One or more rotator cuff tendons may become inflamed from overuse, aging, a fall on an outstretched hand, or a collision. Sports requiring repeated overhead arm motion or occupations requiring heavy lifting also place a strain on rotator cuff tendons and muscles. Normally, tendons are strong, but a longstanding wearing down process may lead to a tear.
Typically, a person with a rotator cuff injury feels pain over the deltoid muscle at the top and outer side of the shoulder, especially when the arm is raised or extended out from the side of the body. Motions like those involved in getting dressed can be painful. The shoulder may feel weak, especially when trying to lift the arm into a horizontal position. A person may also feel or hear a click or pop when the shoulder is moved.
Pain or weakness on outward or inward rotation of the arm may indicate a tear in a rotator cuff tendon. The patient also feels pain when lowering the arm to the side after the shoulder is moved backward and the arm is raised. A doctor may detect weakness but may not be able to determine from a physical examination where the tear is located. X rays, if taken, may appear normal. An MRI can help detect a full tendon tear, but does not detect partial tears. If the pain disappears after the doctor injects a small amount of anesthetic into the area, impingement is likely to be present. If there is no response to treatment, the doctor may use an arthrogram, rather than an MRI, to inspect the injured area and confirm the diagnosis.
Doctors usually recommend that patients with a rotator cuff injury rest the shoulder, apply heat or cold to the sore area, and take medicine to relieve pain and inflammation. Other treatments might be added, such as electrical stimulation of muscles and nerves, ultrasound, or a cortisone injection near the inflamed area of the rotator cuff. The patient may need to wear a sling for a few days. If surgery is not an immediate consideration, exercises are added to the treatment program to build flexibility and strength and restore the shoulder's function. If there is no improvement with these conservative treatments and functional impairment persists, the doctor may perform arthroscopic or open surgical repair of the torn rotator cuff.
Source: The National Institute of Arthritis, Musculoskeletal and Skin Diseases
Last reviewed: May 2001
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