The rotator cuff is the group of four tendons and muscles that surround the shoulder joint. Often confused with other names (rotary cuff, rotator cup), the proper word used to describe these muscles and tendons is the rotator cuff. When the rotator cuff is injured, it's the tendons of the rotator cuff that are harmed; it is these tendons that connect the rotator cuff muscles to the bone. When the tendons are inflamed or torn, they cannot function properly. The rotator cuff is not only important for lifting and the strength of the shoulder, but the muscles and tendons are critical to the normal stability and mechanics of the shoulder. Without a properly functioning rotator cuff, you would expect some limits to normal shoulder function.
Not all shoulder pain is from a rotator cuff injury. Many people with shoulder pain may be told by a friend or family member that their symptoms sound like their rotator cuff problem. However, there are other causes of shoulder pain. Without an accurate diagnosis, the treatment may not properly target the actual problem. If another condition—such as a frozen shoulder or labral tear—is not recognized, the treatment plan developed may not be effective. Before beginning any treatment plan, be sure you understand the source of your pain.
Rotator cuff tears are extremely common, especially as we age. While rotator cuff tears are uncommon in people in their 20s, 30s, and 40s, as we get older, they become extremely common. In fact, by the time someone is in their 70s or 80s, rotator cuff tears are actually expected. Just as other parts of our body change with age (think grey hairs or skin wrinkles), a torn rotator cuff in someone in their 60s or older is not an unusual occurrence.
Almost all rotator cuff tears will improve with nonsurgical treatment. While surgery plays an important and necessary role in treatment of these injuries, the vast majority of people with a rotator cuff tear never need surgical intervention and can resume normal, active lifestyles. While sometimes surgery becomes necessary, this is typically not the first treatment of a rotator cuff injury.
Most people with a torn rotator cuff don't even realize they have a problem, as most have no discomfort and minimal limitations in function. If one does experience symptoms of a rotator cuff problem, the most likely one they are to voice is pain. This pain is typically over the top of the shoulder and arm. In some individuals, the pain can descend down the outside of the arm all the way to the elbow.
Weakness of the shoulder: This can cause difficulty lifting the arm up overhead or difficulty with activities such as reaching, getting dressed, or carrying objects.
Numbness in the arm: Sometimes, if there is significant inflammation, there can be nerve irritation causing numbness and tingling going down the arm.
Swelling of the shoulder: In acute injuries, swelling or even bruising around the shoulder joint can sometimes occur.
Physical therapy: Physical therapy is probably the most important treatment when attempting nonsurgical care of a rotator cuff injury. By optimizing muscle and tendon function, and training other muscles to compensate for damage, many people can find relief of rotator cuff injuries with appropriate therapeutic intervention.
Anti-inflammatory medications: Inflammation is commonly associated with discomfort in people who have rotator cuff injuries. Controlling this inflammation can be accomplished with a variety of modalities, including oral medications. Oral anti-inflammatory medications do have possible side effects, so you should check with your doctor before beginning any new medication regimen for treatment of a rotator cuff problem.
Ice application: Ice application is commonly used to help control pain and inflammation. While the results of application of ice or transient and certainly do not lead to long-standing improvement, it can be a helpful way to control the discomfort associated with a rotator cuff injury.
Cortisone injections: Cortisone injections do not heal damage to rotator cuffs, but they do help control inflammation. One of the benefits of a cortisone injection over oral anti-inflammatory medications is that the medication is delivered exactly to the location of the problem, therefore there tend to be less systemic side effects. That said, too much cortisone is probably not ideal, but an occasional injection is likely a safe treatment.
The goal of these treatments is to reduce inflammation and strengthen the muscles that surround your shoulder. Physical therapy is often helpful at improving the mobility and mechanics of the shoulder joint while not placing excessive stress on the damaged muscles and tendons. Even people who do athletic activities can find dramatic relief with help from a knowledgable therapist.
However, in some situations, surgery may be recommended to repair the torn tendons. Determining when surgery may be appropriate depends on the type of rotator cuff tear, your activity level, and the treatments that have already been used.
While surgery is often the best treatment to attempt to restore normal function of the shoulder, there are some reasons people opt not to have surgery. First, most people do not require full function to do all the activities they want to do. Many people can do sports, housework, and their jobs with rotator cuff tears. Second, the rehab after surgery can be long and difficult. Many patients have symptoms for six months to a year following surgery.
There are several surgical options for treatment of a rotator cuff tear. The exact type of surgery may depend on factors including the size and location of your tear, your surgeon's preference, and the activities you want to be able to return to after surgery. Discuss which type of surgery may be recommended for treatment of your rotator cuff tear with your doctor.
Healing after surgery for a rotator cuff tear is entirely dependent on you being able to perform proper rehabilitation and avoid activities that may injure the healing tendons. Rehab after rotator cuff surgery can vary widely, but there are some general principles that are true for most people who undergo surgery to treat a rotator cuff tear.
Again, rehab following rotator cuff surgery can be long and difficult. Many patients take a year to get back to normal. Some less-invasive surgical procedures can speed recovery and make rehab less painful, but be prepared for a recovery that may be longer than your would want. The good news is, the vast number of patients are back to full activities within several months, and most return to their normal activities.
A rotator cuff problem, like any injury, is never something anyone welcomes. On a positive note, remember that most people with one are able to return to their usual activities after appropriate treatment of these injuries. While surgery can be an effective treatment, most people can find successful results with noninvasive treatment options, which is always a preferred route if you can take it.
Pappou, IP, et al. "AAOS Appropriate Use Criteria: Optimizing the Management of Full‐Thickness Rotator Cuff Tears" J Am Acad Orthop Surg. 2013 Dec;21(12):772-5.
Pedowitz RA, et al. "Optimizing the management of rotator cuff problems" J Am Acad Orthop Surg. 2011 Jun;19(6):368-79.