Rotator cuff injuries and recovery

Rotator cuff injuries  are very common and the rotator cuff is the most common cause of shoulder pain Many rotator cuff disorders do not always involve a trauma or an injury.  Some of you may have suffered a recent injury to your shoulder and some of you simply woke up with shoulder pain for no known reason.  Causes of rotator cuff problems are varied and include degenerative, genetic, inflammatory or are age/activity  related reasons.  While many rotator cuff injuries can be caused by a recent trauma or repetitive stresses.  The most common cause of rotator cuff  pain is usually because of a degenerative or attritional process.

                                              WHAT IS THE ROTATOR CUFF?

The rotator cuff are a series of 4 small muscles that are located around the shoulder and deep to the deltoid, a  larger and better  known muscle . These muscles coordinates the function of the shoulder by harnessing the power of the larger deltoid, pectoralis, and other muscles and turning that power into useful, well coordinated, and fluid motion.  It is very easy for the larger more powerful muscles to over-power the rotator cuff and cause over-use injuries.  This is a very common source of shoulder pain in overhead athletes, and weight lifters or those of you who are active in the gym.

The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and keeping it stable.

The tendons of the rotator cuff pass underneath a bony area on their way to attaching the top of the arm bone. These tendons join together to form a cuff that surrounds the shoulder joint. This provides the stability of the joint and allows movement of the arm bone on the shoulder bone.


There are many different conditions which cause our rotator cuff to hurt.  The majority of rotator cuff problems are due to overuse, or are degenerative in nature.  Some rotator cuff conditions are “acute” or the result of a recent accident or fall.  Rotator cuff symptoms can vary significantly.  Very severe shoulder pain might not mean you have a severe rotator cuff injury.  Shoulder pain from rotator cuff tendinitis can be more severe than the pain from a tear — and shoulder pain associated with a large tear may be much less than the shoulder pain experienced by someone with a small tear.


  • Tendinosis : the most common cause of shoulder pain
  • Tendonitis : common in athletes who push too hard 
  • Partial tear of the rotator cuff
  • Full thickness tear of the roator cuff
  • Calcific Tendonitis : calcium deposits in the rotator cuff 
  • Internal impingement

Shoulder pain in young patients (15-30) may be due to  instability where the shoulder ligaments are  loose and the shoulder can dislocate.  Traumatic rotator cuff injuries are rare in teenagers.  The pain associated with instability is because the instability causes the rotator cuff to work very hard to keep the shoulder in position. Patients over 40 who suffer from shoulder pain tend to suffer from more degenerative problems — whereas younger patients tend to suffer more overuse type injuries, typified by tendonitis and inflammation    Over the age of 35-40 most shoulder pain patients will have pain due to rotator cuff tendinosis, partial rotator cuff tears, or full thickness rotator cuff tears.

Rotator cuff tendinosis 

Symptoms from tendinosis generally come on slowly over time and reach a point where you are very uncomfortable. Some patients can identify an activity or injury which precipitated the onset of pain, but most people with rotator cuff tendinosis have no idea why their shoulder started bothering them.  One of the hallmarks of rotator cuff tendinosis is terrible night pain. The pain is usually on the side, and occasionally on the front of the shoulder.    Patients with tendinosis typically do not have weakness.  They may have weakness which is secondary to pain (and you simply do not want to use the arm).   Snapping or popping in the shoulder may occur because the rotator cuff is no longer smooth,   Patients with tendinosis  may have pain when lifting their arm in certain positions, and loss of motion may occur.  Pain is usually along the side of your upper arm and some people describe the pain as radiating down towards their elbow. Patients with rotator cuff tendinosis may have trouble putting on a coat, putting on a bra, trying to reach up high or reach behind their back.

If you surgeon mentions that you have rotator cuff impingement, Impingement Syndrome or Rotator Cuff  Syndrome — you are more than likely suffering from rotator cuff tendinosis or a partial tear or fraying of the rotator cuff.  Rotator cuff impingement theorists also used to believe that a *bone spur* caused most rotator cuff problems.  Most academic surgeons no longer believe that rotator cuff impingement or tears are due to bone spurs around the shoulder.  If you are told you require shoulder surgery because of a bone spur… you should probably seek a second opinion.

Overuse rotator cuff tendinitis 

Overuse tendinitis typically occurs in patients who participate in certain sports.  Pitchers, swimmers or volleyball players with shoulder pain the day after they played is a common presentation.  Their pain is mild to severe.  Their pain is usually along the back or side of the shoulder and responds well to rest and anti-inflammatories.   Some of these patients (especially overhead athletes) can have overuse rotator cuff like pain, but the actual cause is that the shoulder is loose or unstable and the rotator cuff is working too hard to maintain the shoulder joint in its proper position.   Some overhead athletes also have a condition known as Internal Rotator Cuff Impingement and this can present as a case of rotator cuff tendinitis, but the actual cause of pain is “micro”-instability (where the shoulder is loose, but not enough to make it dislocate).

Rotator Cuff Tears 

Rotator cuff tears are surprisingly common.  Many patients have rotator cuff tears and do not even know it.  Many rotator cuff tears are degenerative, and are not the result of a single injury to the tendon.  This means your tendon simply wore out over time.  Some rotator cuff injuries or tears do occur because of trauma and are termed acute rotator cuff tears. Degenerative rotator cuff tears and acute rotator cuff tears are two different situations that require a different treatment approach in most cases.   Why do some rotator cuff tears lead to pain and others do not… we don’t know!.

Partial thickness rotator cuff tears

 Partial thickness rotator cuff tears are very common and unless your pain has not improved with non-operative treatment, are rarely an indication for surgery. The rotator cuff is very thick and partial tears occur when a portion of the rotator cuff pulls away from its attachment to the bone.  Most patients with partial thickness rotator cuff tears will present in a manner similar to patients who suffer from tendinosis—and in many situations, the treatment is very similar.  Most patients with tendinosis, and partial tears will improve with rest, ice, medication, physical therapy or an occasional injection. Their most common complaint is pain with lifting the arm overhead — and they will also, typically have severe pain at night.

Full thickness rotator cuff tears

Full thickness or complete tears are also common.  Full thickness rotator cuff tears need to be broken down into categories to approach them properly.

  • Acute : These are the result of an injury
  • Degenerative: Your tendons simply wore out
  1. Small: tears that are less then 1 cm long
  2. Medium
  3. Large: Tears that involve a large percentage of your rotator cuff

Degenerative cuff  tears are similar in appearance to your favorite pair of blue jeans.  One day you look down and you see a hole around the knee.  Did you tear them… no. The denim just wore out.

Patients with different types of rotator cuff tears will present with similar symptoms or complaints.  To a large degree your symptoms from your rotator cuff tear will depend on the size of the tear, or what percent of the rotator cuff is actually torn.  Most patients will have pain along the side of the shoulder, pain with reaching up, pain with turning the steering wheel in your car or pain when trying to sleep at night.  The night pain, at times, can be unbearable.  Patients with small rotator cuff tears may not notice any weakness… while those of you with large tears will notice weakness and difficulty lifting the arm or reaching high into a cabinet or above your head.

Source : , article written by Howard J. Luks ,MD ,Chief of Sports Medicine and Arthroscopy 




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