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Rotator cuff injury


Expert reviewer, Mr Roger Tillman, Consultant Orthopaedic Surgeon
Next review due May 2022

A rotator cuff injury is when you have inflammation (soreness and swelling) or a tear in the muscles and tendons (connecting tissue) in your shoulder. You can develop it after an injury to your shoulder or after years of wear and tear on your shoulder joint. It’s a common cause of shoulder pain and is more likely to affect older people or active people. If you have a rotator cuff injury, it can be difficult and painful to do everyday tasks, such as brushing your hair and getting dressed.

A woman's shoulder

About rotator cuff injury

Your rotator cuff is the group of muscles and tendons that surround your shoulder joint. They work together to keep your shoulder stable and working well. The rotator cuff works with the ligaments that connect the bones in your shoulder together, to keep your shoulder joint in its socket. A capsule that covers your shoulder joint also helps to keep it in place.

If you injure these muscles and tendons or they become sore and swollen over time, it’s called a rotator cuff injury.

Types of rotator cuff injury

There are a number of conditions that can affect your rotator cuff. The main ones are listed below.

  • 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. Tears can develop after an injury or if you dislocate your shoulder. Small tears can also develop in the tendon after general wear and tear over a long period of time.
  • Tendinopathy. This is when you have pain in and around the tendons of your rotator cuff because they are no longer able to repair themselves properly. It’s usually because of wear and tear of your rotator cuff over time.

You can also have a combination of wear and tear with an injury, which is why shoulder injuries or pain can become more common over the age of 40.

Symptoms of rotator cuff injuries

The main symptom of a rotator cuff injury is pain at the top and side of your shoulder. The pain can be a dull general ache, or it can feel severe and sudden if you tear your rotator cuff in an accident.

Shoulder pain often gets worse if you’re doing something where your arm is above your head. You may also find that the pain is worse at night, especially if you sleep on the injured shoulder. In this case, it can affect your sleep and make you feel tired.

Other symptoms of a rotator cuff injury include:

  • a feeling of weakness when you lift or move your arm from the shoulder
  • inability to move your shoulder fully
  • a clicking or grating sound when you move your shoulder

These symptoms may be caused by problems other than rotator cuff injury. If you have any of these symptoms, see your physiotherapist or GP for advice.

Diagnosis of rotator cuff injuries

Your physiotherapist or GP will ask about your symptoms and your pain. They’ll examine you and ask you to do certain movements to check how well your shoulder is working. They may also ask about any activities you do that could be causing your condition.

You might need to have some other tests, which may include:


All of these scans show your doctor images of the inside of your shoulder.

Depending on the cause of your pain, your GP may refer you to see a specialist. This could be a physiotherapist, a surgeon or a doctor who specialises in joint conditions.

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Treatment of rotator cuff injuries

The type of treatment you need depends on the type of injury you have, and how severe it is. Your doctor will discuss your options with you and advise you which is best for you.

Self-help

There are some things that you can do to help yourself. Rest your shoulder as much as you can – try not to lift heavy weights or do activities that involve lifting your arm over your head. There are some gentle stretches you can do that may help. See the section on Physiotherapy (below) for more information.

You might find it helps to use an ice pack to help relieve pain. Wrap the ice pack in a towel or dishcloth before using it. Never put an ice pack directly on to your skin as it may cause damage or give you a burn.

If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. If these don’t work well enough, your GP may suggest taking paracetamol with codeine. You can buy this from a pharmacy. 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. They’ll show you some rotator cuff stretches and exercises that you can do at home to help improve the strength and movement of your shoulder. The type of exercise and how long you will need to do them will depend on the type of injury you have.

Steroid injection

If the treatments above don’t work or your pain is severe or your movement limited, you may need to have a steroid injection. This is an injection into the area around your shoulder joint. It can help to reduce swelling, pain and stiffness. This will ease your symptoms and make physiotherapy exercises more comfortable. However, steroid injections can have side-effects. For example, you may find your pain initially gets worse or you get facial flushes. Talk to your doctor for more information.

Surgery

If other treatments haven’t worked for you or if you have a large tear, your doctor may suggest you have an operation.

An operation can be done either as open surgery, mini-open repair or keyhole surgery. Open surgery is usually for large tears and involves making a large cut in your skin to do the operation. In mini-open repair, your surgeon will do the operation through a small cut. They’ll use arthroscopy as part of the operation too. Keyhole surgery (arthroscopy), involves using a thin, flexible camera and special instruments to look inside and treat your shoulder joint.

Your surgeon will give you advice on which type of surgery is best for you. Treatment for a rotator cuff injury aims to ease your pain and to give you as much movement in your shoulder as possible. But recovering from a rotator cuff injury can be a slow process. You may need to take several weeks off work, particularly if you have an operation to repair a tear.

