Is it difficult to raise your shoulder over your head? Do you experience pain at night or have trouble sleeping on your side? Does it hurt to lift a heavy bag of groceries or your grandchild? If so, you may have a rotator cuff injury or disorder.

In the past, a torn rotator cuff was considered to be a permanent injury. Fortunately, advances in physical therapy and surgical techniques have made rotator cuff injuries much more easily rehabilitated.

The Role of the Rotator Cuff
The rotator cuff is a group of tendons and related muscles that stabilize the shoulder joint. The shoulder is a ball-and-socket joint with three main bones held together by muscles, tendons, ligaments, and the joint capsule. These bones include the upper arm (humerus), collarbone (clavicle), and shoulder blade (scapula).

The rotator cuff helps keep the upper arm bone secured in the shoulder joint socket, while allowing you to raise and rotate your arm. The rotator cuff moves within a confined space that contains a small fluid sac (bursa). The bursa provides a cushion between the bone and tendons. Inflammation, excess fluid, or bone spurs can reduce the space available that allows the bone and tendon to rub against each other. The tendons can become damaged and cause inflammation of the tendons or bursa. The tendons weaken and may ultimately be torn.

Rotator cuff disorders include partial tear of the tendons, complete tear of the tendons, tendonitis (inflammation of the tendons), bursitis (inflammation of the bursa), and calcific tendonitis (calcium buildup in the tendons).

Causes of Injury
The damage described above can be caused by a variety of things:
• Natural aging and degeneration of the tendon.
• Arthritis that can cause bony growths in the affected area.
• Decreased blood supply to the tendons.
• Injury to the rotator cuff or a nearby broken bone.
• Joint looseness can affect tissue fiber or cause scar tissue.
• Calcium buildup in the tendons.
• Overuse or repetitive activities.

Identifying a Rotator Cuff Disorder
Shoulder pain, weakness, and stiffness are common symptoms of a rotator cuff injury or disorder. To properly identify the cause of discomfort, the best course of action is to be evaluated by a qualified physician.

During this evaluation, a primary care physician or orthopedic surgeon asks the patient about the pain and observes the joint motion. In addition to discussion and a physical exam, x-ray, ultrasound, or MRI may be used as diagnostic tools.

Non-Surgical Treatment
Less severe rotator cuff injuries are usually treated without surgery. A combination of rest, ice, NSAIDs, and/or physical therapy often can manage minor shoulder problems. In some cases, cortisone injections may be needed to relieve the pain.

However, it’s important to note that repeated cortisone injections can weaken the tendons and eventually lead to additional damage—or more severe damage. Be sure to discuss the pros and cons of injections with your physician.

Surgical Treatment
Although most rotator cuff injuries are treated non-surgically, there are cases in which surgery is the most effective alternative. If the shoulder doesn’t respond adequately to the non-surgical treatments mentioned above or if the tear is severe, surgery may be recommended. Surgery for partial tears usually can be done with minimally invasive techniques or using an arthroscope, which is a lighted tube with a tiny camera on one end.

Patients are required to keep their shoulder immobilized while healing from rotator cuff surgery. This can affect the shoulder’s ability to properly move after the four- to six-week recovery period. To regain proper function, extensive physical therapy may be needed.

Avoiding Rotator Cuff Injury
Rotator cuff injuries only occasionally are caused by severe trauma to the area; most are caused by overuse. Using proper techniques when playing sports, reducing repetitive overhead motions, and maintaining overall muscle strength can help minimize the likelihood of rotator cuff injuries. In addition, when a rotator cuff problem first appears, it’s important to seek treatment and guidance to help prevent the injury from becoming more severe. TPW