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Rotator cuff injury

A rotator cuff injury is inflammation or damage to the muscles and tendons in your shoulder.

Rotator cuff injuries are the most common cause of shoulder pain in the UK. Shoulder pain affects up to a quarter of the UK population, 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) joins with 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. It describes inflammation (soreness and swelling) or damage to one or more of the muscles, tendons or bursa that make up your rotator cuff.

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Details

  • Types of rotator cuff injury Types of rotator cuff injury

    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.

    Rotator cuff tendinopathy

    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.

    Rotator cuff tear

    This is when one or more of the 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 over time by overuse and wear.

  • Symptoms Symptoms of rotator cuff injuries

    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

    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 an accident or 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.

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  • Diagnosis Diagnosis of rotator cuff injuries

    Your GP will ask about your symptoms and examine you. They may ask about your medical history and any activities that may be causing your condition.

    Your GP may refer you to an orthopaedic surgeon, a sports physician or a hospital clinic for tests to look at your shoulder. 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.
  • Physiotherapy

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including physiotherapy.

  • Treatment Treatment of rotator cuff injuries

    Treatment of a rotator cuff injury depends on the type of injury you have and how severe it is.

    Self-help

    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.

    Physiotherapy

    Your GP may refer you to a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility). They 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 your rotator cuff tear isn’t getting better after trying other types of treatment, your GP may recommend that you have a steroid injection into your shoulder joint. See our frequently asked questions for more information.

    Surgery

    Your orthopaedic surgeon or sports physician may recommend surgery if your rotator cuff is torn and 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 – 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 using a small thin camera to look inside and treat your shoulder joint.
    • 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 is best for you. See our frequently asked questions for more information about how to speed up your recovery after surgery.

  • Causes Causes of rotator cuff injuries

    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 your 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. This can lead to a tendon tear because it slows down your body’s ability to repair damage.
    • Growths of bone called bone spurs. These may develop on the underside of your acromion as you get older 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 35. This is because most 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.
  • FAQs FAQs

    Am I more likely to dislocate my shoulder if I have rotator cuff injury?

    Answer

    Yes, possibly. Large tears in your rotator cuff can cause your shoulder joint to be less stable and more likely to dislocate.

    Explanation

    Some people dislocate their shoulder because the muscles around their shoulder joint have different strengths. A large rotator cuff tear weakens the muscles that protect your shoulder, which can make the shoulder joint less stable. However, most shoulder dislocations happen as a result of trauma, such as a fall.

    Also, shoulder dislocation itself can sometimes cause a tear in you rotator cuff. If this happens, you’re at a higher risk of dislocating your shoulder again.

    How can I help to speed up my recovery from rotator cuff repair surgery?

    Answer

    It's important to do a programme of daily stretching and strengthening exercises to help your shoulder recover.

    Explanation

    After your operation, you’ll probably wear a sling for between four and six weeks while your shoulder heals. Once your surgeon thinks it’s safe for you to move your arm and shoulder, they will refer you to a physiotherapist. Your physiotherapist will give you a programme of exercises to do to help you regain use of your shoulder. You will usually need to keep doing exercises to strengthen your shoulder for several months.

    It's important to do the exercises as instructed by your physiotherapist to achieve a good outcome after your surgery. You’ll probably be able to get back to your normal activities after about six months.

    How do I know when I'm fully recovered from my rotator cuff injury?

    Answer

    If you no longer have any pain in your shoulder, it's often a good indication that your shoulder has recovered.

    Explanation

    When you’ve recovered from your injury, you shouldn't have any pain in your shoulder. You should be able to:

    • reach behind your back
    • reach overhead
    • push or pull a load of a similar weight to what you were able to move before you had the injury

    The time your shoulder takes to heal can depend on what caused your injury, your age and general health. It can take several months.

    You should have a chat with your GP or physiotherapist to check that you’re fully recovered.

    If I don't have a rotator cuff injury, what other conditions may be causing my shoulder to be painful?

    Answer

    Rotator cuff injuries are the most common cause of shoulder pain, but other conditions can also cause pain in your shoulder.

    Explanation

    Other conditions that can cause pain in your shoulder include the following.

    • A frozen shoulder can cause your shoulder joint to become stiff and painful, making movement difficult. It's more common if you're between 40 and 60, or if you have diabetes.
    • A fracture is a partial crack or full break of a bone. It's usually a result of impact directly onto your shoulder and is very painful.
    • Arthritis is a degenerative condition that can affect your bones and the surrounding muscles and tendons too. Arthritis may cause pain and swelling, and decrease the mobility of your shoulder.
    • Dislocation occurs when the ball of your humerus (upper arm bone) comes out of your ball and socket shoulder joint. It's usually the result of impact or twisting of your arm.

    If I have a steroid joint injection, will there be any side-effects?

    Answer

    Steroid joint injections may cause some side-effects.

    Explanation

    Your GP may recommend that you have a steroid joint injection if your rotator cuff injury isn’t getting better after trying other types of treatment. Side-effects are the unwanted but mostly temporary effects you may get after having a steroid joint injection. Side-effects or potential complications include:

    • an infection in your shoulder joint
    • an increase in pain and swelling in the injected area
    • thinning or a change of colour in the skin near the site of the injection
    • a flushed (red) face and neck
    • feeling faint
    • harder to manage blood glucose control if you have diabetes

    If you're concerned about the side-effects of steroid joint injections, speak to you GP.

  • Resources Resources

    Further information

    Sources

    • Shoulder pain. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published October 2012
    • Shoulder pain. PatientPlus. www.patient.co.uk/patientplus.asp, published 16 May 2012
    • Shoulder pain. Clinical Evidence. clinicalevidence.bmj.com, published 22 July 2010
    • Hole JW, Koos KA. Human anatomy. Mosby. 2nd edition. Dubuque. 1994: 202
    • Map of Medicine. Shoulder pain. International View. London: Map of Medicine; 2013 (Issue 1)
    • Rotator cuff injuries. Medscape. www.emedicine.medscape.com, published 21 April 2014
    • Shoulder impingement/rotator cuff tendinitis. American Academy of Orthopedic Surgeons. orthoinfo.aaos.org, published February 2011
    • Rotator cuff tears. American Academy of Orthopedic Surgeons. orthoinfo.aaos.org, published May 2011
    • Rotator cuff tears: surgical treatment options. American Academy of Orthopedic Surgeons. orthoinfo.aaos.org, published May 2011
    • Shoulder dislocation. Medscape. www.emedicine.medscape.com, published 3 October 2012
    • Shoulder dislocation. PatientPlus. www.patient.co.uk/patientplus.asp, published February 2011
    • Shoulder subacromial injections. Medscape. www.emedicine.medscape.com, published 8 March 2013
    • Joint injection and aspiration. PatientPlus. www.patient.co.uk/patientplus.asp, published 16 May 2012
    • Shoulder trauma (fractures and dislocations). American Academy of Orthopedic Surgeons. orthoinfo.aaos.org, published September 2007 
  • Related information Related information

  • Author information Author information

    Reviewed by Dylan Merkett, Bupa Health Information Team, August 2014.

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