Understanding Rotator Cuff Pain

Rotator cuff pain typically affects the front and side of the shoulder and upper arm. This discomfort often indicates an injury, inflammation, or degeneration of the tendons in the rotator cuff.

What Is the Rotator Cuff?

The rotator cuff is a group of four muscles and their tendons that surround the shoulder blade (scapula) and attach to the upper arm bone (humerus). These tendons are crucial for lifting and rotating the arm, providing both stability and mobility to the shoulder joint.

Symptoms of Rotator Cuff Pain

Symptoms can vary depending on the cause but generally include:

• Sharp or aching pain and swelling over the front or outer part of the shoulder and upper arm, sometimes extending down the arm.
• Difficulty with tasks like combing your hair or reaching behind your back.
• Weakness in the arm, making activities such as reaching into upper cabinets or lifting objects challenging.
• Pain while sleeping on the affected shoulder, possibly causing disturbed sleep.
• In some cases, rotator cuff tears may be less painful than expected, and rotator cuff tendinosis might not cause noticeable symptoms, especially early on.

Distinguishing Tendinitis from Tendinosis

When to Seek Medical Attention

If you experience any of the following, consult an orthopedician:

• Severe or sudden shoulder pain
• Swelling, bruising, redness, or warmth around the shoulder joint
• Persistent or worsening pain
• Pain associated with breathing difficulties, dizziness, or abdominal pain
• Trouble lifting your arm overhead or carrying objects
• Any trauma or visible deformity of the shoulder

Causes of Rotator Cuff Pain

Rotator cuff pain usually results from one of three conditions:

1. Rotator Cuff Tendinitis
   • Cause: Inflammation or injury to a healthy rotator cuff tendon, often from repetitive overhead activities or sports such as tennis, swimming, or baseball.
   • Risk Factors: Conditions like diabetes and obesity can increase risk.
2. Rotator Cuff Tear
   • Cause: A tear in the tendon, commonly due to trauma (like falls or direct blows) or chronic overuse. Smoking and obesity can also heighten risk.
   • Demographics: More common in middle-aged and older adults.
3. Rotator Cuff Tendinosis
   • Cause: Degeneration and thinning of tendons due to aging and decreased blood supply. Poor posture, smoking, repetitive activities, and genetics can contribute.

Diagnosis of Rotator Cuff Pain

Diagnosis involves a physical examination and imaging studies:

• At-Home Function Tests: Simple tests like the Empty Can Test, Lift-Off Test, and Resistance Testing to assess strength and pain with specific movements.
• Pain-Relief Test: Injecting lidocaine into the shoulder to see if the pain is due to tendinitis or a rotator cuff tear.
• Imaging: MRI scans can identify tears and other issues. Arthrograms and ultrasounds may also be used for detailed assessment. Large tears may require referral to an orthopedic surgeon for possible surgical intervention.

Treatment for Rotator Cuff Pain

Treatment depends on the specific condition:

• Rotator Cuff Tendinitis and Tendinosis: Often managed with self-care measures:
  • Avoid activities that worsen the pain
  • Use cold packs and NSAIDs (like Advil or Aleve) to reduce inflammation
  • Apply heat and perform gentle shoulder massages before exercise
  • Engage in physical therapy to improve stretching and range of motion
• Rotator Cuff Tear:
  • Small tears may be treated similarly to tendinitis, with physical therapy focusing on restoring shoulder function.
  • Larger tears might need surgical repair, either through open surgery or minimally invasive arthroscopy. Post-surgery, physical therapy is crucial for recovery and regaining function.

Preventing Rotator Cuff Pain

To lower the risk of rotator cuff issues:

• Warm up before exercising
• Use proper lifting techniques
• Perform shoulder-strengthening exercises
• Maintain good posture
• Avoid smoking and manage your body weight

Summary

Rotator cuff pain, common among athletes and older individuals, can arise from tendinitis, tendinosis, or tears. Many cases improve with conservative treatments like physical therapy and activity modification, but severe tears may require surgery. Early diagnosis and appropriate management are essential for effective recovery and to prevent future problems.