My shoulder hurts! Could it be my rotator cuff?

By Dr. John-Erik Bell

Whether your preferred activity is tennis, paddling, rock climbing, skiing, swimming, golf, or a host of other athletic pursuits, chances are you need a healthy shoulder to enjoy them and perform at your best. Some of the most commonly injured structures in the shoulder are the rotator cuff muscles and tendons.

The rotator cuff is a group of four muscles responsible for stabilizing the shoulder and provides the wide range of motion that lets you do lots of important activities like lifting, reaching, throwing, pushing, and pulling. These muscles connect your upper arm to your shoulder blade and provide strength in rotational and overhead movements of the arm.

The rotator cuff can be hurt either by repetitive motion or a sudden traumatic injury. As you get older, the rotator cuff becomes weaker and is more likely to be damaged. The most common symptoms of a rotator cuff injury are pain with overhead reaching, pain that interferes with sleep, loss of shoulder mobility and weakness of the arm. These symptoms can make simple everyday tasks difficult to complete and can make it difficult to get a good night’s sleep.

Rotator cuff injuries range from simple tendonitis, impingement syndrome or bursitis, calcific tendonitis, partial tears, and complete tears of the tendons. Tendonitis is caused by inflammation of the tendon and is the result of overuse. Inflammation is when the rotator cuff and nearby tissues are irritated and swollen. The rotator cuff is covered by a cushioning tissue called the bursa, which can also become inflamed and painful when it pinches against bone spurs on the shoulder blade. This is called impingement syndrome, which involves both bursitis and rotator cuff inflammation. Occasionally, calcium deposits will form and build up in the rotator cuff, which results in a very painful condition known as calcific tendonitis. The most severe injury of the rotator cuff is when the tendons tear apart. Sometimes these tears are partial, but sometimes the tears can be very serious and actually tear away from the bone they should be attached to.

Fortunately, most rotator cuff problems can be treated without surgery. It is important to see your doctor to make sure that the correct diagnosis is made before starting treatment. Often, this can be done with a good examination of the shoulder and sometimes with x-rays. Your doctor will be able to detect weakness of the rotator cuff, which can be a sign of injury to the tendons. In some cases, an ultrasound or MRI might be necessary to look at the rotator cuff more closely than x-rays can.

Most shoulder problems are first treated with a combination of rest, ice, anti-inflammatory medications, physical therapy, and sometimes injections when pain is severe. Rest means avoiding the specific activities that cause the shoulder pain, such as repetitive overhead motions or heavy lifting, but you should not completely stop using the shoulder or else you could develop a stiff or “frozen” shoulder. Icing the shoulder with an ice pack or a pack frozen vegetables over your shirt or over a thin towel for 15 minutes at a time, two to three times per day can help minimize inflammation. Over-the-counter anti-inflammatory medications such as ibuprofen or naproxen are very helpful as well, but be sure to check with your doctor to make sure these are safe to take. When the pain is especially bad, the injection of powerful anti-inflammatories like cortisone into the inflamed bursa can be extremely helpful. The most important part of treatment for rotator cuff problems is physical therapy. Sometimes this can be done as a home exercise program that you can do on your own, but usually the supervision of a physical therapist is needed as well.

Shoulder therapy focuses on range of motion, strengthening, and stability. The motion and stability of the shoulder blade is often overlooked and is critical to successful treatment of rotator cuff problems. The first phase of therapy focuses on regaining lost mobility of the shoulder, which sometimes is hard to detect, especially external rotation (reaching out to the side while facing forward) and internal rotation (reaching behind your waist and high up on your back). Your rotator cuff is responsible for both of these motions. Once range of motion is restored, the focus turns to strengthening and stability. There are some great recommendations for shoulder therapy that can be found here:

http://patients.dartmouth-hitchcock.org/ortho/exercises_for_overhead_athlete.html

If your shoulder does not improve with these treatments, or if the rotator cuff is completely torn, then your doctor may recommend surgery. Surgery for rotator cuff problems is usually done as an outpatient, which means you don’t have to stay in the hospital. In most cases, the rotator cuff can be repaired “arthroscopically,” requiring only small incisions. A fiber-optic magnifying camera about the diameter of a pen is inserted in the back of the shoulder, which allows the surgeon to see on a high-definition video monitor the bones and cartilage of the shoulder joint, the biceps tendon, the labrum (a ring-like cartilaginous stabilizing cushion that surrounds the socket), the rotator cuff, the bursa, and any bone spurs that may be causing impingement. After surgery, physical therapy is needed to restore function to the shoulder. The success rate for surgery depends on the severity of the tear that is found, but in most cases patients experience significant relief of pain and improvement in function after surgery.

With these recommendations and the help of your doctor, you should be able to return successfully to the activities you love. We’re here to get you back to your passion, and look forward to seeing you on the court, in the water, on the trails, on the field, or on the mountain soon!