A rotator cuff tear is an injury that damages the fibers of the tendons and muscles that stabilize the shoulder, collectively called the rotator cuff. Depending on the severity of the injury, a rotator cuff tear may involve some or all of the tendon fibers.
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What is a rotator cuff injury?
A rotator cuff injury affects the muscles and tendons that stabilize the shoulder and hold the upper arm bone in place. Injuries to this area of the body are usually due to overuse but can also result from trauma like a sudden strain or impact.
Common causes of a rotator cuff injury
The most common cause of a rotator cuff injury is wear and tear of the tendons in the rotator cuff. That deterioration usually results from repetitive motions with the arm above the head.Such motions may be part of athletic activities (such as basketball) or other repetitive activities, like construction work. The other common cause of rotator cuff injuries is acute trauma, such as an impact injury.
Age also plays a factor. Blood supply to the rotator cuff naturally decreases as we age, making the rotator cuff slower to repair itself. As a result, wear and tear from daily activities, sports, and repetitive motions affect the shoulder more as we get older.
In some cases, your rotator cuff injury may follow another injury. For instance, dislocating your shoulder can pull on the surrounding tendons and cause a rotator cuff tear.
Types of rotator cuff injury
There are three kinds of rotator cuff injury: rotator cuff tendonitis, bursitis, and rotator cuff tears. Understanding the anatomy of the rotator cuff can help you better understand your injury.
The rotator cuff is a group of muscles and tendons that surround your shoulder joint and keep your arm in the shoulder socket. It attaches to the upper arm bone and allows you to lift and rotate your arm. Between the rotator cuff and the top of your shoulder, there is a lubricating sac called a bursa, which allows the rotator cuff to glide smoothly and freely when you move your arm.
Bursitis affects the bursa, while the other two conditions affect the tendons of the rotator cuff:
- Bursitis: The bursa, a fluid-filled sac that reduces a joint's internal friction, becomes inflamed due to compression.
- Tendonitis: The rotator cuff tendon becomes irritated or inflamed.
- Rotator cuff tears: The rotator cuff tendons may partially tear from overuse or fully tear from a sudden injury.
Symptoms of rotator cuff injuries
Rotator cuff injuries of all three types present similar symptoms, the most common of which is pain during movement. Other common symptoms of a rotator cuff tear or injury include:
- Pain when raising or moving your arm
- Stiffness in the shoulder
- Tenderness of shoulder or mild swelling
- A clicking sound in the shoulder
- Reduced strength and mobility in the shoulder
In extreme cases, pain may never fade and even wake you from sleep.
If you tear your rotator cuff in an accident (acute trauma), the shoulder will immediately become weak and exhibit pain when you lift your arm. Your symptoms may also vary in severity, depending on whether you have a partial or complete tear.
- Partial: The tear goes part of the way through the tendon. Your tendon is still attached to the bone but is torn and thin.
- Complete: A portion of the tendon or an entire tendon has completely separated from the bone.
It depends on the cause of your injury. Degenerative tears usually start as a mild, nagging pain that worsens over time. Acute injuries typically feel like a strong, dull ache or a sudden, sharp pain. However, everyone's pain threshold is different, so some people with a rotator cuff tear don't feel any pain. Nearly everyone will experience weakness in their shoulder or arm, even if they don't have pain or discomfort.
Lying down can put pressure on the rotator cuff, especially for side sleepers who sleep on the injured side.
Rotator cuff injury risk factors
Rotator cuff injuries most commonly impact people who work jobs requiring heavy lifting and athletes playing sports such as baseball and tennis. Repeatedly using your rotator cuff can wear down the tendon tissue over time, causing damage or irritation. Accidents or falls causing sudden trauma to your shoulder can also lead to rotator cuff injuries.
Common risk factors for a rotator cuff injury include:
- Age. As you get older, you’re more likely to suffer a rotator cuff tear.
- Occupation. Any job that requires you to lift your arms over your head repeatedly increases your risk.
- Playing sports. Activities like baseball, tennis, and weightlifting can strain the shoulder.
How to prevent rotator cuff injuries
It can take a long time to recover from rotator cuff injuries, so prevention is the best medicine. A rotator cuff injury prevention protocol would likely include exercises to strengthen the rotator cuff muscles and warm-ups to prepare the shoulders before vigorous exercise.
Be mindful of repetitive shoulder motions, especially ones with the arms above the head. Performing this kind of motion too much—whether for sport or for work—can sometimes lead to rotator cuff tears or other injuries over time.
It's better to catch a rotator cuff injury early. If you're experiencing shoulder pain or other rotator cuff symptoms, don't ignore them. Get them checked before they worsen.
Treating a torn rotator cuff
You should speak with a shoulder specialist if you have signs of a torn rotator cuff. Because a rotator cuff injury is usually caused by overuse, it may worsen without treatment, physical therapy, or modifications to your routine.
Depending on the cause and type of damage, treatment for a rotator cuff injury may include surgery or more conservative approaches such as ice and rest. A specialist in orthopedic and/or sports medicine can help you determine the treatment plan that’s best for you.
The sooner you visit a doctor for rotator cuff injury treatment, the faster your recovery. If you have a rotator cuff injury, request an appointment with our Sports Medicine service today.
FAQs about rotator cuff injuries
You may be surprised to learn you have a rotator cuff injury, so it's normal to have questions.
Usually, the symptoms of a torn rotator cuff are localized in the shoulder. However, the pain may extend up to the neck and down to the elbow.
If you are experiencing sharp pains or if your shoulder has suddenly lost function and mobility, it is probably a tear. If you can trace your pain back to a specific collision, such as a sports injury (especially if you noticed a pop at the time of the accident), it may be a sign of a rotator cuff tear. Pain that has come on gradually is more likely to be a rotator cuff strain.
Medical imaging is the most accurate way to diagnose your rotator cuff injury. In tandem with a review of shoulder imaging, your doctor will discuss the shoulder pain you're experiencing with you, so it's a good idea to consider when and how the pain started.
Rest is vital to recovering from a rotator cuff injury, regardless of the cause. A doctor or physical therapist may suggest exercises to rehabilitate your range of motion during a rotator cuff injury, but you should avoid other movements that place additional stress on the shoulder.
Exercises to avoid:
- Throwing a ball or swinging a racket over the head
- Swimming strokes that require an overhead reach
- Lifting weights above the head or away from the body, such as shoulder presses
- Lifting weights that pull the arm away from the shoulder, such as a deadlift or shrug
Many other shoulder conditions, such as arthritis, frozen shoulder, and shoulder impingement syndrome, present similar symptoms to rotator cuff injuries. One of our shoulder experts can determine whether your pain and lost mobility are due to a rotator cuff injury.
Learn more about common causes of shoulder pain.
