Rotator cuff injury and treatment

Your rotator cuff is the group of muscles and their tendons that surround your shoulder joint. Tendons are strong bands of tissue that connect muscles to bones. Your rotator cuff helps to keep your shoulder stable and moving well.

You can injure your rotator cuff suddenly, or it can happen over time due to wear and tear on your shoulder joint.¹

There are different types of rotator cuff injury. The main ones include:

• rotator cuff tear. This is when one or more of the muscles and tendons that make up your rotator cuff tears. You can have a partial or a full tear. A tear can happen suddenly, after a single injury. Or, it can develop gradually, over time.²
• tendinopathy. This term covers many different conditions affecting the tendons around your shoulder. Sometimes the tendons can become trapped between a bone at the top of your arm and the top of your shoulder blade. This is called subacromial or shoulder impingement.

Most rotator cuff injuries develop slowly, over time. You’re more likely to develop them as you get older. This is because as you age, the amount of wear and tear on your shoulder joint increases. Your tendon also can’t repair itself as well as you get older.

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, freestyle swimming and sports such as tennis.

You can also get a tear in your rotator cuff if you have a sudden (acute) injury to your shoulder. This might include a fall or other accident.³

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. Sometimes the pain can spread down towards your elbow.

Shoulder pain often gets worse if you’re doing something where you lift your arm or raise it 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 rotator cuff injury symptoms include:

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

There are other problems affecting your shoulder that may cause these symptoms. If you have any of these symptoms, see your GP or physiotherapist for advice.

Your physiotherapist or GP will usually be able to diagnose rotator cuff injury by asking about your symptoms and examining you. You will be asked about any injuries you’ve had, and about any activities that increase your pain. They will examine your shoulders and ask you to do certain movements to check how well your shoulder is working.

In some cases, your GP may recommend getting images of your shoulder to get a better look at what is happening with your rotator cuff and shoulder joint. This may include:

• a shoulder X-ray
• an MRI scan
• an ultrasound scan.

The type of rotator cuff injury treatment you’ll have depends on several factors. These include the type of injury you have, how severe it is, your age and how active you usually are.

Most rotator cuff wear and tear injuries are a part of the normal ageing process and physiotherapy can help to relieve pain, build up strength in your shoulder and get you back to full function.

If your injury is serious and unlikely to improve with rest and physiotherapy, your GP may refer you to an orthopaedic surgeon to determine whether surgery to repair the injured shoulder is the best for you. For many people, non-surgical management can be enough to allow you to use your shoulder again.⁴

You may be advised to rest your shoulder for a period of time. You’ll need to avoid lifting heavy weights or activities that involve lifting your arm over your head.⁵ You can gradually start to increase the activity you do when your shoulder starts to feel better.

You might find it helps to use an ice pack to relieve pain. Over the counter pain relief such as paracetamol or anti-inflammatories might also help. Your GP or pharmacist can help with medication advice.

A physiotherapist can show you some rotator cuff stretches and exercises you can do at home to help improve the strength and movement of your shoulder. The exact exercises you’ll need to do will depend on the type of injury you have. You may continue having physiotherapy sessions for up to 6 weeks. Many people make a good recovery within this time.

If your shoulder pain is still severe despite trying the measures above, your GP can refer you for a steroid injection. A steroid injection can help to reduce swelling and pain in your shoulder. This may reduce your symptoms enough to be able to continue with physiotherapy exercises. However, steroid injections can have side-effects. You should speak to your GP or physio to help you weigh up the risks and benefits of having one.

Your GP may refer you to an orthopaedic surgeon if you have a rotator cuff tear caused by a sudden injury or if you have a long-term injury and other treatments haven’t helped.

Types of surgery for a rotator cuff injury include open surgery, mini-open repair and keyhole surgery.⁶

• Open surgery is usually for large tears and involves making a single large cut at the front of your shoulder to do the operation.
• Keyhole surgery (arthroscopy) is where your surgeon inserts special instruments through small cuts in your shoulder joint to look inside and repair the tear.
• Mini-open repair involves using both arthroscopy and making a small cut to perform the operation.

You and your surgeon will discuss which type of surgery is best for you.

You’ll need to commit to a rehabilitation program after rotator cuff surgery, to help regain the strength and movement in your shoulder. This can be a slow process, and it can take over 6 months to get back to normal function.⁷ You will not get back the same strength that you had before your rotator cuff injury, but sticking to your rehabilitation program will increase your chances of a successful recovery.

This article was originally published on bupa.co.uk and has been amended in line with Australian guidelines.

The Australian Physiotherapy Association can help you find a physio near you.

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Musculoskeletal Health Australia provides information and support for people living with arthritis and musculoskeletal conditions. Visit their website or call them on 1800 263 265.