Repetitive stress. Repeating the same shoulder motions again and again can stress your rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of activities that can put you at risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well.
Typically tears occur in those over age 40, but occasionally tears are seen in younger individuals. Typical signs of a rotator cuff tear include pain with overhead use of the arm, weakness or pain preventing or disrupting sleep.
Stop doing what caused the pain and try to avoid painful movements. Limit heavy lifting or overhead activity until the shoulder pain subsides. Icing the shoulder may help it feel better. Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) also may be helpful.
There are 2 main causes of rotator cuff tears: injury and degeneration. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand. It may also develop over time due to repetitive activities. Rotator cuff tears may also happen due to aging, with degeneration of the tissues.
Rotator cuff injuries are most often caused by progressive wear and tear of the tendon tissue over time. Repetitive overhead activity or prolonged bouts of heavy lifting can irritate or damage the tendon. The rotator cuff can also be injured in a single incident during falls or accidents.
Before exercising, warm up your muscles and tendons in a warm shower or with a heating pad. You may experience some mild soreness with muscle-toning exercises — ice applied to the shoulder should help relieve it — but if you develop sharp or severe pain, stop the exercises for a few days.
Rotator cuff tears do not heal on their own without surgery, but many patients can improve functionally and decrease pain with nonsurgical treatment by strengthening their shoulder muscles. Just because there is a tear, does not necessarily mean a surgery is needed.
Return to activities — Most people with rotator cuff tendinitis see improvement in pain and function after 6 to 12 weeks of rehabilitation. If shoulder pain does not improve after several weeks of physical therapy exercises, most clinicians will recommend further evaluation. (See 'Rotator cuff injury tests' above.)
doi:10.1186/s12891-018-2319-9 most physicians recommend sleeping on your back. Laying on your back won't put pressure on the injured shoulder or force it into an awkward position. For the first few days or weeks, when symptoms are at their worst, consider sleeping on a wedge pillow or in a recliner.
Moist heat, such as a hot bath, shower, or a heat pack, can help loosen up your shoulder when you feel pain in your shoulder. An ice pack applied to the shoulder 20 minutes at a time, 3 to 4 times a day, may also help cut down the swelling when you are in pain. Wrap the ice pack in a clean towel or cloth.
Tearing and injury to the rotator cuff become more likely as tendons in the shoulder naturally wear down over time. Due to gravity, laying down can cause the rotator cuff to stretch and pull, leading to significantly worsened pain at night.
Red flags include: Trauma, pain and weakness, or sudden loss of ability to actively raise the arm (with or without trauma): suspect acute rotator cuff tear. Any shoulder mass or swelling: suspect malignancy. Red skin, painful joint, fever, or the person is systemically unwell: suspect septic arthritis.
If left untreated, a rotator cuff tear can severely restrict function and range of motion. The tear can also increase over time. This may cause partial rotator cuff tears to progress to total tears.
Ultrasound does have the ability to identify rotator cuff tendon tears but with certain limitations. One factor is that it requires special training for the staff, as this is a less commonly performed imaging test. Second, the tendons may not be adequately seen in obese patients or those with a limited range of motion.
Symptoms. Rotator cuff pain commonly causes local swelling and tenderness in the front of the shoulder. You may have pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position.
Make an appointment with your doctor if your shoulder pain is accompanied by: Swelling. Redness. Tenderness and warmth around the joint.
Without any treatment—either rest and rehabilitation or surgery—rotator cuff disorders may get worse. Over time, you may have more pain. You may lose range of motion and strength in your shoulder, making it harder to do your daily activities.
Physiotherapists have been treating patients with rotator cuff tears of the shoulder for years. A lot of tears do not require surgery, and physiotherapists can assess and treat the resulting weakness and tightness with specific exercises.
Patients are often advised to wear a sling or brace for the first 4–6 weeks after rotator cuff repair surgery to prevent them from performing any physical activities involving the affected shoulder (3).
Patients with “well-balanced” massive rotator cuff tears may still have good active motion and be able to perform their activities of daily living.
How Massage Therapy Can Help Rotator Cuff Muscle Strains and Tendinitis. The infraspinatus and teres minor are not susceptible to an impingement stress but rather tensile stress. In low grade strains where the tendon is still intact, massage for strain or tendinitis to these muscles can also be very helpful.
Overhead Activity Leads to Shoulder Injuries
“Any time your arms are raised up over your head, the rotator cuff might be in an awkward position,” said Dr. Wittstein, a Duke orthopaedic surgeon. “This in combination with lifting or lowering something heavy away from the body really strains the rotator cuff.”
At MedStar Health, we frequently see patients experiencing pain in the shoulder that results from: Tendonitis in the rotator cuff, which can be painful but doesn't involve any structural damage. A partial tear, during which parts of the tendon slowly peels away from the cuff.