Rotator Cuff Injuries

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Rotator Cuff Injuries Simon Evans PhysiotherapyThe Rotary Cuff is a group of muscles and tendons that surround the shoulder joint firmly holding the head of the bone of the upper arm in the shallow socket of the shoulder. A dull ache in the shoulder can be caused by a Rotator Cuff injury which is often worsened when you try to sleep on the affected area.

Rotor cuff injuries often occur in people who repeatedly perform overhead motions in their work or in their sport. Examples of those who are affected with rotator cuff injuries include painters, carpenters and people playing baseball or tennis whilst also higher risk can come with increase in age.

Physical therapeutic exercises have been found to help people recover from Rotator cuff injuries. Physiotherapy exercise help improve the flexibility and power of the muscles around the shoulders.

Most of the time a single injury can result in rotator cuff tears. In such circumstances, medical assistance should be provided as soon as possible. Severe cases of rotator cuff tears may require surgical repair, transfer of alternative tendons or joint replacement.

What are the Causes of a Rotator Cuff Injury?

Rotator cuff injuries differ as it can range from mild to severe. They usually belong in one of three categories.

  • Tendinitis (inflammation) is an injury which is caused by an excessive use of a rotator cuff. Tennis players who use overhead services and painters who have to climb before doing their job are the type of people that are affected by this type of injury.

  • Bursitis is another common rotator cuff injury. It occurs as a result of the inflammation of the bursa and are fluid-filled sacs that sit between the rotator cuff tendons and the underlying bone.

  • Another thing that causes rotator cuff tears is excessive use or acute injury. The tension which connects the muscle to bones can overstretch (strain) or tear, partially or completely. Shortly after a fall, the rotary cuff can also strain or tear, a car accident or other sudden injuries. These injuries usually cause intense and immediate pain.

Symptoms of Rotator Cuff Injury

It is not all rotator cuff injuries that cause pain. Some occur as a result of degenerative conditions, where the rotator cuff can be damaged for months or years before the onset of the symptoms.

Common symptoms of rotator cuff injury include:

  • Difficult in reaching the entire range of shoulder movements
  • Difficult to sleep on the affected shoulder
  • Pain or tenderness when reaching overhead
  • Shoulder pains, especially at night
  • Progressive shoulder weakness
  • Difficult to get behind

If you experience any of these symptoms for more than a week or lose the function of your arm, contact your doctor.

Risk Factors

The following factors can increase the risk of Rotator Cuff Injury:

  • Age: As you grow older, there is an increase risk of developing a rotator cuff injury. Individuals who are above the age of 40 years are more prone to rotator cuff tears.

  • Some Sports: Athletes who make use of arm motions regularly, such as baseball pitchers, archers and tennis players have a higher risk of having a rotator cuff injury.

  • Construction Jobs: Jobs that require repetitive arm motion such as carpentry or home painting that are often overhead movement can cause rotator cuff pain as time goes on.

  • Family History: There may be a genetic component associated with rotator cuff injuries since they appear more often in some families.

Diagnosis of Rotator Cuff Injury

During a physical examination, the doctor will press on various parts of your shoulder and move your arms into different positions and testing the strength of the muscle around your shoulders and your arms.

In some cases, an imaging test such as X-rays may be recommended.

  • X-ray: Although this test may not show the rotator cuff tear, the test can be able to visualize bone spurs or other potential causes of pain, such as arthritis.

  • Ultrasound: This type of test makes use of sound waves to create images of structures in your body, especially soft tissues such as the muscles and tendons. It provides dynamic tests, assessing the structures of the shoulder as they move. Ultrasound also provides a quick comparison between the affected shoulders and the healthy shoulders.

  • Magnetic Resonance Imaging (MRI): MRI makes use of radio waves and a powerful magnet. The resulting images show all the structures of the shoulders in a great detail. Image quality depends on the quality of the equipment used.

Treatment of Rotator Cuff Injury

Conservative treatments such as rest, ice and physiotherapy are sometimes all you need to recover from rotator cuff injuries. If the injury is serious and involves complete tears of the muscles or tendons, surgery may be the best option for you.


Should your pains not reduce through conservative treatment, your doctor / physiotherapist may recommend a steroid injection that will be given in your shoulder joint, especially if the pain affects your sleep, daily activity or exercise. Although these injections are often of temporary use, care must be taken in order to ensure that they are used properly as they can contribute to long term weakening of the tendon.


Physiotherapy is usually one of the first treatments that your doctor may suggest. Exercises adapted to the specific location of your rotator's injury can help you restore the flexibility and strength of your shoulder. Physiotherapy is also an important part of the recovery process after rotator cuff surgery.


Many types of surgery are available for rotator cuff injuries including:

  • Arthroscopic tendon repair: This procedure involves surgeons inserting a small camera known as arthroscope and tools through small cuts to reattach the torn tendon to the bones.

  • Open tendon repair: These type of surgery works through a larger cut to reconnect the damaged tendon to the bone. Unlike arthroscopic procedures; open tendon repair is usually cured in the same time frame, but recovery may be more uncomfortable.

  • Tendon transfer: If the torn tendon is too damaged to be reattached to the arm bone; surgeons may decide to use a nearby tendon as a replacement.

  • Shoulder Replacement: Massive rotator cuff injury can require the replacement of the shoulder. In order to improve the stability of the artificial joint, an innovative procedure (reverse shoulder arthroplasty) installs the ball part of the artificial joint on the scapula and the socket part onto the arm bone.

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