Shoulder pain? Is a rotator cuff injury to blame?

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The rotator cuff consists of four muscles that turn to tendons in the shoulder, holding it in place and allowing for movement, such as the ability to raise and rotate your arm.

The most common location of pain related to the rotator cuff is down the front and outside of the arm.  There is a large variation among injuries to the rotator cuff. The degree of injury can range from irritation and inflammation, to a partial tear, to a complete tear, and then a tear with retraction.

Symptoms

The most common location of pain related to the rotator cuff is down the front and outside of the arm. The symptoms are often described as a dull ache when at rest and can be sharp and severe with certain activities. Symptoms off and are worse at night particularly when sleeping on the affected side. Weakness and inability to raise the arm are signs of a more significant rotator cuff injury. Stiffness in the shoulder isn’t necessarily from a rotator cuff injury but can develop if the injury goes untreated.

Causes of injury

Some patients may find that their pain develops over an extended period of time, while others can attribute it to a specific event or trauma.

A rotator cuff injury might happen from a sudden trauma, such as at the time of a skiing accident. An injury can also occur during athletics with repetitive use (baseball, swimming, tennis, etc.), or it may occur from a gradual age-related degenerative process. Rotator cuff injuries are more common when there is weakness and imbalance with these muscles.

Certain occupations are more likely to put you at risk. Injuries are common with heavy manual labor over an extended period of time, especially when overhead activity is common. Baggage handlers at the airport can develop significant shoulder and rotator cuff injuries. Manual laborers are susceptible to serious shoulder wear and tear associated with repetitive use from activities like hanging drywall or painting.  

When to see a doctor

Injuries that happen suddenly where there is a pulling or tearing sensation are concerning, especially when the symptoms don't resolve quickly within a week or two.  Symptoms that are consistent throughout the day, worse with activity — and especially when they keep you awake at night — are important to be evaluated by a medical professional.

Exam and treatment

To help identify the source of pain, we start with X-rays and a physical exam. There are certain findings on the physical exam that help identify the problem. Examples of these findings include location of the pain, range of motion, specific areas of weakness, and what maneuvers reproduce any symptoms. When symptoms are persistent despite a period of rest, anti-inflammatories, stretching and ice, an MRI is very helpful to determine the exact cause and extent of any structural damage.

If there's not a traumatic injury, and an associated gradual onset of shoulder pain, then physical therapy, a period of rest, anti-inflammatories, and activity modification are often helpful to resolve most symptoms.

Surgical options and recovery

When other measures are not adequate, arthroscopy or “scope” is extremely effective for the majority of shoulder conditions. This is an outpatient surgical procedure that helps to diagnose more accurately and also repair rotator cuff tears and any other associated injuries or conditions in the shoulder.

For very advanced rotator cuff conditions where the tear is torn and retracted and not repairable, we consider a shoulder replacement surgery. This is generally reserved for patients older than 65 years of age or with other more severe extenuating circumstances.  There are some at-the-cuff related surgical procedures which require minimal use of a sling. Usually, a formal repair of the tendon is associated with 6 weeks in a sling. 

Physical therapy is also an important aspect of rotator cuff recovery and rehabilitation.  The majority of patients are quite active and have returned to the majority of their interests after 3 to 4 months.

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