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Rotator cuff injury

Key points

  • Rotator cuff pain can be caused by inflammation or tearing of your rotator cuff tendons or msucles. Or a tendon becoming trapped or squeezed.
  • Rotator cuff injury is more common if you do repetitive actions that raise your arms, such as racket sports, swimming or decorating. Rotator cuff injuries can also result from an accident or fall.
  • Treatment involves resting your shoulder, pain relief and rehabilitation exercises. Corticosteroid injections can help with the pain. Some people may need surgery to repair a torn rotator cuff.

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

About rotator cuff injuries

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.

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 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.

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.

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.

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.

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

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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