Rotator Cuff Injuries

The rotator cuff is a group of four muscles and their tendons, which envelope the main shoulder joint (where the upper arm bone sits on a shallow socket in the shoulder blade).

The rotator cuff allows the arm to raise and rotate (at the shoulder joint) and helps to stabilize the shoulder joint during movement. Though each rotator cuff muscle moves the arm (from the shoulder joint) in a specific direction, they all work together to stabilize the shoulder joint.

A strain or tear in the rotator cuff may occur suddenly from trauma (such as a fall) or gradually from chronic overuse.

Causes / Risk Factors for Rotator Cuff Injury

Whether injury develops gradually from overuse or suddenly from a traumatic injury, it is often because the rotator cuff is not strong enough for the given task.

Weak rotator cuff muscles
If any of the rotator cuff muscles are weak, the humerus may not be kept centered in the socket of the shoulder blade, and the surrounding soft tissues may be placed under abnormal pressure. This may lead to irritation and inflammation of the rotator cuff tendons.

Advanced age
Age-related changes in the tendons leave them weaker, less elastic, and more susceptible to injury.

Chronic overuse of shoulder
(especially activities involving repetitive overhead movement such as swimming, tennis, stacking objects on high shelves). Minor injuries that are not given a chance to heal can cause chronic inflammation and degenerative changes in the tissues. Early treatment is important.

Poor Posture
Slouching reduces the space within the shoulder joint that the rotator cuff tendons pass through.

Participating in contact sports
Acute shoulder injuries are often due to a blow to the shoulder or a fall.

Symptoms of Rotator Cuff Injury

The main symptoms of rotator cuff injuries are shoulder pain and weakness. Symptoms worsen when lifting the arm above shoulder level. A rotator cuff tear will cause more weakness than rotator cuff tendonitis but the symptoms are similar.

Symptoms may occur suddenly if the rotator cuff in injured by a traumatic injury – such as an accident or fall. The majority of rotator cuff injuries occur gradually and symptoms appear gradually.

Preventing Rotator Cuff Injuries

Rotator cuff exercises to strengthen the rotator cuff helps to stabilize the shoulder joint and reduce the risk of rotator cuff injuries. Strengthening exercises strengthen the muscles and the tendons.

Avoid lifting heavy objects, especially overhead. Use two hands to lift heavy objects to distribute the weight.

Take breaks from repetitive overhead activities. Fatigued rotator cuff muscles can’t properly stabilize the shoulder joint.

Maintain Proper Posture. Keep shoulders down and back.

Treatment Of Rotator Cuff Injuries

Treatment involves avoiding overhead activities and any activity that causes pain, rehabilitative exercises, anti-inflammatory medications, applying ice, applying heat, stretching exercises to prevent frozen shoulder, sometimes a cortisone injection, possible surgery.

Relative Rest

Rest does not mean total rest. Using the shoulder for everyday activities prevents muscles from atrophying. Avoid activity that causes pain especially overhead activities. Avoid the activity that caused the injury in the first place (if it can be identified).


Stretching exercises are usually started after the first couple of days to prevent frozen shoulder. Consult a physician before beginning exercises if you have shoulder pain.

Strengthening exercises are prescribed as the shoulder heals, when a physician or physical therapist determines the shoulder is ready. Exercises done too soon may cause further injury.

Applying Ice

For acute injuries, applying ice covered by a cloth for 20 minutes, every three or hours for the first couple of days helps limit swelling and pain and shortens healing time. Do not ice for over 20 minutes at a time to avoid frostbite. Do not apply ice directly to skin; cover ice with a wet or dry cloth. Moist cold penetrates more deeply than dry cold, but many people prefer to use dry cold.

For chronic injuries, applying ice after an exercise or activity that has aggravated the injury can minimize pain.

If you have circulatory problems or nerve damage, consult a physician before applying heat or cold.


Do not apply heat for the first few days after an acute injury. Do not apply heat to a swollen joint as it will increase inflammation. Wait about four or five days or until swelling has subsided. Heat increases circulation, helps relax the muscles, and relieves pain. Apply heat for 15 to 20 minutes at a time, and wait at least an hour before reapplying to avoid overheating the tissues.

For chronic injuries, apply heat before exercises or activities that may cause soreness. Warm muscles are more elastic than cold muscles. A warm bath or shower before stretching exercises decreases the chance of injury. Moist heat penetrates more deeply than dry heat.


Wrapping the shoulder with ace (elastic) bandages helps minimizes swelling after an acute injury. If numbness occurs, the wrap is too tight. An ace bandage may also be used to hold on an ice pack.

Massage Therapy

Deep tissue massage is often used in the treatment of soft tissue injuries such as tendonitis. Massage therapy relieves pain and increases range of motion while it increases circulation and speeds healing. Massage therapy also reduces stress and the production of stress hormones. Stress hormones heighten the perception of pain and contribute to tight muscles (which may cause or increase pain). Massage therapy is contradicted if there is swelling of the joint.

Cortisone injections

Sometimes cortisone (a steroid with powerful anti-inflammatory properties) injections can provide enormous relief of symptoms. However, there is a limit to how many times it can be safely used. Three cortisone injections is considered the limit by many physicians. Overuse of cortisone weakens the structure of tissue and increases the risk of it tearing. Cortisone taken orally can have serious side effects but when injected into a joint, not much is absorbed into the bloodstream.

Because of the ‘3-injection limit’, physical therapy is important in preventing problems from reoccurring.


If conservative treatment does not bring sufficient relief of pain and/or restore adequate shoulder function, surgery may be recommended. Surgery may be needed to reattach a torn rotator cuff tendon or, in the case of shoulder impingement, to smooth rough surfaces and remove damaged tissue.

Complications Of Rotator Cuff Injuries

Injuries that cause one to limit use of the shoulder because of pain may lead to frozen shoulder. Frozen shoulder may be prevented with range of motion exercises.
For more information on specific rotator cuff injuries, see rotator cuff tendonitisrotator cuff tears, and shoulder impingement syndrome.