Causes of rotator cuff injuries

There are some things that may make a rotator cuff injury more likely. If you’re over 60, you’re more likely to develop this type of injury. This is because you’ve had more wear and tear on your shoulder joint than younger people.

You’re also more likely to develop a rotator cuff injury if you do a lot of repeated overhead movements. This includes activities such as throwing, painting, lifting weights and swimming front crawl.

Frequently asked questions

  • After your operation you’ll be asked to wear a sling. At first, you’ll be asked to do some gentle physiotherapy exercises. Your physiotherapist will show you what you need to do and will gradually build the exercises up to help strengthen your shoulder and regain full movement.

    How long you need to do exercises for will depend on how severe your injury was and the type of operation you had. It can take between three months to a year to fully recover from rotator cuff surgery.

  • Rotator cuff injuries are the most common cause of shoulder pain. Other causes of shoulder pain include the following.

    • Frozen shoulder. This is when your shoulder joint becomes stiff and painful, making movement difficult. Treatment includes painkillers, physiotherapy and steroid injections.
    • Conditions which cause your shoulder joint to become unstable. These include a dislocated shoulder and hypermobility, which is when your joints move easily beyond the normal range.
    • Conditions such as arthritis in the joint between your shoulder and collarbone (the acromioclavicular joint).
    • Inflamed biceps tendon. The biceps tendon connects your biceps muscle to your bone at the top of your arm.
    • Tearing in the structure around the rim of your shoulder socket. This is known as a glenoid labral tear.

    The symptoms of these conditions can sometimes overlap, so it’s important to get medical advice to make sure you get the right diagnosis and treatment.

  • No, but the symptoms of a rotator cuff injury and frozen shoulder can be similar so it can be difficult to tell which condition you have. Both conditions will give you pain in your shoulder and restrict your movement. But there are some subtle differences.

    • With a frozen shoulder, your symptoms will often develop slowly over time.
    • If you have a frozen shoulder, your shoulder is likely to feel painful when you move it. The condition can limit your shoulder movement in all directions. This can restrict your everyday life because even putting on a jacket can be difficult.
    • A rotator cuff injury may develop slowly after years of wear and tear on your shoulder joint. But it may come on suddenly if you injure your shoulder joint.
    • If you have a rotator cuff injury, the pain often gets worse if you’re doing something where your arm is above your head.
    • You might hear a clicking or grating noise with a rotator cuff injury but you won’t have this if you have a frozen shoulder.

    Your doctor may be able to tell the difference between the two conditions by examining you and asking about your symptoms. But sometimes you’ll need to have a scan to check this.


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Related information

    • Rotator cuff injury. BMJ Best Practice. bestpractice.bmj.com, last reviewed December 2018
    • Rotator cuff tears. OrthoInfo. orthoinfo.aaos.org, last reviewed March 2017
    • Shoulder pain. PatientPlus. patient.info/patientplus, last edited 23 June 2015
    • Rotator cuff injuries. Medscape. emedicine.medscape.com, updated 12 February 2016
    • Shoulder anatomy animated tutorial. Medical Multimedia Group eOrthopod.com. www.youtube.com, published September 2016
    • Shoulder pain. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2017
    • Tendinopathy. BMJ Best Practice. bestpractice.bmj.com, last reviewed December 2018
    • Rotator cuff injury/subacromial bursitis. The MSD Manuals. www.msdmanuals.com, last full review/revision March 2018
    • Subacromial shoulder pain – commissioning guide. Royal College of Surgeons. www.rcseng.ac.uk, published 2014
    • Rotator cuff and shoulder conditioning program. OrthoInfo. www.orthoinfo.org, published 2017
    • Joint injection and aspiration. PatientPlus. patient.info/patientplus, last edited 15 February 2016
    • Sun Y, Chen J, Li H, et al. Steroid injection and nonsteroidal anti-inflammatory agents for shoulder pain. A prisma systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2015; 94(50):e2216. doi: 10.1097/MD.0000000000002216
    • Personal communication, Mr Roger Tillman Consultant Orthopaedic Surgeon, 1 April 2019
    • Joint hypermobility. Versus Arthritis. www.versusarthritis.org, accessed 9 January 2019
    • Acromioclavicular joint problems. PatientPlus. patient.info/patientplus, last edited 24 August 2016
    • Bicipital tendinopathy. PatientPlus. patient.info/patientplus, last edited 2 November 2016
    • Glenoid labral tear. The MSD Manuals. www.msdmanuals.com, last full review/revision March 2018
  • Reviewed by by Rachael Mayfield-Blake, Freelance Health Editor, May 2019
    Expert reviewer, Mr Roger Tillman, Consultant Orthopaedic Surgeon
    Next review due May 2022



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