HomeHealth articlesphysiotherapyRotator Cuff Injury - Types | Symptoms | Causes | Diagnosis | Treatment

Rotator cuff injury is the damage of the tissue around the shoulder joint. This article will explain in detail about the rotator cuff injury and its preventive measures.

Written by

Dr. Sneha Kannan

Medically reviewed by

Sreenivasa Rao

Published At November 12, 2019
Reviewed AtAugust 3, 2023

Introduction:

The muscles and tendons that help in the movement of your shoulders are called the rotator cuff. Any injury to this group of muscles can cause a dull ache in the shoulder, which worsens with shoulder movement. This type of injury is commonly seen in athletes and people who repeatedly move their shoulders like painters and carpenters. Most people recover from this injury with the help of physiotherapy.

What Is Rotator Cuff Injury?

The group of muscles and tendons that work together to stabilize the shoulder and allow you to move it is called rotator cuff. The muscles that make the rotator cuff are:

  1. Supraspinatus muscle - It keeps the upper arm stable and helps in lifting the arm.

  2. Infraspinatus muscle - It helps in shoulder rotating action.

  3. Subscapularis muscle - It connects the upper arm to the shoulder blade and helps in rotating the shoulder.

  4. Teres minor muscle - It is the smallest muscle and also helps in rotation.

Shoulder

img source : rosept

These tendons get injured easily as they move in a very tight space. When you move your shoulder properly, these muscles move and help with the movement. But when you stress or strain it beyond its capacity, these muscles rub against the bony process in the shoulder bone (acromion). This results in the muscles getting injured and inflamed.

Types of Rotator Cuff Injuries:

The types of rotator cuff injury are:

  • Wear and Tear - Repetitive movements and advancing age can cause general wear and tear of these muscles.

  • Rotator Cuff Tendinitis - Overuse can cause inflammation of the tendons in the rotator cuff. This type of injury is commonly seen in athletes who swim or play tennis and volleyball.

  • Shoulder Bursitis - The inflammation of the bursa, which is the fluid-filled sac between the shoulder joint and rotator cuff tendons, is called shoulder bursitis.

  • Rotator Cuff Tear - The tendons, that are the fibers that connect the muscle to the bone, can tear fully or partially. It can occur from a sudden injury or due to repetitive motion. Untreated rotator cuff tendinitis can eventually lead to a tear. This causes shoulder pain, inability to move the shoulder fully, and shoulder weakness.

  • Shoulder Impingement - Shoulder impingement is when the muscles in the rotator cuff rub or impinge on the shoulder bones. It is the most common cause of shoulder pain and rotator cuff tear.

What Symptoms Does Rotator Cuff Injury Cause?

Symptoms are not seen with all types of rotator cuff injuries. Repetitive motions can gradually damage the muscles over the years. The common symptoms include:

  • Shoulder pain while performing certain activities.

  • Inability to achieve a full range of shoulder motion.

  • Inability to sleep on the affected side.

  • Severe pain while lifting your hands overhead.

  • Throbbing pain at night.

If these symptoms last for more than a week, or if you lose sensation or function of your arm, consult a doctor immediately.

What Causes Rotator Cuff Injury?

The following are the most common causes of rotator cuff injury:

  • Arthritis and patients with knee pain sit and rise from the chair by putting excess force on their arm. As their knees hurt, they take support from the chair handles. The shoulder joint is not built for this, and this results in crushing and grinding of the rotator cuff tendons.

  • Shoulder injuries from falls, accidents, and sports collisions.

  • Repetitive activities like pushups, swimming, painting a house, etc., can cause injury of the rotator cuff.

  • Sudden overhead arm movements commonly seen in athletes can result in rotator cuff tear.

Risk Factors:

Such injuries are commonly seen in:

  • People older than 40 years.

  • Athletes who play contact sports.

  • People who play tennis, baseball, and archery.

  • Painters and carpenters.

  • Some families (genetics).

How Is Rotator Cuff Injury Diagnosed?

Your doctor will press your shoulders in different areas, and he or she will tell you to perform various shoulder movements. Physical examination also tests for the strength of the rotator cuff muscles. If needed, your doctor might tell you to get the following tests:

  • X-ray - X-rays will not show a rotator cuff tear, but it is used to rule out other conditions that can cause shoulder pain like bone spurs or arthritis.

  • Ultrasound - Here, sound waves are used to produce images of muscles and tendons in the shoulder. You can also see how your muscles stretch with movements.

  • Magnetic resonance imaging (MRI) - Strong radio waves magnets are used to obtain a detailed view of all hard and soft structures in the shoulder.

How Is Rotator Cuff Injury Treated?

Most types of rotator cuff injuries get better with rest, ice compressions, and physical therapy. Surgery is indicated only in severe cases of rotator cuff tear. The treatment options include:

1) Conservative treatments - Rest the affected shoulder, apply ice, and consult a physiotherapist for physical therapies. Your doctor will prescribe painkillers and anti-inflammatory medicines.

