What Is the Best Treatment for Rotator Cuff Injury?

Symptoms of a rotator cuff tear include:

• Pain at rest and at night, especially when lying on the affected shoulder
• Pain lifting and lowering the arm or with specific movements
• Weakness when lifting or rotating the arm
• Crepitus or crackling sensation when moving the shoulder in certain positions
• If the injury occurs suddenly, such as from a fall:
  • Intense pain
  • A snapping sensation 
  • Immediate weakness in the upper arm
• Sometimes rotator cuff tears do not cause pain, but they will still cause arm weakness and other symptoms

Symptoms of rotator cuff tendinitis include: 

• Swelling and tenderness in the front of the shoulder
• Pain and stiffness when lifting the arm
• Pain when the arm is lowered from an elevated position
• Pain radiating from the front of the shoulder to the side of the arm
• Sudden pain with lifting and reaching movements
• Athletes in overhead sports may have pain when throwing or serving a tennis ball
• If the pain comes on suddenly, movement may be limited and painful
• As the tendinitis progresses, symptoms may increase:
  • Pain at night
  • Loss of strength and range of motion
  • Difficulty placing the arm behind the back, such as for buttoning or zippering

The two main causes of rotator cuff tears include:  

• Injury (acute rotator cuff tear)
  • Can occur from falling down on an outstretched arm or lifting something too heavy with a jerking motion
  • May also occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder
• Degeneration (chronic rotator cuff tear)
  • Most tears occur from wearing down of the tendon slowly over time
  • Naturally occurs with age
  • More common in a person’s dominant arm
  • Risk factors for degenerative tears include: 
    • Repetitive stress, for example, from sports such as baseball, tennis, rowing, and weightlifting, as well as jobs and household chores that require repeating the same shoulder motions over and over 
    • Reduced blood supply as we age, which hinders the body’s ability to repair tendon damage
    • Bone spurs can develop on the underside of the top outer edge of the shoulder blade (acromion bone) as we age, and the spurs rub on the rotator cuff tendon (called shoulder impingement)

Risk Factors for rotator cuff tears include: 

• Age over 40 years
• People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears
  • Athletes such as tennis players and baseball pitchers
  • Painters, carpenters, and others who do overhead work 
• Traumatic injuries, such as falls

Rotator cuff tendinitis can be caused by:

• Participating in sports that use the arms overhead, such as swimming, baseball, and tennis 
• People who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting 
• A minor injury

The type of rotator cuff injury is diagnosed with a patient history and physical examination of the shoulder that may include tests to assess range of motion and strength. 

Tests used to help diagnose the type of a rotator cuff injury include: 

• X-rays
• Magnetic resonance imaging (MRI) scan