Health Topics for Bones, Joints and Muscles

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Department of Orthopaedics

Sports Related Injuries

Rheumatology Clinic

Pediatrics Rheumatology

UI Spine Center

Rotator cuff injury

Common injuries of the rotator cuff are tendonitis, bursitis, impingement syndrome, and rotator cuff tear. The rotator cuff is made up of muscles and tendons that hold the bones of the shoulder in place. The rotator cuff helps to move the shoulder and make it stronger. A bursa is a fluid filled sac. There are two bursae between the shoulder joint and the rotator cuff that keep the cuff from rubbing on the shoulder.

The shoulder is the most moveable joint in the body. Because the shoulder can move so many different ways, it is not very stable. Injuries to the shoulder are often overuse injuries. Overuse injuries usually happen to people over 40 years old. An injury might result from:

• a fall on the shoulder or an out-stretched hand
• moving the shoulder in the same way over and over or
• lifting heavy items

Tendonitis is an inflammation of a tendon usually caused by the tendon being pinched between other parts of the shoulder. Tendonitis can cause the tendon to become thicker. Impingement syndrome occurs when the thickened rotator cuff tendon gets trapped under a bone of the shoulder. Bursitis is an inflammation of a bursa. Tendonitis, bursitis and impingement syndrome may occur alone or all at the same time.

A rotator cuff tear may be acute or chronic. An acute tear is usually from a fall on the shoulder or a severe injury. A chronic tear happens when the shoulder is moved in the same way over and over. This happens gradually over a long time.

Symptoms of an injury to the rotator cuff may include shoulder pain, mostly when moving the shoulder or sleeping on it. The shoulder may feel weak, or it may be hard to lift the arm out from the body or over the head. Often the symptoms start slowly. If there is an injury like a fall the pain will be sudden. When an acute tear happens there will be a tearing feeling in the shoulder and pain that goes into the arm.

A healthcare provider should be seen for pain in the shoulder. Usually, the provider will have the person with an injury see an orthopedic specialist. An orthopedic specialist treats injuries to bones, muscles, and joints. X-rays, MRI, or an arthrogram may be needed. An arthrogram is done by injecting dye into the shoulder joint and taking an x-ray.

Treatment starts with rest of the shoulder, ice, and non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxen. Rest the shoulder for several days, then slowly start gentle stretching exercises. A cloth-covered ice pack can be put on the shoulder for no more than 20 minutes 4 to 8 times a day. Aspirin or medicines that have aspirin in them should not be given to anyone younger than 18 years of age. Taking aspirin is a risk for a serious illness called Reye's syndrome. Non-steroidal anti- inflammatory drugs (NSAIDs) should be taken with food or milk to prevent stomach upset. NSAIDs should be avoided by anyone who has been diagnosed with asthma, ulcer disease, or a bleeding disorder. Taking NSAIDs increases the risk of bleeding with trauma, dental work, surgery, or if taking blood thinners (anticoagulants).

Sometimes an ultrasound treatment will be used. This warms deep tissues and helps the blood flow. Occasionally, the provider may inject a steroid medicine into the shoulder. If there has not been any improvement after 6 to 12 months, surgery may be needed. Usually, this will be an arthroscopy. An arthroscopy, is a surgery using a small lighted telescope to look in the shoulder joint. A very small cut is made for the arthroscope. Other small cuts may be made for other small instruments. Often open surgery is needed for an acute tear that is all the way through the rotator cuff.

Shoulder injuries can be prevented. Shoulder exercises strengthen the muscles and tendons of the shoulder joint and keep it moving. Anyone with a job with a lot of physical activity with shoulder movement, should take breaks often to rest the shoulders. If shoulder pain lasts longer than a few days or is sudden and severe, a healthcare provider should be seen.

Last Reviewed 2005

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIL File BONE3450.RF2 VRS# 7637 Data Version 7.0 Copyright 1999-2000, 2003 McKesson Health Solutions LLC. All rights reserved.