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Rotator cuff injury


Expert reviewer, Mr Roger Tillman, Consultant Orthopaedic Surgeon
Next review due February 2020

A rotator cuff injury is when you have inflammation or a tear in the muscles and tendons (connecting tissue) in your shoulder. It can develop 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. A rotator cuff injury can make it difficult and painful to do everyday tasks, such as brushing your hair and getting dressed.

Image of the shoulder of a woman exercising

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. Along with the ligaments that connect the bones in your shoulder together and the capsule that covers your shoulder joint, the rotator cuff helps to keep your shoulder joint in its socket.

A rotator cuff injury is an injury to, or inflammation of (soreness and swelling), the muscles and tendons that make up your rotator cuff.

Types of rotator cuff injuries

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, such as a fall or a dislocated shoulder. Small tears can also develop in the tendon after general wear and tear over a long period of time.
  • Tendinopathy. This is when the tendons of your rotator cuff are no longer able to repair themselves properly, causing pain in and around them. It’s usually because of wear and tear of your rotator cuff over time.

Symptoms of rotator cuff injuries

The main symptom of a rotator cuff injury is pain. The pain can be a dull general ache or it can be severe and sudden if your rotator cuff is torn because of an accident.

The 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. Some people have pain in the muscle of their upper arm too.

Other symptoms of a rotator cuff injury include:

  • a feeling of weakness when you lift or move your arm from the shoulder
  • you’re unable to move your shoulder fully
  • there is a clicking or grating sound when you move your shoulder

These symptoms may be caused by problems other than rotator cuff injuries. 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 will examine you and ask you to do a series of movements to check how well your shoulder is working. They may also ask about any activities you do that could be causing your condition.

Your GP may arrange for you to have other tests, including:


All of these scans can 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 surgeon or a doctor who specialises in joint conditions for example.

Treatment of rotator cuff injuries

The type of treatment you need depends on the type of injury you have and how severe it is.

Self-help

There are a number of 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.

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 also suggest taking paracetamol with codeine. You can buy this from your 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 (a health professional who specialises in maintaining and improving movement and mobility). They will show you a series of specific exercises that you can do at home, to help improve the strength and movement of your shoulder. The type of exercises you have, and how long you will need to do them for, will depend on the type of injury you have.

Steroid injection

If other treatments don’t work, or if your pain is severe or your movement limited, your GP may suggest a steroid injection.

This is an injection into the area around your shoulder joint, which can help to reduce swelling, pain and stiffness. This can ease your symptoms and make physiotherapy exercises more comfortable. Steroid injections can have side-effects, for example your pain may initially get worse or the injection could damage your joint. Talk to your doctor for more information.

Surgery

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

An operation can be done either as open surgery or as keyhole surgery. Open surgery is usually for large tears and involves making a large cut in the skin to do the operation. Keyhole surgery, such as an arthroscopy, involves using a thin, flexible camera and special instruments to look inside and treat your shoulder joint.

Your surgeon will be able to 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 have 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, swimming and lifting heavy weights above shoulder height.

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 six and 12 months to fully recover from rotator cuff surgery.

  • Rotator cuff injuries are the most common cause of shoulder pain. Other conditions that can also cause shoulder pain include.:

    • 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 that affect the joint between your shoulder and collarbone. This is called the acromioclavicular joint.
    • Inflamed biceps tendon. The biceps tendon connects your biceps muscle to your bone at the top of your arm.
    • The structure around the rim of your shoulder socket tearing. This is known as a glenoid labral tear.

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Related information

    • Rotator cuff injury. BMJ Best Practice. bestpractice.bmj.com, last updated January 2016
    • Shoulder pain. PatientPlus. patient.info, last checked June 2015
    • Rotator cuff tears. American Academy of Orthopedic Surgeons. orthoinfo.aaos.org, last reviewed May 2011
    • Shoulder pain. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2015
    • Rotator cuff injuries. Medscape. emedicine.medscape.com, updated February 2016
    • Musculoskeletal problems. Oxford handbook of General Practice. (online). Oxford Medicine Online. oxfordmedicine.com, published online April 2014
    • Rotator cuff injury. The MSD Manuals. www.msdmanuals.com, last full review October 2014
    • Joint injection and aspiration. PatientPlus. patient.info, last checked February 2016
    • Carr AJ, Cooper CD, Campbell MK, et al. Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]. Health Technol Assess 2015; 19(80)
    • Frozen shoulder. PatientPlus. patient.info, last checked October 2015
    • Hypermobility syndrome. PatientPlus. patient.info, last checked October 2015
    • Biceps tendonitis. PatientPlus. patient.info, last checked June 2013
    • Glenoid labral tear. MSD Manuals. www.msdmanuals.com, last reviewed October 2014
    • Rotator cuff repair. Shoulderdoc.co.uk. www.shoulderdoc.co.uk, accessed September 2016
    • Factor D, Dale B. Current concepts of rotator cuff tendinopathy. Int J Sports Phys Ther 2014; 9(2):274–88
    • Personal communication, Dr Leon Creaney, Consultant Sport and Exercise Medicine Physician, September 2016
    • Shoulder anatomy animated tutorial. Medical MultiMEDIA Group. eorthopod.com, accessed September 2016
  • Reviewed by Sarah Smith, Freelance Health Editor, October 2016
    Expert reviewer, Mr Roger Tillman, Consultant Orthopaedic Surgeon
    Next review due February 2020



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