What is rotator cuff disorder?

The rotator cuff is a group of tendons and muscles around the shoulder that keeps the shoulder joint stable. It is what allows you to raise and rotate your arm. Over time, daily wear and exercise can cause the tendons to rub on the bones of your shoulder. This is called impingement. This condition may cause the tendons to bruise, degenerate, or tear.

In many people, these problems do not cause pain. When they do cause pain, you can do things to reduce the pain and swelling. These include rest, physical therapy, ice and heat, and anti-inflammatory medicine. If you still have pain after trying these treatments, you and your doctor can discuss having a steroid injection or surgery.

If the rotator cuff problem isn’t checked, wear and tear and limited movement can lead to other shoulder problems. These may include stiffness or frozen shoulder. Doing some activities can lead to problems like bursitis and tendinopathy. Recovery varies. Most people feel better after several weeks of rehabilitation. Some treatments can last longer.

A rotator cuff disorder causes pain and weakness in your shoulder. Most often, the pain is on the side and front of the upper arm and shoulder. It may hurt when you do everyday things, such as comb your hair or reach for something. You may have pain during the night and trouble sleeping.

Treatment depends on your symptoms, your age, and how active you are. Your treatment may include:

• Medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are often used for pain and inflammation. If other treatments don't help, your doctor may give you a shot of steroid medicine in the shoulder.
• Home treatment, such as rest and applying cold or heat.
• Physical therapy to stretch and strengthen the shoulder.

Most rotator cuff disorders aren't treated with surgery. But doctors may do surgery if a rotator cuff tendon is torn. They may also do it if several months of other treatments haven't helped. Whether or not you get surgery will depend on your age, the amount of other damage in the shoulder, and the chances that surgery will be a success in your case. And surgery is not a substitute for physical therapy. Even after surgery, you may need months of physical therapy to recover fully.

The long-term changes to the shoulder joint from everyday wear and tear can't be totally prevented. But you may be able to prevent some rotator cuff problems if you:

• Keep the muscles in your shoulders flexible and strong. Daily exercises may be the best way to do this and help prevent a rotator cuff disorder.
• Have good posture. Stand straight and relaxed, and don't slump.
• Don't lift objects that are too heavy for you, especially over your head.
• Avoid sports or other activities where forceful contact or falls are likely or common.
• Don't keep your arms out to the side or raised over your head for long periods of time. If you must do these activities:
  • Take breaks often. Ice your shoulder several times a day and at night.
  • Take a nonsteroidal anti-inflammatory drug (NSAID) to relieve any swelling and pain in the tissues that are being pinched.

Medicines don't heal rotator cuff disorders. They help with pain and inflammation. This allows you to start exercises to stretch and gradually strengthen the shoulder, which reduces the risk of stiffness or a frozen shoulder.

The types of medicines used to treat a rotator cuff disorder are:

Nonsteroidal anti-inflammatory drugs (NSAIDs).

NSAIDs are the most common medicines used to help manage rotator cuff disorders. They are available with or without a prescription. NSAIDs come in pills and in a cream that you rub over the sore area. Or you can use acetaminophen.

Corticosteroid shots.

These are strong medicines that are often only given after a few weeks of other treatment. Your doctor may recommend not having this shot near the time of rotator cuff surgery.

Home treatment of a rotator cuff disorder can help relieve pain and keep the problem from getting worse. It may include rest and NSAID pain medicines like ibuprofen or naproxen. Or you can use acetaminophen. Ice and heat may help with pain. Your doctor may recommend special exercises or physical therapy.

Surgery may be an option if:

• Your rotator cuff injury is very severe or likely to worsen.
• You have severe pain and loss of shoulder function that haven't been helped by other treatment.
• You have shoulder weakness caused by a complete tear.
• You don't have other shoulder problems, such as arthritis.

Surgery mostly is used to repair a torn rotator cuff when there is little sign of other problems. People who have advanced rotator cuff disorders and tendons that are frail and stiff usually do less well with surgery. Surgery may work to repair the tear. But it can't repair all the damage caused by age or degeneration.

Shoulder surgery may include:

• Debridement. This removes loose fragments of tendon and other debris.
• Rotator cuff repair.
• Subacromial smoothing. This shaves bone or removes growths.

Sometimes a rotator cuff tear is too severe to be fixed in the usual ways. Your doctor may suggest surgery to move another tendon, replace the torn tendon, or surgery to replace the shoulder.

Things that may increase the risk of rotator cuff disorders include:

• Aging.
• Holding or moving your arm overhead often. This may include painting, working as a waiter, or playing tennis, baseball, and other throwing sports.
• Previous shoulder injuries. These may include dislocations and broken bones.
• Having a rotator cuff tear in the other shoulder.
• Irregularities of the muscles, tendons, and bones in the shoulder that increase wear on the rotator cuff tendons.
• Having received multiple corticosteroid injections in the shoulder. This may weaken tendons and increase your risk.
• Smoking. This decreases the blood supply and slows healing.
• Shoulder instability.

Most rotator cuff disorders are caused by a mix of overuse and normal wear and tear.

Overuse.

Activities in which you use your arms above your head a lot—such as tennis, swimming, or house painting—can lead to rotator cuff problems. Even normal motions made often over a long period can stress or injure the rotator cuff.

Normal wear and tear.

Using your shoulder for many years slowly damages the rotator cuff. As you age, everyday activities can lead to changes in the rotator cuff. These changes include thinning and fraying of the tendons and reduced blood supply.

It takes great force to tear a healthy rotator cuff tendon. This can happen during sports, an accident, or a severe fall. But even a simple movement like lifting a suitcase can cause a rotator cuff tear in an older adult or someone whose shoulder is already damaged.

The rotator cuff is a group of tough, flexible fibers (tendons) and muscles in the shoulder. Rotator cuff disorders include:

• Irritation or damage to the tendons (tendinopathy, sometimes called tendinitis).
• Inflammation or irritation of a bursa (bursitis). In the shoulder, a bursa is a small, fluid-filled sac that serves as a cushion between the tendons and the bones.
• Impingement. This means that a tendon is squeezed or rubbed against bone.
• Calcium buildup in the tendons. The buildup can cause a painful condition called calcific tendinopathy.
• Partial or complete tears of the rotator cuff tendons.

A physical therapy (PT) and rehabilitation (rehab) program usually involves exercises to stretch and slowly strengthen the shoulder. Stretching includes range-of-motion exercises. Exercises to strengthen can help you build and keep shoulder function and stability. Some physical therapists may use other techniques to relieve pain and reduce muscle spasms. These may include massage or ultrasound.

Rehab may be used without surgery. Or it may be part of your recovery after surgery. It can reduce pain in the soft tissues, such as the muscles, ligaments, and tendons. It can also improve function and build muscle strength.

A good recovery depends a lot on how you do with rehab. If you follow your PT plan closely and get help when you need it, you are more likely to restore your shoulder's strength and movement.