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Rotator cuff injury

Published by Bupa's health information team, February 2008.

This factsheet is for people who have a rotator cuff injury, or who would like information about it.

Rotator cuff injury is a general term used to describe a number of different ways the muscles and tendons that make up the rotator cuff in your shoulder can become damaged.

About rotator cuff injuries
Symptoms
Causes
Diagnosis
Treatment
Prevention
Further information
Questions and answers
Video
Sources

About rotator cuff injuries

Shoulder pain affects around one in five people in the UK and rotator cuff injury is the most common cause.

Your shoulder joint is a ball and socket joint, formed by the ball-shaped end of the upper arm (the humerus) and a shallow socket on the edge of the shoulder blade (scapula). The joint is shaped rather like a golf ball on a tee. The rotator cuff is made up of a group of four muscles (called the subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons. It plays a crucial role in keeping your shoulder joint stable. The tendons wrap around the shoulder, forming a cuff around the ball of the humerus.

On top of the shoulder joint is a bone called the acromion. In the gap between the shoulder joint and the acromion is a space that some of the rotator cuff tendons run through. In this space is a fluid-filled pad called the subacromial bursa, which cushions the tendons.

Rotator cuff injury is a general term to describe inflammation (soreness and swelling) or damage to one or more of the muscles or tendons that make up the rotator cuff. There are a number of conditions that can affect your rotator cuff. The most common ones are inflammation of the rotator cuff tendons, which is called tendonitis, or tearing the muscles or tendons.

Types of rotator cuff injury

Rotator cuff tendonitis

The tendons of your rotator cuff can become inflamed. This is known as tendonitis or non-calcific tendonitis. The tendons can become pinched against one of the other structures that make up your shoulder joint. This can be both the cause and the result of tendonitis. It most often affects the tendons which run underneath the acromion. When a tendon becomes trapped or squeezed, it's known as impingement syndrome. The subacromial bursa can also become swollen and inflamed, and this is called bursitis.

Rotator cuff tear

This is when the muscles or tendons that make up your rotator cuff become completely or partially torn. It may be a result of a trauma, such as a fall, or due to tiny tears to the tendon through use and wear over time.

Symptoms

Symptoms of a rotator cuff injury may include:

pain and tenderness over your shoulder (and for some people this extends down the arm too), particularly when you raise your arm out to the side, reach behind you or lift or pull a heavy weight
pain at night, particularly when you sleep on the affected side
a feeling of weakness in your shoulder
a limited range of movement in your shoulder

Depending on the type of injury you have, the pain may come on gradually (common in tendonitis) or you may have a sudden twinge of pain (common if it's a tear).

If you have any of these symptoms, you may wish to see your GP or a chartered physiotherapist, who will assess your injury and give you guidance on treatment.

Causes

Rotator cuff injuries may occur due to one or more of the following.

Wear with age. Over the age of 40 you are at an increased risk of rotator cuff injuries because your tendons start to wear down with age and can become more prone to injury. Calcium deposits can rub against the tendons, causing further inflammation known as calcific tendonitis.
Repetitive overhead motions with your arms. You are more likely to have a rotator cuff injury if you do certain sports, activities or occupations. Examples include swimming, weight lifting or playing racquet sports, or occupations such as painting, decorating or window cleaning.
Lifting or pulling an object that is too heavy for you or lifting it in the wrong way can cause you to strain or tear a rotator cuff tendon or muscle.
Landing on an outstretched hand to break a fall can tear or strain a rotator cuff muscle or tendon. Rotator cuff injuries often occur if you dislocate your shoulder.
Muscle imbalance. When some of the muscles in your rotator cuff are stronger than others, your shoulder may be more prone to injury. This can be the result of errors in the way you train for a sport or activity.
Musculoskeletal disease, such as rheumatoid arthritis, can cause the rotator cuff muscles to become weaker.

Diagnosis

You may wish to visit your GP or a chartered physiotherapist if you have pain in your shoulder. He or she will ask about your symptoms and examine you and will ask you about any injury or activity which may be causing your condition.

You may need to have a scan. There are a number of ways that your doctor can see your shoulder in more detail.

MRI (magnetic resonance imaging) scan - uses magnets and radio waves to produce images of the structures which make up your shoulder.
Ultrasound scan - uses sound waves to produce an image of your rotator cuff muscles and tendons.
X-ray - a standard X-ray doesn't show your rotator cuff but can be used to see if you have calcium deposits in your tendons or to check if there are any underlying problems with your bones.

Treatment

Treatment for your rotator cuff injury depends on the type of injury and how severe it is. Your GP or physiotherapist will give you advice on how to treat your rotator cuff injury. The following self-help measures may help.

Self-help

Rest your shoulder initially, avoiding any movements which cause your shoulder to be painful. Start to do gentle movements as soon as possible to prevent stiffness in your shoulder.
Ice packs, or a bag of frozen peas, wrapped in a towel and applied to your shoulder for a maximum of 10 minutes at any one time can help to reduce inflammation. You shouldn't apply ice directly to your skin as this can damage your skin - place a cloth between the ice and skin. Don't put ice on your left shoulder if you suffer any known heart problems.
Stretches and strengthening exercises can help build up strength and flexibility in your shoulder. It's important to get advice from a medical professional, such as a physiotherapist, on which exercises and stretches you should do and how to do them correctly. The exercises will be tailored to your specific injury.
Take over-the-counter anti-inflammatory medicine, such as ibuprofen, to reduce pain and inflammation. Always read the patient information leaflet that comes with the medicine.

Non-surgical treatments

A chartered physiotherapist can assess the movement patterns of your shoulder and can measure weakness or tightness in certain muscle groups. Your physiotherapist will discuss with you which treatment technique he or she will use for your individual circumstances and may give you some exercises to do at home.

For some people, the doctor may recommend an injection of a steroid called corticosteroid, but this is usually only done when other treatments have been tried but haven't helped.

Surgical treatments

Rotator cuff injuries can usually be successfully treated through non-surgical treatments. However, some may need to be repaired by surgery, for example to repair a tear in your rotator cuff or to remove calcium deposits. The surgery may be done as open surgery or you may have an athroscopy in which a narrow, flexible, tube-like telescopic camera called an arthroscope is inserted through a small incision in your shoulder (commonly known as keyhole surgery).

Prevention

To prevent rotator cuff injuries, make sure you:

have the correct technique when playing sports or doing activities that use your shoulder, particularly overhead motions
do exercises and stretches to keep your rotator cuff muscles strong and supple

You should get advice from a trained professional such as a chartered physiotherapist to ensure that you are performing exercises or sports with the correct technique. It's also important that you do a range of exercises to strengthen all of your rotator cuff muscles. Strengthening some of your shoulder muscles and not others can make your rotator cuff more prone to injury.

Further information

The Chartered Society of Physiotherapy
020 7306 6666
www.csp.org.uk