Rotator cuff injuries have an image problem.

First off, a lot of people are simply confused: According to Google, 1,300 people each month search for “rotator cup.” The rotator cuff has “cuff” in its name because it is a cuff-like network of four muscles with tendons that connect to your upper arm bone o(humerus) ball joint.

These tendons can become inflamed from overuse and age. When the tendons are really worn down, they can even tear.

This leads to yet another perception problem. The shoulder joint is often taken for granted, and early signs of injury are ignored.

“The rotator cuff is the most unique and complex joint of the body, hands down,” points out David Glaser, MD, Chief of Shoulder and Elbow Service at the Penn Musculoskeletal Center. “It has the most motion of any joint in the body, and it relies on every aspect.”

Here’s the third perception problem: Most people think rotator cuff injuries can only happen to athletes, particularly baseball players.

But Dr. Glaser actually sees a bunch of post-50 active weekend warriors and 60- to 80-somethings who still go hard on a tennis court or the golf course.

Below, he sets the record straight on common questions about rotator cuff injuries.

Q and A with Dr. Glaser

What are common causes of rotator cuff injuries?

Injury to the rotator cuff causes shoulder pain, which can be either acute or chronic. A jarring motion like a sudden blow to the shoulder can cause acute pain. Chronic pain can arise from a job that requires constant lifting and reaching overhead, or a sport that requires constantly winding the arm.

Rotator cuff injuries can also be tricky to diagnose. Other conditions, like arthritis or neck injury can mimic the pain of the rotator cuff.

Does a rotator cuff injury always require surgery?

Treatment for a rotator cuff injury does not automatically mean surgery. It can also be treated with physical therapy or medication, such as injections or anti-inflammatories.

“Our goal is to make patients feel better,” Dr. Glaser explains. “Sometimes, patients have one injection, and they feel better permanently. Other patients do not do respond as well to injections, and we have to look at other ways to help get them back to being pain-free.”

Do you need treatment right away?

Although a rotator cuff injury can be severe, many people don’t seek treatment as soon as they should. When they wait to seek treatment, they often risk worsening the damage and losing more function.

Dr. Glaser has seen some of the worst-case scenarios: “People are not able to use their hands. They can’t scratch the side of their head, comb their hair or effectively feed themselves. They’re functional at waist-level only.”

When is surgery necessary?

Dr. Glaser recommends surgery for people with acute rotator cuff injuries, such as those that stem from a fall and leave people unable to reach upward.

“For people who have chronic cuff tears or shoulder pain, or are having rotator cuff problems, those patients need to try physical therapy, injections and anti-inflammatory use,” he says. “If those don’t work, that’s a good time to discuss surgery.”