The rotator cuff is a group of muscles that attach via tendons to the head of the upper arm bone (the humerus). The function of the cuff is to center the head of the humerus in the socket and move the arm. These tendons are in a constant state of rebuilding and breaking down. When the rate of breaking down exceeds the ability of the tendon to rebuild, micro tears occur causing pain and inflammation. This inflammation is known as tendonitis. In the extreme case, this inflammation can result in the failure of the tendon known as a rotator cuff tear. Repetitive overhead activity or heavy lifting can irritate or weaken the tendon. Sometimes this can also lead to a gradual tear in the rotator cuff tendon making it difficult to raise or rotate your arm. Acute tears can also happen with a sudden force that overwhelms the tendon such as a shoulder dislocation. This results in an immediate inability to raise or rotate the arm.
Rotator cuff tendonitis and tears
- Over use. Engaging in repetitive overhead activities such as swimming, throwing, playing tennis, or pitching
- Age, As we age, the blood supply that allows the tendon to build up and break down decreases. Over the age of 40, this makes the tendon more prone to inflammation (i.e., tendonitis and tear)
- Arthritis. People who develop shoulder arthritis can form bone spurs that can impinge and wear the tendon leading it to tear
- Heavy manual labor jobs and certain sports. Occupations involved include carpentry or house painting and sports include those requiring repetitive overhead activity such as pitchers, quarterbacks, or tennis players
- A dull ache deep in the shoulder
- Difficulty/ pain if sleeping, especially if you lie on the affected side
- Difficulty/pain reaching overhead or behind your back
- Immediately if you are unable to raise your arm after an injury or the pain is severe
- If the pain continues for longer than three weeks
Untreated rotator cuff tendonitis or tears can lead to permanent loss of motion or strength and can lead to progressive wearing out of the joint. If the shoulder is not moved for a long time, the surrounding tissue can get scarred or thickened causing a frozen shoulder with very limited motion.
- History. The first step to a diagnosis is a thorough history, including when and how the pain began. Was it directly related to a trauma or of gradual onset? Where is the pain located? Are there any other issues that can masquerade as shoulder pain such as a history of neck arthritis?
- Physical Exam. Look for abnormal findings, including tenderness, weakness, deformity, and decreased range of motion. Provocative tests will be performed to help isolate the source of the pain.
- Imaging. X-rays are typically taken to examine the bones that make up the shoulder.
- MRI and ultrasound help evaluate the soft tissues identifying tears or inflammation of the tendons
Treatment for tendonitis usually involves rest from the offending activity. Physical therapy can help improve the flexibility of the shoulder, which decreases the stress on the tendons and strengthens the rotator cuff and other muscles of the functional shoulder unit.
Medications taken either by mouth or local injection can be used to reduce inflammation and pain.
Surgery is used in the treatment of rotator cuff tendonitis and tears. In the setting of tendonitis or gradual tears, surgery is used to remove any spurs that may be impinging on the cuff causing the tendonitis or tear and to repair the torn cuff. Acute traumatic rotator cuff tears usually require immediate surgery.
- Stretch regularly and before activity
- Strengthen your shoulder girdle muscles
- Maintain the range of motion of your shoulder
- Avoid nicotine
- Gradually work up to heavy lifting if desired as part of your workout routine