Rotator cuff problems

Definition:

The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and keeping it stable.

Rotator cuff tendinitis refers to irritation of these tendons and inflammation of the bursa (a normally smooth layer) lining these tendons.
A rotator cuff tear occurs when one of the tendons is torn from overuse or injury.

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.