Shoulder pain and shoulder injuries are quite common, especially among athletes and non-athletic older people. In fact, most active folks will have a brush with shoulder pain at some point in their lives. One of the most common causes of shoulder pain is an injury to the rotator cuff. What are the signs that the shoulder discomfort you’re experiencing is coming from your rotator cuff?
Anatomy of the Rotator Cuff
The rotator cuff is made up of four muscles and their attached tendons. These muscle/tendons are the:
· Supraspinatus–Rotates shoulder outward
· Infraspinatus – Rotates shoulder outward
· Teres minor–Rotates shoulder outward
· Subscapularis–Rotates shoulder inward
The function of these muscles and tendons is to reinforce and stabilize the shoulder joint and help you lift and rotate your shoulders. When these tendons become irritated or inflamed, they can cause pain and reduce the range-of-motion of the arm and shoulder. This is known as rotator cuff tendonitis. With tendonitis of the rotator cuff, the tendons are still intact but are irritated and inflamed. However, a rotator cuff tendon can also tear. These tears can be partial tears or involve the full thickness of the rotator cuff tendon or muscle. Full-thickness rotator cuff tears are more common with an acute injury.
A partial tear to a rotator cuff tendon is more common than a full-thickness tear, and simple rotator cuff tendonitis is even more prevalent. Rotator cuff injuries, in general, are more common in people who do work that requires lifting their arms overhead repetitively and those who play sports, like tennis or volleyball that emphasize overhead movements. But weight trainers get rotator cuff injuries too. The risk also increases with age. In fact, as many as 80% of people over the age of 80 have a torn rotator cuff, however small. You can expect that number to increase as more people stay active into the latter decades of life.
How Do You Know if You Have a Rotator Cuff Tear?
Any shoulder pain, especially pain in the shoulder brought about by lifting or other activities should raise concerns. Pain in a shoulder when lifting overhead isn’t normal and needs evaluation. Inflammation or a partial tear in a rotator cuff tendon can cause vague pain in the front of the shoulder that may extend down the arm. The pain typically gets worse with lifting overhead or moving the arm away from or behind the body. The affected arm and shoulder may be weak as well. Remember, rotator cuff tears don’t necessarily come from an acute injury. Instead, repetitive overhead motion can cause small tears to form that leads to inflammation and pain.
Another common complaint of people with a rotator cuff injury is shoulder pain when lying on the affected shoulder. Often, the pain of a rotator cuff injury worsens at night. In some cases, the affected shoulder will make popping or crackling sounds with movement, a phenomenon known as crepitus.
If you have problems raising your arms out to the side or in front of your body higher than shoulder level, it’s suspicious for a rotator cuff injury. You may notice that it hurts when you reach your arm behind you to brush your hair or scratch your back. It’s also not uncommon to have mild weakness on the side where the injury is. Rotator cuff tears, as opposed to tendonitis, usually cause more severe pain and there’s typically weakness. You may find it impossible to raise your arms over your head or push things away from your body.
These signs and symptoms might give you a clue that something is wrong, but there is a test orthopedic physicians and physical therapists do to check for a rotator cuff injury, and you can try it at home.
· Raise the affected arm to 90 degrees with your palm facing behind you.
· Ask someone to push down on your arm while you try to resist the force.
If you feel pain during this maneuver, you probably have a rotator cuff injury or tear. The only definitive way to find out is through an MRI imaging study.
How Do You Treat a Rotator Cuff Injury?
Rotator cuff tendonitis or a partial rotator cuff tear will usually improve with conservative therapy, including pain control and physical therapy. Full-thickness rotator cuff tears, however, may require surgery. Even with partial-thickness tears, it can take six months or longer to recover shoulder function.
Some people with a rotator cuff injury develop a frozen shoulder, a condition where shoulder mobility is extremely limited. The limited mobility is because the connective tissue over the bone within the joint thickens due to lack of movement. It can take a year or longer, even with physical therapy, to regain full mobility after a frozen shoulder. It is more common in middle-aged women and people with thyroid disease or diabetes.
The best treatment for a rotator cuff injury is physical therapy, and a frozen shoulder will need longer-term therapy to restore mobility.
How to Prevent Rotator Cuff Injuries
Regular strength training can strengthen the four rotator cuff muscles and make them more resistant to injury. However, weight training with bad form is what commonly causes rotator cuff injuries in the first place. The move most likely to injure a rotator cuff is lifting overhead, particularly if you use bad form and a weight that’s too heavy. Overhead presses and anterior and lateral raises are exercises that place stress on the rotator cuffs unless you use impeccable form. These aren’t exercises you should load up the weight on. Go for lighter weight, higher volume.
Fortunately, weight training, using good form, strengthens the rotator cuff muscles. But keep your shoulder workouts balanced. For every exercise that strengthens your rotator cuff, do one that targets your deltoids to promote balanced strength development. Also, don’t overtrain your shoulders, as you also work these muscles when you do other compound lifts, like push-ups and deadlifts. Twice a week is enough to do overhead presses and raises that are especially taxing to the rotator cuff tendons and muscles.
The Bottom Line
Keep your shoulders healthy by training sensibly and keeping your workouts balanced. It’s worth it!
· Geriatr Orthop Surg Rehabil. 2015 Sep; 6(3): 220–224.
· MedLine Plus. “Rotator Cuff Injuries”
· Up to Date. “Rotator Cuff Tendinitis and Tear”