Rotator Cuff Injury: Causes and Treatments

What is a rotator cuff injury?

A rotator cuff injury is a shoulder injury where there is damage to a group of shoulder muscles and tendons, leading to a decrease in it's range of motion. Additionally, this muscle group helps stabilise the head of your upper arm bone (humerus) in the shoulder blade socket. This injury can hinder daily activities due to the painful shoulder when moving it. This condition may occur suddenly as an acute injury or develop gradually as chronic shoulder pain. Individuals with this injury often experience inflammation and shoulder pain.

Common causes of rotator cuff injury

This injury can happen as a result of sudden external force, such as during falling with an outstretched arm or wear and tear of the shoulder tendon tissue over time.

Some common causes of this injury include:

• Repetitive movement:

  • Sports like tennis and rowing include repetitive motions that can put a lot of strain on the rotator cuff muscles, weakening them.

  • Additionally, occupations such as painter and carpenter that require repetitive lifting and overhead activities, , are more susceptible to this injury.

• Lack of blood supply: 

  • As the body ages, blood supply to the rotator cuff tendons decreases. Causing these muscle groups to be deprived of oxygen and nutrients, making them more prone to tendon tear, hindering rotator cuff function.

• Bone spurs: 

  • Overgrowth of shoulder bone spurs can cause the bone to rub against the rotator cuff when lifting the arm. This can cause constant irritation against the muscle group in the shoulder, which eventually leads to a partial or complete tear.

Risk factors

In addition to the aforementioned causes, several other risk factors can increase the chances of this injury, including:

• Age:

  • The likelihood of suffering a rotator cuff injury increases with age due to degenerative changes that weaken the muscles, particularly in individuals over 40 years old.

• Dominant arm: 

  • As we frequently rely on our dominant arm for our routine activities, it becomes more prone to repetitive movement, which can lead to this injury.

• Sport activities: 

  • Some types of rotator cuff injuries are more common in people who participate in sports like baseball, tennis, and heavy lifting. The repetitive motions in these activities can lead to irritation or damage to the tendons.

• Family history: 

  • If there is a history of this injury in your family, it may be hereditary, increasing your risk of developing the same condition.

Types of rotator cuff injury

When the tendon or muscle group in the shoulder tears, they can tear partially or completely. The former means the tendon remains partially attached to the arm bone, while the latter indicates that the tendon has fully detached from the bone.Based on these classifications, there are a few common types of these injuries that can occur, including:

1. Rotator cuff tear

   • A condition where the tendon tissue experiences damage, ranging from partial tear to complete tear of the tendon from the bone.

2. Rotator cuff tendinopathy

   • This condition refers to inflammation, which is the degeneration of the tendons that attach to the shoulder bone. 

   • Rotator cuff tendinopathy includes tendonitis (acute inflammation of the tendon) and tendinosis (chronic degeneration of the tendon).

3. Rotator cuff impingement

   • This occurs when the acromion (the bony top of the shoulder) rubs against the rotator cuff tendons and bursa during arm movements.

   • This can lead to pain and limited motion, especially when doing overhead motions.

4. Shoulder bursitis 

   • In this condition, the bursa (a small fluid-filled sac that serves to cushion the rotator cuff) becomes inflamed as a result of repetitive activities such as throwing baseballs or lifting objects overhead repeatedly, leading to pain and swelling.

Rotator cuff injury symptoms

Some common symptoms that may occur from this injury, such as:

• A dull ache in the shoulder that may intensify during the night or when the arm is at rest.

• Shoulder weakness, which causes difficulties in moving the arm and hinders reaching tall places.

• Shoulder weakness and stiffness, which limits the arm’s range of motion.

• A popping or cracking sensation when moving the affected arm up or down.

If you're experiencing any of the mentioned symptoms, don’t hesitate to request an appointment at Thomson Medical. Our healthcare providers are ready to provide you with an accurate diagnosis and a personalised treatment plan.

Diagnosis of rotator cuff injury

When you visit a healthcare provider, the doctor will begin the diagnosis by discussing your symptoms and how they happened. After that, they may check your medical history, including any family history, to identify potential genetic factors contributing to your condition.
Subsequently, a healthcare provider may perform a physical exam of the affected shoulder. During this assessment, they will apply pressure to various areas of the shoulder to identify tenderness, evaluate pain levels, and assess the range of motion.

Additionally, to get a better diagnosis, healthcare providers can perform imaging tests such as:

• X-rays to check if there’s any bone fractures and rule out other possible causes of shoulder pain, such as arthritis and bone spurs.

