Introduction
Your rotator cuff is made up of the muscles and tendons in your shoulder. Four
major muscles (subscapularis, supraspinatus, infraspinatus and teres minor) and
their tendons connect your upper arm bone (humerus) with your shoulder blade.
They also help hold the ball of your upper arm bone firmly in your shoulder socket,
as if holding a golf ball on a tee. The combination results in the greatest range of
motion of any joint in your body.
Rotator cuff injuries are fairly common. Causes of the injury may include falling,
lifting and repetitive arm activities, especially those done overhead. These
activities may include throwing a baseball, reaching up to work on a car on a rack or
placing items on shelves above your head. The injury is also common among people
whose jobs or hobbies include heavy demands on their shoulders, such as athletes,
archers and people in the construction trades. Poor posture, especially as related to
your shoulders hunched forward, also can contribute to rotator cuff injury. As you
get older, your risk of a rotator cuff injury increases.
Most of the time, treatment involves self-care measures or exercise therapy.
Other treatments include steroid injections and surgery.
Signs and symptoms
Signs and symptoms of a rotator cuff injury may include:
 Pain and tenderness in your shoulder, especially when reaching overhead,
reaching behind your back, lifting, pulling or sleeping on the affected side
 Shoulder weakness
 Loss of shoulder range of motion
 Inclination to keep your shoulder inactive
The most common symptom is pain. You may experience it when you reach up to
comb your hair, bend your arm back to put on a jacket or carry something heavy.
Lying or sleeping on the affected shoulder also can be painful. If you have a severe
injury, such as a large tear, you may experience continuous pain and muscle
weakness.
Causes
A rotator cuff injury involves any type of irritation or damage to your rotator cuff
muscles or tendons, including:
 Tendinitis. Tendons in your rotator cuff can become inflamed due to overuse
or overload, especially in athletes who perform a lot of overhead activities,
such as tennis or racquetball players. In some people, the space where the
rotator cuff resides can be narrowed due to the shape of different shoulder
bones, including the outside end of the collarbone or shoulder blade.
 Bursitis. The fluid-filled sac (bursa) between your shoulder joint and
rotator cuff tendons can become irritated and inflamed.
 Strain or tear. Left untreated, tendinitis can weaken a tendon and lead to
chronic tendon degeneration or to a tendon tear. Stress from overuse also
can cause a shoulder tendon or muscle to tear.
Common causes of rotator cuff injuries include:
 Normal wear and tear. Increasingly after age 40, normal wear and tear on
your rotator cuff can cause a breakdown of fibrous protein (collagen) in the
cuff's tendons and muscles. This makes them more prone to degeneration
and injury. With age, you may also develop calcium deposits within the cuff
or arthritic bone spurs that can pinch or irritate your rotator cuff.
 Poor posture. When you slouch your neck and shoulders forward, the space
where the rotator cuff muscles reside can become smaller. This can allow a
muscle or tendon to become pinched under your shoulder bones, including
your collarbone, especially during overhead activities, such as throwing.
 Falling. Using your arm to break a fall or falling on your arm can bruise or
tear a rotator cuff tendon or muscle.
 Lifting or pulling. Lifting an object that's too heavy, or doing so improperly
— especially overhead — can strain or tear your tendons or muscles.
Likewise, pulling something, such as an archery bow of too heavy poundage,
may cause an injury.
 Repetitive stress. Repetitive overhead movement of your arms can stress
your rotator cuff muscles and tendons, causing inflammation and eventually
tearing. This occurs often in athletes, especially baseball pitchers and tennis
players. It's also common among people in the building trades, such as
painters and carpenters.
When to seek medical advice
See your doctor as soon as possible if you have severe shoulder pain or you're
unable to use your arm. Call your doctor if you've had shoulder pain that has lasted
for more than a week.
Screening and diagnosis
If your injury appears to be severe or your doctor can't determine the cause of
your pain through physical examination, he or she may recommend diagnostic
imaging tests to better delineate your shoulder joint, muscles and tendons. These
may include:
 X-rays
 A magnetic resonance imaging (MRI) scan
 An ultrasound scan
 An arthrogram, a special type of X-ray in which dye is injected into the
shoulder joint before the X-ray is taken to enhance the image of the joint
Treatment
Most of the time, treatment for rotator cuff injuries involves exercise therapy.
Your doctor or a physical therapist will talk with you about specific exercises
designed to help heal your injury, improve the flexibility of your rotator cuff and
shoulder muscles and provide balanced shoulder muscle strength. Depending on the
severity of your injury, physical therapy may take from three weeks to several
months.
Other treatments may include:
 Steroid injections. Depending on the severity of your pain, your doctor may
use a corticosteroid injection to relieve inflammation and pain.
 Surgery. If you have a large tear in your rotator cuff, you may need surgery
to repair the tear. Sometimes during this kind of surgery, doctors may
remove a bone spur or calcium deposits. The surgery may be performed as an
open repair through a 6- to 10-centimeter incision, or as an arthroscopic
repair with the aid of a small camera inserted through a smaller incision.
 Arthroplasty. Some long-standing shoulder muscle tears may contribute to
the development of rotator cuff arthropathy, which can include severe
arthritis. In such cases, your doctor may discuss with you more extensive
surgical options, including partial shoulder replacement (hemiarthroplasty) or
total shoulder replacement (prosthetic arthroplasty). A unique treatment
option now available involves the use of a reverse ball-and-socket prosthesis.
This reverse shoulder prosthesis is most appropriate for people who have
very difficult shoulder problems. These include having arthritis in the joint,
along with extensive tears of multiple muscles and tendons (rotator cuff)
that support the shoulder, or having extensive rotator cuff tears and a
failed previous shoulder joint replacement.
Self-care
A minor injury often heals on its own, with proper care. If you think you've injured
your rotator cuff, try these steps:
 Rest your shoulder. Stop doing what caused the pain and try to avoid painful
movements. Limit heavy lifting or overhead activity for four to seven days
until your shoulder starts to feel better.
 Apply ice and heat. Putting ice on your shoulder helps reduce inflammation
and pain. Use a cold pack, a bag of frozen vegetables or a towel filled with
ice cubes for 15 to 20 minutes at a time. Do this every couple of hours the
first day or two. After about two or three days, when the pain and
inflammation have improved, hot packs or a heating pad may help relax
tightened and sore muscles. Limit heat applications to 20 minutes.
 Take pain relievers. Over-the-counter (OTC) nonsteroidal anti-inflammatory
drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) or
naproxen (Aleve), may help reduce pain. Acetaminophen (Tylenol, others) also

may help relieve pain. Follow label directions and stop taking the drugs when
the pain improves.
Keep your muscles limber. After one or two days, do some gentle exercises
to keep your shoulder muscles limber. Total inactivity can cause stiff joints.
In addition, favoring your shoulder for a long period of time can lead to
frozen shoulder, a condition in which your shoulder becomes so stiff you can
barely move it. Once your injury heals and you have good range of motion in
your shoulder, continue exercising. Daily shoulder stretches and a balanced
shoulder-strengthening program can help prevent a recurrence of your
injury.In addition, daily exercises can help prevent an injury if you use your
rotator cuff often. Your doctor or a physical therapist can help you plan an
exercise routine.