2) Physical therapy - Exercises specially designed for this type of shoulder injury will help reduce pain and restore flexibility and strength to the shoulder.

3) Injections - If your pain did not get better with physiotherapy, the doctor might recommend getting a steroid injection directly into the shoulder joint. It is indicated for people who have pain that interferes with sleep and other activities. This only gives temporary relief.

4) Surgery - The surgeries done are:

  • Arthroscopic tendon repair - Here, the surgeon inserts an arthroscope, which is a small tube with a camera, inside the shoulder joint through small incisions, and the torn tendon is reattached.

  • Open tendon repair - Here, the surgeon makes a larger incision to visualize the joint and then reattaches the damaged tendon.

  • Tendon transfer - In case of damaged tendon, a nearby tendon is used to replace the damaged one.

  • Shoulder replacement - In severe cases, the shoulder might need replacement. An artificial joint is placed.

Preventive Measures:

For people at risk, perform shoulder stretches and strengthening exercises. Ask a fitness specialist how to perform these exercises properly.

Conclusion:

Rotator cuff injuries are very common in old age, or especially when a person is more involved in physical work. It may repair without a surgical intervention, or some people may require surgery to fix the torn rotator cuff. Pain relivers, rest, and physical therapy can help treat the condition, but the recovery may take a longer time as the healing process is slow.

Frequently Asked Questions

1.

What Are the Signs of a Rotator Cuff Tear?

The following are the symptoms of a rotator cuff tear:
 - Difficulty and pain while raising the arm.
 - Clicking or popping sounds or sensations when moving the arm.
 - Shoulder pain worsens at night or when resting the arm.
 - Shoulder weakness and struggling in lifting items.

2.

How Long Does a Rotator Cuff Injury Take to Recover?

The tendon takes six to eight weeks to heal to the bone. The length of recovery time depends on the size of the tear. Full recovery time for small tears is about four months, and six months for large tears. Complete recovery from severe, massive tears can take six to twelve months.

3.

Is It Possible for the Rotator Cuff Injury to Heal On Its Own?

The muscle partially or completely tears away from the bone in most rotator cuff tears. Rotator cuff tears are not self-healing. Rotator cuff repair is required to restore the shoulder joint. A rotator cuff injury should be treated by a shoulder surgeon.

4.

Is It Possible to Heal a Rotator Cuff Without Surgery?

Rotator cuff tears do not heal without surgery, but by strengthening their shoulder muscles, many patients can improve function and reduce pain. Mild rotator cuff tears or sprains usually heal in four weeks. A tear does not always necessitate surgery.

5.

Is an MRI Needed to Diagnose a Rotator Cuff Tear?

A skilled shoulder physiotherapist or doctor can usually diagnose a rotator cuff tear without using an MRI (magnetic resonance imaging). However, a suspected partial-thickness or full-thickness rotator cuff tear can be confirmed using ultrasound (US) or MRI. An MRI uses magnets and powerful radio waves to provide a detailed view of all hard and soft structures in the shoulder.

6.

How Can Rotator Cuff Pain Be Managed At Home?

Avoid painful movements and stop doing what caused the pain. Heavy lifting or overhead activity should be avoided until the shoulder pain subsides. Icing the shoulder may relieve pain. Over-the-counter pain relievers like Ibuprofen or Acetaminophen may also be beneficial.

7.

Is Rest Beneficial For Rotator Cuff Injuries?

Conservative treatments, such as rest, ice, and physical therapy, can sometimes be enough to help a rotator cuff injury heal. However, if the injury is severe, surgery may be required. Most people require six months of rehabilitation after surgical repair before their strength and shoulder function return to normal.

8.

What Is The Severity of a Rotator Cuff Tear?

Rotator cuff issues, if left untreated, can result in permanent loss of motion or weakness of the shoulder joint. Delaying treatment for a torn rotator cuff increases the risk of further damage to the shoulder because the tendons and muscles cannot heal properly. Overworked muscles will fray, and additional tears may form.

9.

Should a Rotator Cuff Be Massaged?

Massage therapy is an excellent treatment option for rotator cuff injuries because it reduces inflammation and pain, releases scar tissue, loosens tight and tense muscles, and improves the range of motion in the shoulder girdle. Many rotator cuff injuries benefit from soft-tissue therapies such as remedial massage to aid in rehabilitation.

10.

Should I Use a Sling to Treat a Rotator Cuff Injury?

Patients are frequently advised to wear a sling or brace for the first four to six weeks following rotator cuff repair surgery to prevent them from engaging in any physical activities that involve the affected shoulder. However, there are benefits and drawbacks to early mobilization after rotator cuff repair. If at all possible, avoid using a sling with a rotator cuff injury. Gentle pendulum motions can be performed by leaning forward and letting the arm hang, swinging in small circles or back and forth. To keep moving throughout the day, perform gentle stretching exercises frequently.
Sreenivasa Rao
Sreenivasa Rao

Physiotherapy

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