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Four million people suffer from rotator cuff/upper arm pain a year. This injury can limit work, self-care, and daily household duties. This article was designed to give the reader general information on rotator cuff injuries.

What is the rotator cuff?

The rotator cuff consists of 4 muscles (supraspinatus, infraspinatus, teres minor and subscapularis) that stabilize and move the upper arm. These muscles connect to the humerus (upper arm bone) via tendons. Based on the small space located under the acromion (upper outside portion of the shoulder at top of shoulder joint) the tendons they are easily compressed, rubbed or overused during various activities. This discussion does not include post operative care.

Types of injuries associated with the rotator cuff:

• Rotator cuff tendinopathy or tear: Rotator cuff tendinopathy can include any disease or injury to the tendon:
  • Tendinitis is an irritation or acute inflammation from micro-tearing of the tendon.
  • A rotator cuff tear can be labeled as a partial or full thickness tear.
    • A partial tear means that one side of the tendon has a tear that does not extend through the entirety of the tendon's dept.
    • A full thickness tear extends through the entire depth of the tendon (from bottom to top) and is associated with more significant weakness, pain, and disability.
  • Calcific deposits can also form in the tendon, causing inflammation and pain. The presence of these deposites can be seen on x-ray, MRI, and diagnostic ultrasound.     

Common symptoms associated with rotator cuff injuries:

Injury of any of the rotator cuff tendons can occur from repetivite activity (most common), especially when performed in a poor posture or from trauma to the arm and shoulder. Symptoms of rotator cuff injuries includes:

• Burning in the shoulder region (front, side, or back of shoulder)
• Pain that extends from the shoulder joint and sometimes radiates down the upper arm to the lower arm (occasionally below the elbow)
• Pain with elevation or rotation of arm, especially with active motion (moving the arm yourself)

If inflamed, the patient can have pain at rest. A worsening in shoulder pain at night is common, especially during the inflammatory phase.

If you have deformation of the shoulder joint, significant swelling, redness or heat, fever and/or chills, history or suspicion of cancer, unexplained changes in sensation or strength of the arm, signs of a heart attack or any other unexplained symptoms associated with the shoulder pain, seek the help of a physician immediately.

Does a rotator cuff injury cause instability of the shoulder?

A rotator cuff tear or mild to moderate weakness of this region alone does not typically create significant instability of the shoulder or the sense that the shoulder is popping in or out of the socket. There must also be an underlying tear of the shoulder labrum and/or capsule, genetic joint laxity or significant weakness from a stroke or some other neurologic injury for this level of instability to occur. 

I have a diagnosed rotator cuff injury. Now what should I do?

Seek physical therapy to increase ROM, strength and decrease pain and disability! Guidance on what activities will prolong versus reduce your symptoms are key. Adding activities at the right time during the healing process is essential to proper healing and repair of the rotator cuff tissue. We at Fyzical Lake Forest understand not all patients respond to various treatments the same, however, the following options are a great place to start decisions about care. Here are the most recent top guidelines based on research:

• Medications: For acute pain - Acetaminophen (Tylenol) oral and or topical NSAIDs (oral - ibuprofen, Motrin, Advil, topical - Voltarin) are supported as a 1st line to control pain. Please seek the advise of your physician to confirm the type and dosage that is safe for you.
• Injections: 
  • Platelet rich plasma (PRP) injections - may be beneficial after failure of initial nonsurgical care.
  • Corticosteroids (including steroid injection) are not suggested as an initial treatment for pain. May be utilized if initial treatment fails to control pain and decrease disability
•  Rehabilitation treatments supported by evidence: 
  • Exercise: should be active (gentle ROM and strengthening exercises). A workplace exercise program addressing challenging tasks should be initiated when applicable along with ergonomic (workspace and tool) modifications as necessary. 
  • Manual therapy: such as massage, joint mobilization, and traction can be helpful to reduce pain. 
  • Modalities:
    1. Acupuncture: helpful when performed in combination with an exercise program. 
    2. Shockwave therapy: definitely helpful for calcific tendonitis (calcium deposits are located in the tendon), may be helpful for non-calcific rotator cuff pain
    3. Ultrasound: may be useful for patients who have calcific tendinopathy but not supported for use with non-calcific tendinopathy

Rehabilitative treatments that are not supported by evidence:

There is insufficient evidence to support the following to help decrease rotator cuff tendon pain and associated disability:

1. Electrical stimulation including: TENS and interferential current
2. Proprioceptive taping i.e., Kinesiotaping (K-tape)
3. Iontophoresis
4. Pulsed electromagnetic fields
5. Opioids (Percocet, vicoden, etc.) In general, Aleve has been found to be better for chronic pain.
6. Hyaluronic acid injections are not recommended for rotator cuff tendinopathy

In summary, we encourage discussion of your particular injury with a provider that knows your full medical history and current medical situation. Hopefully these guidelines are helpful in formulating questions for your provider on what type of care they suggest and assist in your personal medical decisions regarding rotator cuff pain. 

The information provided in this article is not to substitute for an evaluation with a medical provider.