Shoulder Injuries: Rotator Cuff Pain and Treatment

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I Can Hardly Raise My Arm, and It Hurts!

When you have a rotator cuff injury, it can seem like you can't do anything anymore. The simplest tasks cause intense pain, and you may not even be able to lift your arm at all.

For most of your life, you have taken for granted that you can move your arm in any direction. When that capacity is lost, you feel that loss intensely. Mostly you feel the pain associated with trying to do much of anything. Reaching up or holding something is likely impossible, and it hurts to do even simple things like putting on a coat.

Sometimes when you are going through an ordeal or a serious injury it seems you will never make it to the other side. It doesn't look like it's ever going to get better, and you wonder how you can live with it lin the ong term.

What Is a Rotator Cuff Injury?

Shoulders are one of the most complex parts of the body, providing a greater range of motion than any other joint. The amazing piece of workmanship known as the rotator cuff is the group of muscles and tendons that keep the ball of your upper arm bone firmly in place within the shoulder socket. The shoulder socket is shallow, to allow full rotation of the arm in almost every direction.

But along with incredible possibilities for movement comes the chance for undue stresses to the tendons that hold this assemblage together.

Muscles of the Rotator Cuff

Back view: shoulder joint with rotator cuff muscles

Front view: shoulder joint with rotator cuff muscles

Four Muscles and Their Tendons Make Up The Rotator Cuff

The four muscles of the rotator cuff are attached to the ball-shaped end of the armbone (humerus) by long tough tendons, and on the other end to the scapula, the triangular bone of the shoulder. These muscles are:

• the supraspinatus muscle, going over the top of the humerus, which raises the arm;
• the infraspinatus and teres minor muscles, which swing the arm away from the body;
• and the subscapularis muscle, which swings the arm toward the body.

Of these, the supraspinatus tendon, especially, is vulnerable to injury or inflammation where it passes under a bony projection on the scapula (the acromion).

Causes of Rotator Cuff Injury

Injury can come suddenly from tearing one of the tendons, for example in a fall or when lifting or trying to reach something. If a tendon actually tears, as opposed to just being inflamed and irritated, one may hear a popping sound or feel immediate pain, plus weakness and pain when one tries to raise or rotate the arm.

Generally, though, the cause of the injury is something that has been going on for years. Repeated movements of the arm, especially movements that raise the arm or swing it around, can cause the tendon to deteriorate. It rubs against bone, becomes irritated, becomes filled with scar tissue which is weaker and less flexible than the original material, and can eventually tear.

Rotator cuff injuries are common among: pitchers, quarterbacks, cheerleaders, weightlifters, volleyball players, house painters, carpenters, swimmers, archers, boxers, tennis players, and anyone whose lifestyle or profession requires making the same arm movement over and over, especially an arm movement that involves raising the arms over the head.

Aging is also an increased risk for this type of injury, and sometimes a simple movement can finally cause it to appear: in particular, lifting something over your head, or catching a falling object. Smoking is also a risk factor.

Symptoms

A mild injury may cause pain only when doing activities with the injured arm. A moderate injury may cause pain during and after the activity, plus pain at night, which can be enough to wake you up if you sleep on the side that is injured. A severe injury can cause constant pain. An injury can make it difficult or impossible to do many common activities such as tucking in a shirt, let alone reaching over one’s head.

Treatment: Non-Surgical Options

If you're suffering now, you likely want to know how fast it can be fixed. The answer depends on the type of injury, which may range from inflammation of the tendon, to a complete or partial tear that might require surgery.

Most often, treatment involves self-care measures and exercise therapy. Initial self-care allows the injury to stabilize by resting the joint for a couple days to a couple weeks—not totally immobilizing the joint with a sling, but carefully moving it through its range of motion several times a day (says Kaiser). Treating it with cold (for the first few days) and then heat, and using anti-inflammatory and pain medications like ibuprofen and naproxen, reduces inflammation. Don’t go back to activities that hurt.

Once the injury heals, and some range of motion has returned, the correct exercises will recondition and strengthen the muscles that support the joint, to reduce the stress on the vulnerable tendon. As with some other chronic joint conditions, keeping the surrounding muscles strong protects the joint, and fights the effects of age to some degree.

Foremost is to deal with the injury promptly. Just pampering it for many days on end with no improvement is not the answer. Nor is it the answer to just keep on doing activities that cause pain. Knowing when to see a doctor is critical as is understanding the proper way to care for yourself. If a rotator cuff injury is not acute, recovery is most often possible with proper exercise therapy.

Treatment: Surgical Options

It is possible to stitch a torn tendon back together; in fact, in extreme cases it is possible to replace the whole shoulder joint, as with a hip replacement.

Although it’s important to get medical help promptly, and not wait for a joint injury to get better by itself, the authoritative American Academy of Orthopedic Surgeonssays there is no evidence that delaying surgery causes worse outcomes.

There are less drastic surgical options than stitching a tendon. Removing debris around the tendon, or planing down bone spurs that impinge in it (“subacromial smoothing”), can reduce irritation of the tendon and let it heal. Such surgery can be done arthroscopically (through small openings).