treatment. It can range from a few weeks for minor tears to several months for surgical repairs. Postsurgical rehabilitation can help to restore function and strength through a structured physical therapy program. 

Prevention strategies may include:

• Regular exercise: Strengthening shoulder muscles through targeted exercises.

• Proper technique: Ensuring correct form during sports and occupational activities.

• Avoid overuse: Incorporating rest periods to prevent repetitive strain.

• Ergonomic adjustments: Modifying workspaces to reduce shoulder stress.

• Warm-up and stretching: Preparing muscles and tendons before engaging in physical activities.