• Magnetic resonance imaging (MRI), to evaluate soft tissues in the shoulder, such as ligaments and tendons, to look for both partial or complete rotator cuff tears.

• Ultrasound serves a similar purpose as an MRI, but it enables healthcare providers to evaluate the shoulder structures in real-time during movement. This approach also facilitates a quick comparison between the affected shoulder and the healthy one.

Treatment options

Treatment for a rotator cuff injury depends on the severity of the injury. Mild conditions may be treated with non-surgical treatments. However, if the injury causes severe pain, surgical procedures might be considered. 

Non-surgical (conservative) treatment

• Rest: 

  • Avoid using the injured shoulder to avoid worsening the damage and allow it to rest and heal properly.

• Ice pack: 

  • Apply an ice pack to help alleviate swelling and discomfort. Aim to do this for 15-20 minutes every 1-2 hours during the first 48 hours.

• Compression: 

  • Use an elastic bandage to wrap the injured shoulder to help reduce swelling.

• Over-the-counter pain relievers: 

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce pain and inflammation.

• Topical treatments: 

  • Creams and gels containing NSAIDs or analgesics can provide localised pain relief.

• Corticosteroid injections: 

  • To help reduce severe inflammation or pain, corticosteroids can be injected into the knee joint.

• Physical therapy

  • A rotator cuff injury can be treated through specific exercises that help strengthen the muscles around the shoulder blade, improve flexibility, reduce pain, and restore movement.

However, if your condition worsens with severe pain and the inability to move the injured shoulder despite rest and home treatment, you should consult a doctor for an expert opinion. 

Don’t hesitate to request an appointment with our specialists at Thomson Medical to get an accurate diagnosis and a personalised treatment plan.

Surgical treatment

In cases where conservative treatments fail to provide relief or experiencing a full tendon tear, surgical procedures may be considered. Optional surgical procedures include:

• Rotator cuff debridement: 

  • This minimally invasive procedure involves cleaning out damaged tissue and reducing inflammation from the injured joint to help reduce pain.

• Rotator cuff repair: 

  • This surgery aims to reattach a torn tendon back to its normal position on the humerus, restoring function and stability to the shoulder.

• Muscle transfer: 

  • If the rotator cuff tear is irreparable, a muscle transfer may be performed. This involves relocating tendons from the latissimus dorsi or pectoralis muscles, detaching them from their normal position, and reattaching them to the bone surrounding the shoulder.

• Shoulder joint replacement surgery: 

  • This shoulder replacement procedure is usually reserved for patients with severe rotator cuff tears. This surgery removes damaged areas of bone and replaces them with artificial parts made of metal and plastic (implants).

Prevention steps

Rotator cuff injury is not entirely preventable, especially if it resulted from an activity or accident you cannot avoid. Here are some steps you can take to lower your risk, including:

• Avoid repetitive overhead movements and modify the activities to reduce the risk of injury.

• Make sure to use proper technique, form, and methods during sports and occupational activities.

• To prepare the muscles around the shoulder blade for the physical demands of sport, engaging in muscle-strengthening and warm-up exercises can be beneficial.

• Stretching exercises to be more flexible and improve the motion range of the shoulder.

Rotator cuff injury complications

If left untreated or not treated properly, a rotator cuff injury tear can worsen and lead to complications such as: 

• Persistent pain and restricted movement. 

• Frozen shoulder (adhesive capsulitis).

• Re-tearing of the rotator cuff.

• Muscle weakness and reduced strength in the shoulder.

FAQ

How long does it take for a rotator cuff injury to heal?

The recovery time for a rotator cuff injury largely depends on the treatment approach chosen. Physical therapy may require up to six weeks of sessions, whereas surgical recovery can range from four to six months. However, achieving full recovery may take anywhere from 12 to 18 months.

How do you tell if a rotator cuff is torn or strained?

You can tell if your rotator cuff has been torn or strained if you felt these symptoms:

• Shoulder pain, which may worsens at night or when resting the arm.

• Weakness in the injured shoulder joint.

• Stiffness, which limits the arm range of motion.

• When lifting the affected arm up or down, a popping or cracking sensation can be felt.

Does a rotator cuff tear heal on its own?

Rotator cuff tears generally do not heal on their own without intervention and require nonsurgical treatment to improve functionality and reduce pain through medications.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist at Thomson Medical. Request for an appointment with Thomson Medical today.