The rotator cuff is a common source of pain or injury in the shoulder. It plays a role in the normal function of the shoulder by contributing to the stability of the joint. It is formed of tendons which attach to the humerus, as well as four major muscles which drape over the shoulder joint.
Rotator Cuff Injury Causes and risk factors
A rotator cuff injury can occur due to various causes and risk factors, including:
- Direct blow, fall, or sports-related injury: Traumatic events such as a direct blow to the shoulder, a fall onto an outstretched arm, or sports-related injuries can damage the rotator cuff. These injuries may result from contact sports, accidents, or sudden impacts.
- Degenerative conditions, such as arthritis: Degenerative changes in the shoulder joint, commonly associated with arthritis, can contribute to a rotator cuff injury. Arthritis can lead to the wearing down of the cartilage and bones in the shoulder, making the rotator cuff more susceptible to damage.
- Repetitive stress: Certain sports and activities that involve repetitive shoulder movements can increase the risk of developing a rotator cuff injury. Athletes involved in overhead sports like baseball, tennis, swimming, or weightlifting, which require frequent and forceful use of the shoulder joint, may experience repetitive stress on the rotator cuff. Over time, this can lead to inflammation, tendon degeneration, and eventual injury.
- Bone spurs: Bone spurs, also known as osteophytes, are bony projections that can develop on the edges of bones. In the case of the shoulder joint, bone spurs can form on the acromion (a part of the shoulder blade) or other structures, potentially impinging on the rotator cuff tendons. The presence of bone spurs can increase the risk of rotator cuff tears by causing friction, irritation, and impingement on the tendons during shoulder movements.
Symptoms of Rotator Cuff Injury
A rotator cuff injury can present with various symptoms, including:
- Shoulder pain: One of the primary symptoms of a rotator cuff injury is shoulder pain. This pain can be constant or may occur when you are at rest, especially during nighttime when lying on the affected shoulder. The pain is often localized to the front or outer part of the shoulder and can radiate down the arm.
- Pain or weakness when lifting or lowering your arm: Another common symptom is experiencing pain or weakness when lifting or lowering your arm. Activities such as reaching overhead, carrying heavy objects, or performing certain movements may exacerbate the pain. You may also notice a decrease in strength and difficulty in performing tasks that require arm movements, especially those involving lifting or reaching.
- Limited range of motion: A rotator cuff injury can lead to a decrease in your shoulder’s range of motion. You may find it challenging to move your arm fully or lift it above a certain point. Activities like combing your hair, reaching behind your back, or putting on clothes may become difficult due to this restricted mobility.
- Clicking or popping: In some cases, individuals with a rotator cuff injury may experience clicking or popping sensations in the shoulder joint during certain movements. These sounds can indicate structural abnormalities, such as a tear or impingement within the rotator cuff.
Rotator Cuff Injury Diagnosis and Treatment
Your doctor will evaluate your shoulder by conducting a physical examination. They will assess your range of motion, strength, and areas of tenderness or pain. To confirm the diagnosis and assess the extent of the injury, imaging tests may be ordered. These can include X-rays to rule out other conditions and provide information about the bone structures, as well as MRI (Magnetic Resonance Imaging) or ultrasound to visualize the soft tissues, including the rotator cuff tendons.
Non-surgical treatments include anti-inflammatory medications, rest, ice, corticosteroid injections, and/or physical therapy. Surgical repair may be an option, depending on the severity of the injury. Your orthopedic surgeon may recommend surgery to repair a torn rotator cuff if your symptoms don’t go away after conservative treatment, you have a large tear (more than 3cm), or if it was caused by a recent trauma.
Recovery After Surgery
Most patients will go home the same day of surgery. After your surgery, your care team will put the brace on your arm before you wake up. Your doctor will let you know when it’s okay to take the brace off. You’ll need to remove it for showering and dressing.
This video provides detailed instructions for using your shoulder sling after surgery.
Recovery Timeline
First Week: Immediate Post-Surgery
- Rest: Keep your shoulder in a sling. Rest and manage pain with medications and ice.
- Wound Care: Follow instructions for keeping the surgical site clean and dry.
Weeks 2-4: Early Rehabilitation
- Healing: Continue using the sling. Begin gentle passive range-of-motion exercises as advised by your physical therapist.
- Follow-Up: Attend appointments to monitor progress and adjust treatment.
Weeks 5-8: Progressive Rehabilitation
- Physical Therapy: Start more active exercises to restore range of motion and strength. Gradually resume light activities.
- Sling: Your surgeon will advise when to stop using the sling.
Months 2-4: Strengthening and Functional Recovery
- Advanced Therapy: Focus on strengthening exercises and return to normal activities. Continue supervised physical therapy.
- Activity: Gradually resume sports or heavier lifting with your surgeon’s approval.
Months 4-6: Full Recovery
- Normal Activities: Most normal activities can be resumed. Maintain a regular exercise routine to support shoulder health.
- Final Assessment: Confirm recovery status with your healthcare provider.
Beyond 6 Months: Long-Term Maintenance
- Preventive Care: Continue shoulder exercises and good posture practices. Schedule regular check-ups to monitor long-term health.
This timeline provides a general guide; individual recovery may vary based on specific circumstances. Always follow your healthcare provider’s recommendations.