Symptoms

Rotator cuff injury signs and symptoms 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 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.

When to see a doctor
You should see your doctor if:

• You're experiencing severe shoulder pain
• You're unable to use your arm or feel weak in the arm
• You have shoulder pain that's lasted more than a week

Causes

Four major muscles (subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons connect your upper arm bone (humerus) with your shoulder blade (scapula). A rotator cuff injury, which is fairly common, 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 if you're an athlete who performs a lot of overhead activities, such as in tennis or racquetball.
• 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 a high-poundage archery bow, 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, swimmers and tennis players. It's also common among people in the building trades, such as painters and carpenters.

Risk factors

The following factors may increase your risk of having a rotator cuff injury:

• Age. As you get older, your risk of a rotator cuff injury increases. Rotator cuff tears are most common in people older than 40.
• Being an athlete. Athletes who regularly use repetitive motions, such as baseball pitchers, archers and tennis players, have a greater risk of having a rotator cuff injury.
• Working in the construction trades. Carpenters and painters, who also use repetitive motions, have an increased risk of injury.
• Having poor posture. A forward-shoulder posture can cause a muscle or tendon to become irritated and inflamed when you throw or perform overhead activities.
• Having weak shoulder muscles. This risk factor can be decreased or eliminated with shoulder-strengthening exercises, especially for the less commonly strengthened muscles on the back of the shoulder and around the shoulder blades.

Preparing for your appointment

You'll start by seeing your family doctor or a general practitioner. If your injury is severe and requires surgery, however, you'll likely be referred to an orthopedic surgeon.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• Where is the pain located?
• Does your job or hobby aggravate your shoulder pain?
• When did you first begin experiencing shoulder pain?
• Have you experienced any symptoms in addition to shoulder pain?
• How severe is your pain?
• What movements and activities aggravate and relieve your shoulder pain?
• Do you have any weakness or numbness in your arm?

What you can do in the meantime
In the days before your appointment, you can make yourself more comfortable by:

• Resting your shoulder. Avoid movements that aggravate your shoulder and give you more pain.
• Applying cold packs to reduce pain and inflammation.
• Taking pain medications, if necessary. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve), may help reduce pain. Acetaminophen (Tylenol, others) also may help relieve pain.

Tests 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

Treatment and drugs

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 several weeks to several months to reach maximum effectiveness.

Other rotator cuff injury 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 2 1/2- to 4-inch (6- to 10-centimeter) incision, as a mini-open repair through a 1 1/4- to 2-inch (3- to 5-centimeter) incision, or as an arthroscopic repair with the aid of a small camera inserted through a smaller incision.
• Arthroplasty. Some long-standing rotator cuff tears over time 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.

Lifestyle and home remedies

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 until your shoulder pain subsides.
• 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.
• 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. Try to do some gentle range-of-motion exercises in a pain-free range 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.

Prevention

If you've had a rotator cuff injury in the past, daily shoulder stretches and a shoulder-strengthening program can help prevent a recurrence. Especially important is a program of strength exercise to promote balanced strength about the shoulder. Most people exercise the front muscles of the chest, shoulder and upper arm, but it is equally important to strengthen the muscles in the back of the shoulder and around the shoulder blade.

If you are at risk of rotator cuff injuries — such as from having a job or hobby that requires repetitive shoulder motions — daily exercises can help prevent an injury. Your doctor or a physical therapist can help you plan an exercise routine.

To help prevent a rotator cuff injury:

• Do regular shoulder exercises
• Take frequent breaks at work if your job requires repetitive arm and shoulder motions
• Rest your shoulder regularly during sports that require repetitive arm use
• Apply cold packs and heat pads when you experience any shoulder pain or inflammation