A rotator cuff injury is inflammation of, or damage to, the muscles and tendons in your shoulder.
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Rotator cuff injuries are the most common cause of shoulder pain in the UK. Shoulder pain affects up to a quarter of all people in the UK with seven in 10 of these being caused by a rotator cuff injury.
Your rotator cuff is made up of a group of four muscles (the subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons. They help keep your shoulder joint stable and also help with shoulder joint movement.
Your shoulder joint (also known as your glenohumeral joint) is a ball and socket joint made up of two bones. The ball-shaped end of your upper arm bone (humerus) and a shallow socket on the edge of your shoulder blade (scapula).
On top of your shoulder joint is a bone called the acromion. In the gap between your shoulder joint and the acromion is a narrow space called the subacromial space. This is where your rotator cuff tendons pass through. In this space is a fluid-filled pad called the subacromial bursa, which cushions your tendons.
Rotator cuff injury is a general term to describe inflammation (soreness and swelling) or damage to one or more of the muscles, tendons or bursa that make up your rotator cuff.
There are a number of conditions that can affect your rotator cuff. The most common are inflammation of your rotator cuff tendons and tearing of your muscles or tendons.
The tendons of your rotator cuff can become pinched against one of the other structures that make up your shoulder joint. This can cause your tendons to become inflamed and is known as tendinopathy. Rotator cuff tendinopathy most often affects the tendons that pass through your subacromial space. When a tendon becomes trapped or squeezed, it’s known as rotator cuff impingement.
Your subacromial bursa can also become inflamed – this is called bursitis.
This is when one or more of your muscles and tendons that make up your rotator cuff tear. You can have a partial tear or a full-thickness tear. It may be as a result of trauma, such as a fall, or because of tiny tears in the tendon caused by use and wear over time.
Symptoms of a rotator cuff injury include:
pain in your shoulder (or that moves down your arm), particularly when you raise or lower your arm
difficulty placing your arm behind your back
pain at night, particularly when you sleep on the affected side
a feeling of weakness in your shoulder when you lift or rotate your arm
a clicking or snapping sound when you move your shoulder
The pain may come on gradually if you have tendinopathy, but your pain may be severe and sudden if you tear your rotator cuff because of a fall.
These symptoms may be caused by problems other than rotator cuff injuries. If you have any of these symptoms, see your GP for advice.
Rotator cuff injuries may occur for a specific reason. Some examples are listed below.
Lifting or pulling an object that is too heavy for you, with a jerking motion.
Landing on an outstretched hand to break a fall.
Repeating the same shoulder movements, for example, throwing or lifting.
A lack of blood supply, caused by getting older, can lead to a tendon tear because it slows down your body’s ability to repair damage.
As you get older, growths of bone (bone spurs) may develop on the underside of your acromion and rub on your rotator cuff tendons.
There are some things that increase the likelihood of you getting a rotator cuff injury, including the following.
If you’re over 40, you’re at an increased risk because most of rotator cuff injuries are caused by normal wear and tear that happens as you age.
If you do something that involves repetitive overhead motions with your arms. Examples include swimming, weightlifting, playing racquet sports and occupations such as painting, decorating or window cleaning.
Your GP will ask about your symptoms and examine you. He or she may ask about your medical history and any activities that may be causing your condition.
You may be referred for further tests so that your GP can look at your shoulder in more detail. This may include one or more of the following tests.
MRI scan. This uses magnets and radiowaves to produce images of the inside of your body.
Ultrasound scan. This uses sound waves to produce an image of the inside of your shoulder.
X-ray. This test uses radiation to produce an image of the inside of your body.
Treatment of a rotator cuff injury depends on the type of injury you have and how severe it is.
The following measures may help.
Rest your shoulder initially. Limit activities that involve lifting your arm over your head and don’t perform any movements that cause you pain. Start to do gentle movements as soon as possible to prevent any stiffness in your shoulder.
If you need pain relief you can take over-the-counter painkillers, such as paracetamol, or non steroidal anti-inflammatory drugs, (NSAIDs) such as ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Your GP may refer you to a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility), who will show you suitable exercises to help stretch your shoulder muscles and improve the strength and movement of your shoulder. The exercises will be tailored to your specific injury.
If you have a rotator cuff tear that isn’t getting better after trying other types of treatment, your GP may recommend that you have a steroid joint injection, into your shoulder joint.
Your GP may recommend surgery if you have torn your rotator cuff and if other types of treatment haven’t worked for you.
There are several types of surgery that may be used to repair a rotator cuff injury.
Open surgery – a traditional type of surgery that means your surgeon makes a cut in the skin over your shoulder and repairs your injury through the cut.
Shoulder arthroscopy – a type of keyhole surgery that can be used to look inside and treat your shoulder joint. This is usually done under local anaesthesia. This completely blocks pain from your shoulder area and you will stay awake during the operation.
Mini-open surgery – a combination of arthroscopy and repair through a small cut that is usually 3 to 5cm long.
Your surgeon will be able to give you advice on which type of surgery you will need for your condition.