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Rotator cuff problems


Alternative Names:

Swimmer's shoulder; Pitcher's shoulder; Shoulder impingement syndrome; Tennis shoulder; Tendinitis - rotator cuff; Rotator cuff tendinitis; Shoulder overuse syndrome

Signs and tests:

A physical examination may reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. There is usually weakness of the shoulder when it is placed in certain positions.

X-rays of the shoulder may show a bone spur. They can be done in your doctor's office.

If your doctor feels you may have a rotator cuff tear, you may have one or more of the following tests:

  • An ultrasound test uses sound waves to create an image of the shoulder joint. It can often show a tear in the rotator cuff.
  • MRI of the shoulder may show swelling or a tear in the rotator cuff.

Sometimes, a special imaging test called arthrography is needed to diagnose a rotator cuff tear. Your doctor will inject contrast material into your shoulder joint. Then an x-ray, CT scan, or MRI scan are used to take a picture of it. Contrast is usually used when your doctor suspects a small rotator cuff tear.

Treatment:

TENDINITIS OR IMPINGEMENT SYNDROME

Treatment involves resting the shoulder and avoiding activities that cause pain. It may involve:

  • Ice packs applied 20 minutes at a time, 3 - 4 times a day to the shoulder
  • Taking drugs like ibuprofen and naproxen to help reduce swelling and pain
  • Avoiding or reducing activities that cause or worsen your symptoms

For more information about managing your symptoms at home and returning to sports or other activities, see Rotator cuff - self-care.

You should start physical therapy to learn exercises to stretch and strengthen the muscles of your rotator cuff.

If the pain persists, or if therapy is not possible because of severe pain, a steroid injection may reduce pain and swelling in the injured tendons to allow effective therapy.

With rest and exercise, symptoms often improve or go away. However, this may take weeks or months to occur.

Arthroscopic surgery can remove inflamed tissue and part of the bone that lies over the rotator cuff. Removing the bone may relieve the pressure on the tendons.

ROTATOR CUFF TEARS

Rest and exercise may help someone with a partial rotator cuff tear who does not normally place a lot of demand on the shoulder.

You may need surgery to repair the tendon if the rotator cuff has had a complete tear, or if the symptoms persist despite conservative therapy. Most of the time, arthroscopic surgery can be used. Some large tears require open surgery to repair the torn tendon.

Expectations (prognosis):

Many people recover full function after a combination of medications, physical therapy, and steroid injections after an episode of rotator cuff tendinitis. Some may need to change or reduce the amount of time they play certain sports to remain pain-free.

People with tears of their rotator cuff tend to do well, although their outcome is strongly dependent upon the size of the tear and how long the tear has been present, as well as their age and pre-injury level of function.

Calling your health care provider:

Call for an appointment with your health care provider if persistent shoulder pain occurs. Also call if symptoms do not improve with treatment.

Prevention:

Avoid repetitive overhead movements. Develop shoulder strength in opposing muscle groups.

See also: Rotator cuff - self-care

References:

Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part II. Treatment. Am Fam Physician. 2008;77:493-497.

Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part I. Evaluation and diagnosis. Am Fam Physician. 2008;77:453-460.

Greiwe RM, Ahmad CS. Management of the throwing shoulder: cuff, labrum and internal impingement. Orthop Clin North Am. 2010;41:309-323.

Matsen III FA, Fehringer EV, Lippitt SB, Wirth MA, Rockwood CA Jr. Rotator cuff. In: Rockwood CA Jr, Matsen FA III, Wirth MA, Lippitt SB, eds. The Shoulder. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 17.

Seida JC, LeBlanc C, Schouten JR, Mousavi SS, Hartling L, Vandermeer B, Tjosvold L, Sheps DM. Systematic review: nonoperative and operative treatments for rotator cuff tears. Ann Intern Med. 2010;153:246-255.


Review Date: 7/6/2011
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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