What is the rotator cuff?
The rotator cuff is a
group of four tendons and their related muscles that stabilize the shoulder
joint and enable you to raise and rotate your arm. The
shoulder is a ball-and-socket
joint with three main bones: the upper arm bone
(humerus), the collarbone (clavicle), and the shoulder blade (scapula). These
bones are held together by muscles (the supraspinatus, infraspinatus,
subscapularis, and teres minor),
tendons that attach these muscles to the humerus,
ligaments, and the joint capsule. The rotator cuff
helps keep the arm bone seated into the socket of the shoulder blade.
What are rotator cuff disorders?
The rotator cuff
tendons are a common source of shoulder problems. The tendons and tissues
around them can become irritated, damaged, or weak because of normal wear and
tear over the years, particularly through overuse and repetition of overhead
arm movements. This age-related degenerative process can cause one or more
tendons to rub against the bones (impingement). Impingement also can be caused
by irregularly shaped shoulder bones.
Rotator cuff disorders
inflammation of the tendons (tendinitis) or
the bursa (bursitis), a calcium buildup in the tendons, or
partial or complete tears of the tendon. Partial tears are not uncommon when
the rotator cuff is already damaged, scarred, or weakened. A complete rotator
cuff tear in a person with an otherwise healthy shoulder is most often caused
by a forceful injury.
Many people with shoulder problems feel as
though their shoulder is weak. If weakness is related to pain, you can probably
use your arm and shoulder, but it is uncomfortable. True weakness means that
you are unable to use your shoulder normally because of decreased strength, not
just because of pain. For example, you may be unable to raise your arm, no
matter how hard you try. This kind of weakness may be caused by a tear in one
of the shoulder tendons.
Without any treatment-either physical
therapy or surgery-rotator cuff disorders may get worse. Over time, you may
have more pain and lose range of motion and strength in your shoulder, making
it harder to do your daily activities.
When is nonsurgical treatment used to treat rotator cuff disorders?
Shoulder pain has many different causes and can be
related to something other than a rotator cuff disorder, such as problems in
the upper back and neck. Shoulder pain alone without weakness or limited range
of motion is not a reason to have surgery. Early stages of rotator cuff damage
are usually reversible with nonsurgical treatment, which includes:
- Resting, although gentle movement of the
shoulder is recommended. Prolonged immobilization (holding the shoulder still),
such as with slings or braces, may cause the shoulder joint to become stiff
- Alternating applications of cold and heat.
nonsteroidal anti-inflammatory drugs (NSAIDs).
- Avoiding positions and activities that hurt your
After a period of rest and gentle activity, many people
can relieve their pain and restore strength and flexibility in weakened and
stiff shoulders by following a physical therapy program. These programs include
- Stretch tight shoulder
- Strengthen the muscles that move the
- Allow you to do daily activities without putting excess
strain on your shoulder.
Surgery may not be warranted if:
- Your shoulder problem gets better with
physical therapy and exercise.
- You have torn rotator cuff tendons
but are not bothered by pain, weakness, or stiffness.
- You are able
to continue your daily activities.
- You are not willing or able to
complete the physical therapy program required after surgery.
have other health problems that may make surgery too dangerous as compared to
the expected gain.
When is physical therapy used to treat rotator cuff disorders?
Physical therapy is sometimes needed before surgery to
help determine the cause of your shoulder problem and whether surgery may be
appropriate. While strengthening a muscle that is attached to a torn tendon is
unlikely to be beneficial, strengthening the surrounding muscles may allow your
shoulder to compensate for a rotator cuff tendon tear. If your shoulder gets
better with physical therapy, you may not need surgery. If you do have rotator
cuff surgery, you will need to commit to and complete a physical therapy
program after surgery.
- If your shoulder joint capsule or tendons are
tight, physical therapy can help improve your range of motion and allow your
shoulder to move more smoothly.
- Physical therapy may strengthen the
muscles that move your arm and shoulder.
- Physical therapy helps you learn how to lift and carry objects
and do other activities with your unaffected muscle groups. This puts less
stress on your irritated rotator cuff tendons.
Most exercise programs can be done easily on your own at
home after a health professional or physical therapist has trained you. There
is generally no risk to trying physical therapy for several weeks to see if it
helps, especially if you have had shoulder problems for some time.
For more information, see:
Rotator cuff problems: Exercises you can do at home
(with your health professional's approval).
When is surgery used to treat rotator cuff disorders?
If you are young and your tendon tissue is strong and healthy, surgery
may be a good treatment choice. Your doctor may also recommend surgery if there
is a good chance that your tear will get worse over time.
are two types of surgery for rotator cuff disorders:
Subacromial smoothing removes scar
tissue and damaged tendon, bursa, and debris from the joint (debridement). The surgeon may also remove small
amounts of bone from the underside of the acromion and the acromioclavicular
joint (acromioplasty). Subacromial smoothing usually is effective in relieving
Rotator cuff repair usually starts with
debridement. The repair then involves sewing the torn
tendon or tendons together, and reattaching them to the arm bone. Rotator cuff
repair improves strength and movement.
Surgery may be a good choice for you if both of the following are true:
- You have severe shoulder
- These symptoms have not improved after a period of
nonsurgical treatment, including a well-designed physical rehabilitation
Sudden tears, such as from a major sports injury or auto
accident, often are best treated with early surgery. Very large rotator cuff
tears [those larger than
2in.] and tears that
affect more than one of the four rotator cuff tendons sometimes cannot be
repaired, especially if they are long-standing. But surgery may help relieve
pain by removing damaged tissue from the joint (subacromial smoothing).
What are the risks of rotator cuff surgery?
your rotator cuff tendons are very weak and frayed, surgical repair will not be
as effective in holding the tendon together.
Even after surgery,
you may be advised to avoid lifting heavy objects, doing overhead work, and
returning to sports or activities that require over-the-head movement of the
arm or throwing movements.
Shoulder surgery may relieve some pain
and weakness and make it easier to move your shoulder, but it may not restore
full strength to your shoulder, especially if you have a severe tear in the
tendons or if your tendons are weak.
You may continue to have
pain, which may require more physical therapy or, sometimes, more surgery to
Surgery poses risks of infection, persistent pain,
slow healing followed by stiffness, and a potential need for more surgery. In
addition, all surgeries pose some risks, such as irregular heart rhythms
(arrhythmias), changes in blood pressure, and
Surgery will not be a
substitute for physical therapy. In fact, a good physical therapy program is
necessary for a full recovery after surgery.
For more information, see the topic
Rotator Cuff Disorders.