Rotator Cuff Injuries

Rotator cuff problems often develop gradually, although they can also occur suddenly after an accident or fall. Common symptoms include:

• pain in the shoulder that may worsen at night or when lying on the affected side
• weakness when lifting or rotating the arm,
• stiffness or limited range of motion, and
• a crackling or popping sensation when moving the shoulder.
• in severe cases, everyday activities such as reaching overhead, combing your hair, or getting dressed may become difficult.

Rotator cuff injuries usually result from one of two main causes: overuse or acute trauma.

• Overuse injuries happen when the tendons are repeatedly stressed during activities that involve lifting, throwing, or overhead motions, such as painting, swimming, tennis, or baseball. Over time, the tendons can become irritated and inflamed, leading to tendonitis. Without treatment, this irritation may progress to small tears.
• Trauma from accidents like falling on an outstretched arm, lifting something too heavy, or experiencing a shoulder dislocation. In these cases, the tendon may tear completely. Injury to the rotator cuff is usually due to a fall on an outstretched arm and lifting something very heavy that usually causes a rotator cuff tear. The cuff can also be torn as a result of a broken collarbone or dislocated shoulder.

• Acute, traumatic tears
• Repetitive stress tears
• Degenerative tears to the rotator cuff tendons are due to wear and tear. This is natural with age but can be the result of repetitive stress as seen in baseball, tennis, rowing and weight lifting. Also, as we age, the blood supply to the cuff is reduced, and contributes to the degeneration and tears. People over age 40 are at an increased risk of rotator cuff tears.
• Rotator cuff tears can be partial or complete. Partial tears damage the soft tissue but the cuff remains partially attached. A full thickness tear is when the tendon is torn away from the bone.

• Age is one of the most significant risk factors, as tendon strength and flexibility naturally decrease over time, making tears more common in individuals over 40.
• Occupations and hobbies that involve repetitive shoulder movements, such as construction work, carpentry, or athletics, also raise the risk.
• Poor posture, smoking, and a family history of rotator cuff problems can further contribute.
• Individuals who have experienced prior shoulder injuries may be more vulnerable to additional problems.

Diagnosing a rotator cuff injury begins with a thorough medical history and physical examination. During the exam, your doctor will check for areas of tenderness, test your shoulder strength, and evaluate your range of motion. Imaging tests are often used to confirm the diagnosis. An X-ray can rule out bone-related issues, while an MRI or ultrasound provides detailed images of the soft tissues, allowing doctors to see the size and location of tendon damage. Early diagnosis is important, as prompt treatment can prevent small injuries from becoming larger or more difficult to manage.

Treatment for rotator cuff injuries depends on the severity of the problem. Many mild to moderate injuries can be managed without surgery. These approaches may include rest, activity modification, anti-inflammatory medications, physical therapy, or corticosteroid injections to reduce pain and swelling.

When the tendon is severely torn or when conservative treatments are not effective, surgical repair may be recommended to restore shoulder strength and function. Advances in minimally invasive surgical techniques now allow many patients to recover with less discomfort and quicker healing.