What are rotator cuff disorders?
The rotator cuff is a group of tough, flexible fibers (tendons) and muscles in the shoulder. Rotator cuff disorders occur when tissues in the shoulder get irritated or damaged. Rotator cuff disorders include:
- Inflammation of the tendons (tendinitis) or of a bursa (bursitis). In the shoulder, a bursa is a small, fluid-filled sac that serves as a cushion between the tendons and the bones.
- Impingement, in which a tendon is squeezed and rubs against bone.
- Calcium buildup in the tendons, which causes a painful condition called calcific tendinitis.
- Partial or complete tears of the rotator cuff tendons.
How does the shoulder work, and what does the rotator cuff do?
The shoulder is a joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). The bones are held together by muscles, tendons, and ligaments. The rotator cuff keeps the upper arm bone in the shoulder socket and lets you raise and twist your arm.
The shoulder is a ball-and-socket joint. The ball at the top of the upper arm bone fits into the socket of the shoulder blade. This socket is shallow, which lets you move your arm in a wide range of motion. But it also means that the muscles and tendons of the rotator cuff have to work hard to hold the bones in place. As a result, they are easy to injure and are prone to wear and tear.
What causes rotator cuff disorders?
Most rotator cuff disorders are caused by a combination of:
- Normal wear and tear. Using your shoulder for many years slowly damages the rotator cuff. As you age, everyday activities can lead to changes in the rotator cuff, such as thinning and fraying of the tendons and reduced blood supply.
- Overuse. Activities in which you use your arms above your head a lot—such as tennis, swimming, or house painting—can lead to rotator cuff problems. Even normal motions made often over a long period can stress or injure the rotator cuff.
Both normal wear and tear and overuse can lead to impingement, when a tendon rubs against bone. This damages and irritates the tendon, which causes bleeding and inflammation. Over time, damage to the tendon may build up, so the tendon is more easily injured.
It takes great force to tear a healthy rotator cuff tendon. This can happen during sports, an accident, or a severe fall. But even a simple movement like lifting a suitcase can cause a rotator cuff tear in an older adult or someone whose shoulder is already damaged.
What are the symptoms for rotator cuff disorder?
Symptoms of a rotator cuff disorder include pain and weakness in the shoulder. Most often, the pain is on the side and front of the upper arm and shoulder. It may hurt or be impossible to do everyday things, such as comb your hair, tuck in your shirt, or reach for something. You may have pain during the night and trouble sleeping.
Symptoms of rotator cuff tendinitis
In tendinitis (inflammation in the tendon), the pain usually starts gradually, over the side of the shoulder and the upper arm.
- Your shoulder and arm aren’t particularly weak but it hurts to use them.
- The pain may spread down the outside of the upper arm, even to the elbow.
- The pain may be worse at night and may keep you awake, especially if you lie on that side.
- Lifting the arm to the side or to the front makes the pain worse.
Over time, the pain may get worse or you may have constant pain. In some cases, this is because you actually have one or more small tendon tears.
Some people also have tendinitis in other parts of the shoulder. And some people have neck pain from using other muscles to help move the shoulder.
Symptoms of rotator cuff tears
The most common symptoms of a tear are:
- Pain when you move your arm, especially overhead or against resistance.
- Pain at night.
- Weakness in your shoulder, although some people don’t notice any weakness if the tear is small.
Symptoms of a sudden, severe tear include:
- A popping sound or tearing sensation in your shoulder.
- Immediate pain in your shoulder.
- Weakness and pain when you lift or rotate your arm.
- Limited range of motion and inability to raise your arm because of pain or weakness.
- Possibly, bruising in your shoulder or upper arm.
You can have a complete tear without symptoms, especially if you are an older adult who is not very active.
How are rotator cuff disorders diagnosed?
To diagnose a rotator cuff disorder, doctors ask about any shoulder injuries or past shoulder pain. They also do a physical exam to see how well the shoulder works and to find painful areas or activities. Moving your arm in certain ways can help a doctor learn about the condition of the rotator cuff.
You may have an X-ray to check the bones of the shoulder. If the diagnosis is still unclear, the doctor may order an imaging test, such as an MRI or an ultrasound.
How are rotator cuff disorders treated?
Treatment of rotator cuff disorders should begin soon after an injury or soon after symptoms develop, to give you the best chance of restoring flexibility and strength to your shoulder. Without treatment, inflammation and tears can build up, causing pain, weakness, and loss of function.
Treatment depends on your symptoms, age, and activity level, and on whether your symptoms appear to be related to a rotator cuff injury.
Most rotator cuff disorders are treated without surgery. Your treatment may include:
If symptoms don’t improve after a few months of nonsurgical treatment, you and your doctor may consider testing (such as X-rays or an MRI) to find out if you have a rotator cuff tear.
Surgery often is used to repair a torn rotator cuff. Nowadays, surgery is done arthroscopically using keyhole.
Surgery may be considered if:
- You have a rotator cuff tear caused by a sudden injury.
- Your shoulder doesn’t get better after 3 to 6 months of other treatment.