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The rotator cuff is a group of tough, flexible fibres (tendons) and muscles in the shoulder. Rotator cuff disorders include:
Most rotator cuff disorders are caused by a mix of overuse and normal wear and tear. It usually takes great force to tear a healthy rotator cuff tendon. This can happen during sports, an accident, or a severe fall.
A rotator cuff disorder causes pain and weakness in your shoulder. Most often, the pain is on the side and front of the upper arm and shoulder. It may hurt when you do everyday things, such as comb your hair or reach for something. You may have pain during the night and trouble sleeping.
To diagnose a rotator cuff disorder, doctors ask about any shoulder injuries or past shoulder pain. They also do a physical exam to check for painful areas or activities. You may have an X-ray to check the bones in the shoulder. If needed, the doctor may order more tests.
Treatment of a rotator cuff disorder depends on your symptoms, your age, and how active you are. Most are treated without surgery. You may get medicines and use home treatment, such as rest and applying cold or heat. You may have physiotherapy. Your doctor may also give you a shot of steroid medicine in the shoulder if other treatments haven't worked.
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Most rotator cuff disorders are caused by a mix of overuse and normal wear and tear.
Activities in which you use your arms above your head a lot—such as tennis, swimming, or house painting—can lead to rotator cuff problems. Even normal motions made often over a long period can stress or injure the rotator cuff.
Using your shoulder for many years slowly damages the rotator cuff. As you age, everyday activities can lead to changes in the rotator cuff. These changes include thinning and fraying of the tendons and reduced blood supply.
It takes great force to tear a healthy rotator cuff tendon. This can happen during sports, a mishap, or a severe fall. But even a simple movement like lifting a suitcase can cause a rotator cuff tear in an older adult or someone whose shoulder is already damaged.
Things that may increase the risk of rotator cuff disorders include:
The long-term changes to the shoulder joint from everyday wear and tear can't be totally prevented. But you may be able to prevent some rotator cuff problems if you:
A rotator cuff disorder causes pain and weakness in your shoulder. It may hurt to do everyday activities, such as combing your hair, tucking in your shirt, or reaching above your head.
Because of the pain, you may try not to use your arm. And that can cause even more weakness and stiffness in the shoulder.
With tendinopathy (damage or irritation to the tendon), the pain usually starts bit by bit, over the side of the shoulder and the upper arm.
Over time, the pain may get worse, or you may have constant pain. In some cases, this is because you actually have one or more small tendon tears.
The most common symptoms of a tear are:
Symptoms of a sudden, severe tear include:
You can have a complete tear without symptoms, especially if you are an older adult who is not very active.
If the rotator cuff problem isn't checked, wear and tear and limited movement can lead to other shoulder problems. These may include stiffness or frozen shoulder. Doing some activities can lead to problems like bursitis and tendinopathy. Recovery varies. Most people feel better after several weeks of rehabilitation. Some treatments can last longer.
Call 911 or other emergency services immediately if shoulder or arm pain occurs with chest pain or other symptoms of a heart attack, such as shortness of breath and nausea.
Call your doctor now if you have an injury to your shoulder and:
Call your doctor if:
Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next. A watchful waiting period may vary from a few days to weeks or maybe months.
To diagnose a rotator cuff disorder, doctors ask about any shoulder injuries or past shoulder pain. They also do a physical exam. The exam helps them to see how well the shoulder works and to find painful areas or activities. Moving your arm in certain ways can help the doctor learn about the condition of the rotator cuff.
You may have an X-ray to check the bones of the shoulder. If the diagnosis is still unclear, the doctor may order more tests. This may include an imaging test, such as an MRI, an ultrasound, or sometimes an arthrogram.
Your doctor thinks about your age, job, and activity level when deciding about more tests. A clear diagnosis is important if you are likely to keep doing things that may do more damage to your shoulder.
Treatment depends on your symptoms, your age, and how active you are. Your treatment may include:
Most rotator cuff disorders aren't treated with surgery. But doctors may do surgery if a rotator cuff tendon is torn. They may also do it if several months of other treatments haven't helped. Whether or not you get surgery will depend on your age, the amount of other damage in the shoulder, and the chances that surgery will be a success in your case. And surgery is not a substitute for physiotherapy. Even after surgery, you may need months of physiotherapy to recover fully.
Home treatment is often the first treatment for a rotator cuff problem. Treatment can help relieve the pain and keep the problem from getting worse.
Medicines don't heal rotator cuff disorders. They help with pain and inflammation. This allows you to start exercises to stretch and gradually strengthen the shoulder, which reduces the risk of stiffness or a frozen shoulder.
The types of medicines used to treat a rotator cuff disorder are:
NSAIDs are the most common medicines used to help manage rotator cuff disorders. They are available with or without a prescription. NSAIDs come in pills and in a cream that you rub over the sore area. Or you can use acetaminophen.
These are strong medicines that are often only given after a few weeks of other treatment. Your doctor may recommend not having this shot near the time of rotator cuff surgery.
Surgery may be an option if:
Surgery mostly is used to repair a torn rotator cuff when there is little sign of other problems. People who have advanced rotator cuff disorders and tendons that are frail and stiff usually do less well with surgery. Surgery may work to repair the tear. But it can't repair all the damage caused by age or degeneration.
Shoulder surgery may include:
Sometimes a rotator cuff tear is too severe to be fixed in the usual ways. Your doctor may suggest surgery to move another tendon, replace the torn tendon, or surgery to replace the shoulder.
A physiotherapy (PT) and rehabilitation (rehab) program usually involves exercises to stretch and slowly strengthen the shoulder. Stretching includes range-of-motion exercises. Exercises to strengthen can help you build and keep shoulder function and stability. Some physiotherapists may use other techniques to relieve pain and reduce muscle spasms. These may include massage or ultrasound.
Rehab may be used without surgery. Or it may be part of your recovery after surgery. It can reduce pain in the soft tissues, such as the muscles, ligaments, and tendons. It can also improve function and build muscle strength.
A good recovery depends a lot on how you do with rehab. If you follow your PT plan closely and get help when you need it, you are more likely to restore your shoulder's strength and movement.
Current as of: November 9, 2022
Author: Healthwise StaffClinical Review Board: William H. Blahd Jr. MD, FACEP - Emergency MedicineAdam Husney MD - Family MedicineKathleen Romito MD - Family MedicineKenneth J. Koval MD - Orthopedic Surgery, Orthopedic Trauma
Current as of: November 9, 2022
Author: Healthwise Staff
Medical Review:William H. Blahd Jr. MD, FACEP - Emergency Medicine & Adam Husney MD - Family Medicine & Kathleen Romito MD - Family Medicine & Kenneth J. Koval MD - Orthopedic Surgery, Orthopedic Trauma
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