Rotator cuff injuries

Rotator cuff injury

Rotator cuff injury is one of the most common causes of shoulder pain. There are three common conditions that affect the rotator cuff:

• rotator cuff tendonitis
• rotator cuff impingement syndrome
• rotator cuff tear

Most people with rotator cuff injuries can be successfully treated by a combination of rest, painkillers, anti-inflammatories, osteopathy and occasionally steroid injections. Surgery is sometimes necessary.

What is the rotator cuff?

The rotator cuff is a group of four muscles that are located around the shoulder joint. The rotator cuff muscles help to stabilise the shoulder joint and help with movement of the shoulder. The four tendons of the rotator cuff muscles form one large tendon, called the rotator cuff tendon. This tendon attaches to the top of the humerus. The rotator cuff tendon passes through a very tight space between the bony tip of the shoulder and the ball and socket joint itself. This is where the tendon is most vulnerable to injury.

What are the types of rotator cuff injury/inflammation?

• Rotator cuff tendinitis
• Rotator cuff impingement syndrome
• Rotator cuff tear

Rotator cuff tendinitis

What causes rotator cuff tendonitis?

Tendinitis is the most common problem that affects the rotator cuff. It tends to have a relatively sudden onset, often due to a specific injury. It can also happen due to overuse of the shoulder. It may occur in athletes, particularly those who participate in throwing sports. In non-athletes, there may be a history of recent repetitive movement of the shoulder, for example gardening, or DIY.

Sometimes if the problem is more longstanding, the rotator cuff tendons can develop calcium deposits within.  This is called calcific tendinitis.

What are the symptoms of rotator cuff tendonitis?

The main symptoms are a sudden onset of pain in the shoulder. The pain typically radiates down the arm towards the elbow. It is aggravated by elevating the arm above the horizontal. Sometimes the pain can be sufficiently bad to interfere with sleep.

How is rotator cuff tendonitis diagnosed?

Dr Allfree will normally be able to make the diagnosis just by talking to you and examining your shoulder. He will also examine your shoulder. This usually involves asking you to put your shoulder in various positions. One particular test that can help to diagnose rotator cuff tendinitis is called the painful arc test - you will be asked to start with your arm by your side and then elevate it outwards from your side in an arc. If there is rotator cuff tendnitis, pain is usually felt at a maximum between 70 and 120° in this arc.

Occasionally, you will need to have an x-ray of your shoulder or a more detailed investigation such as an ultrasound scan or an MRI scan. Dr Allfree will be able to request these if necessary.

What are the treatment options for rotator cuff tendonitis?

• Rest is very important for rotator cuff tendonitis. You must stop any aggravating activities that may have brought on the tendinitis. However, do not completely rest your shoulder, because this may cause the shoulder to become stiff, and develop a secondary frozen shoulder.
• Painkillers such as paracetamol are usually helpful. 
• Anti-inflammatories such as ibuprofen are commonly prescribed, although they do have some side-effects.
• Osteopathy may help to keep the shoulder mobile, and you will also be given some simple mobilising exercises to do at home.
• Steroid injections can help to reduce the inflammation in the rotator cuff tendons. They can be repeated if the initial response is good.

Calcific tendonitis is treated in the same way with rest, anti-inflammatory medication, steroid injections and osteopathy. Occasionally, surgery is necessary. An alternative to surgery is a procedure called Extracorporeal Shock Wave Therapy. This helps to break up the deposits of calcium.

What is the outlook for rotator cuff tendonitis?

If rotator cuff tendonitis is adequately treated, there can be complete recovery. If treatment is delayed, this can lead to stiffness of the shoulder, and development of a secondary frozen shoulder, which will delay recovery significantly. 

Rotator cuff impingement syndrome

In impingement syndrome, the rotator cuff tendon gets trapped in the tight space underneath the bony tip of the shoulder. The tendon can eventually become frayed, and this may lead ultimately to a full-blown rotator cuff tear. 

Impingement syndrome occurs usually either due to wear and tear, or to an abnormality in the shape of the bony tip of the shoulder.

What are the symptoms of rotator cuff impingement syndrome

Rotator cuff impingement syndrome causes shoulder pain, which tends to radiate down the arm towards the elbow. The pain tends to be aggravated by elevating the arm above the horizontal, and it is normally worse at night, especially if you lie on the painful side.

How is rotator cuff impingement syndrome diagnosed?

Dr Allfree will usually be able to diagnose rotator cuff impingement syndrome by talking to you and examining your shoulder. You may well have a painful arc.

What are the treatment options for rotator cuff impingement syndrome?

The treatment for rotator cuff impingement syndrome is similar to that for rotator cuff tendinitis. You need to rest from any activity that involves repetitive movement of the shoulder, especially any overhead activity. You may have to modify  your work activities. It is important to keep the arm moving in order to prevent development of a secondary frozen shoulder. Painkillers, anti-inflammatories, osteopathy and steroid injections can often help.

If these treatments are unsuccessful, some people may need to have a surgical decompression operation to enlarge the space for the rotator cuff tendon.

What is the outlook  for rotator cuff impingement syndrome?

With appropriate treatment a rotator cuff impingement syndrome can settle down. Sometimes, however, it may lead to excessive wear and tear of the rotator cuff tendon, which may be a precursor to the development of a full-blown rotator cuff tear.

Rotator cuff tears

What causes a rotator cuff tear?

Rotator cuff tears are most common in people over the age of 45, and are normally due to a longstanding process of wear and tear. The tears are normally within the tendon rather than in the muscles themselves. Younger people can develop rotator cuff tears, but these are normally due to specific injuries.

Rotator cuff tears can be partial or complete depending on the amount of damage to the tendon.

What are the symptoms of a rotator cuff tear?

Pain is the most common symptom of a rotator cuff tear. The pain radiates down the arm towards the elbow, and is aggravated by moving the arm in certain specific directions. The arm will also feel weak if the tear is sufficiently large. 

How is a rotator cuff tear diagnosed?

​Dr Allfree will usually be able to diagnose a rotator cuff tear by talking to you, and by examining your shoulder. If the tear is sufficiently big, you may need an MRI scan or an ultrasound scan, and referral to a surgeon may need to be considered.

What are the treatment options for a rotator cuff tear?

• Painkillers can be helpful in rotator cuff tears. Occasionally, stronger painkillers may be needed.
• Anti-inflammatories such as ibuprofen may help. Side-effects sometimes occur with anti-inflammatories. 
• Ice packs can also help to reduce pain. Purpose made ice packs are available from the Mansfield Clinic.
• Osteopathy may be helpful for people with minor rotator cuff tears.
• Steroid injections to reduce inflammation can be a helpful treatment for minor tears. 
• Surgery is sometimes necessary for large tears, although full repair is not always possible, especially if there is a significant amount of degeneration in the tendon. Surgically widening the space underneath the bony tip of the shoulder may help.

What is the outlook for rotator cuff tears?

Symptoms caused by a small rotator cuff tear may be successfully eased with non-surgical treatments, including rest, osteopathy, painkillers, anti-inflammatories and steroid injections. Surgery may be considered for larger tears, although the results are not always entirely satisfactory.