Rotator Cuff Injury

author : AMSSM

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Does your shoulder hurt? You may have a rotator cuff injury. This article will go through the signs, symptoms and treatment options.

Member Question

When I lift my arm from my side, straight out to my side, I get a pain when my arm is about shoulder high. This is causing discomfort with my swim stroke. Does this sound like a rotator cuff injury? I haven't been swimming for a couple of weeks and the pain/discomfort is still there. It is noticable, and nagging, but I can still swim through it. I just don't want to do further damage, if that is possible. Any thoughts? 

Answer from Billy Haug, MD, CAQSM, CSCS
Member AMSSM 

In reading your symptoms, it looks like the rotator cuff may indeed be the culprit.  Your rotator cuff is made up of the muscles and tendons in your shoulder that connect your upper arm with your shoulder blade.   A rotator cuff injury includes any type of irritation or damage to your rotator cuff muscles or tendons. Causes of a rotator cuff injury may include a fall, or overuse, such as repetitive arm activities — especially in swimming or throwing.  A rotator cuff injury can, in many instances, heal with a combination of time and physical therapy.

Rotator cuff injury signs and symptoms may include pain and tenderness in your shoulder, especially when reaching overhead, reaching behind your back, lifting, pulling or sleeping on the affected side.  Ultimately it may affect strength and range of motion in more severe injuries. 

Tendons in your rotator cuff can become inflamed due to overuse or overload, especially if you're an athlete who performs a lot of repetitive, overhead activities, such as in tennis, baseball or swimming.   The fluid-filled sac (bursa) between your shoulder joint and rotator cuff tendons can become irritated and inflamed.  Left untreated, tendinitis can weaken a tendon and lead to chronic tendon degeneration or to a tendon tear.

Initially, treatment for rotator cuff injuries involves resting your shoulder. Avoid movements that aggravate your shoulder and give you more pain and apply cold packs to reduce pain and inflammation. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce inflammatory pain. If these measures are helpful or not, your doctor or physical therapist will talk with you about specific exercises designed to help heal your injury, improve the flexibility of your rotator cuff and shoulder muscles, and provide balanced shoulder muscle strength. Depending on the severity of your injury, physical therapy may take from several weeks to several months to reach maximum effectiveness.

If your injury appears to be severe or your doctor can't determine the cause of your pain through physical examination, he or she may recommend diagnostic imaging tests such as an MRI to more precisely diagnose the problem.

If therapy is helpful but you reach a “plateau,” further treatment may include a corticosteroid injection.  Depending on the severity of your pain, your doctor may use an injection to relieve inflammation and pain.   If you have a large tear in your rotator cuff, you may need surgery to repair the tear.  The surgery may be performed as an open repair or as an arthroscopic repair with the aid of a small camera inserted through a smaller incision.

To help prevent a rotator cuff injury, be aware of overtraining!  Do regular shoulder exercises that you will learn from your doctor or physical therapist, and modify your training routine until you feel you are making progress.  Most of all, listen to your body.   It will let you know when it is time to rest!

Billy Haug, MD, CAQSM, CSCS

Altru Clinic Department of Sports Medicine

Grand Forks, North Dakota

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date: February 14, 2013