Many people who visit a doctor with shoulder pain have a problem with their rotator cuff. A rotator cuff injury can happen suddenly, such as falling on your outstretched arm.
Or it can develop slowly, resulting from repetitive motions or age-related degeneration. Some people with a rotator cuff injury may not feel any pain.
The condition can be progressive, with degeneration occurring slowly. Only one-third of rotator cuff tears cause pain, according to a study. Your treatment for a rotator cuff injury will depend on the type of damage. For most rotator cuff injuries, doctors prescribe conservative treatment. Research estimates that conservative treatment is effective in 73 to 80 percent of cases of full-thickness rotator cuff tears. Most people regain their range of motion and strength after 4 to 6 months.
If symptoms persist or worsen, your doctor may recommend surgery. Your doctor will also prescribe surgery for severe shoulder injuries. Discuss with your doctor which type of surgery is best for your particular injury. Options include:. Recovery times from surgery vary depending on the type of surgery and extent of your injury.
In some cases, healing can take up to 2 years , but most people are back to their normal activities and recover much sooner than that. Most surgical repairs are successful. Talk with your doctor about ways to increase a good outcome. For example, if you smoke, this will involve quitting. People who smoke are more likely to have a poorer surgical outcome. Treating rotator cuff injuries early can save you from increasing pain and the inability to use your arm and shoulder in daily activities.
The ball-and-socket structure of your shoulder and arm is an intricate arrangement of muscles, tendons, and bone. Injuries to the rotator cuff are common, but treatment is often successful. Certain developmental variations should be noted Fig. The tendon may appear as a double structure. It may be absent. It may be lying in an extrasynovial position in a tunnel in the fibrous capsule, or it may have a mesentery of varying length. Variations also occur in the region of the bicipital groove.
Meyer in described the supratubercular ridge—a ridge of bone continuous with the medial wall of the bicipital groove Fig. Hitchcock and Bechtol found this ridge to be well developed in 8 per cent and moderately developed in 59 per cent of the specimens reviewed. It tends to displace the biceps tendon against the transverse humeral ligament. These observers also noted variations in the obliquity of the medial wall of the bicipital groove. Only 10 per cent of the specimens had a medial wall of 90 degrees.
In 35 per cent it was 75 degrees; in 34 per cent it was 60 degrees; in 13 per cent it was 45 degrees. In 6 per cent it was 30 degrees, and in 2 per cent it was 15 degrees.
Shallow grooves favor displacement of the tendon, forcing it to lie on a fascial sling. Interior of right shoulder joint, posterior view; the posterior portion of the capsule has been reflected medially.
Observe the arrangement of the three glenohumeral ligaments reinforcing the anterior aspect of the fibrous capsule. They are all directed toward the superior aspect of the glenoid fossa; in this instance they all blend with the labrum glenoidale not the case in all shoulders. Note the direct communication of the subscapularis recess with the inside of the joint cavity. In this joint the subscapularis recess communicates with the joint cavity, both above and below the middle glenohumeral ligament.
Top, left , A double biceps tendon. Top, right , Absence of a biceps tendon and a firmly attached labrum to the glenoid rim. Bottom, left , The biceps tendon is extrasynovial, lying within the fibrous capsule. This structure has failed to migrate to an intracapsular position. Note the firm attachment of the labrum to the rim of the glenoid cavity. The inferior glenohumeral ligament in this specimen is well defined and extends from the subscapular area to the triceps area.
Bottom, right , A well-formed mesentery of the biceps tendon and a large incomplete tear in the musculotendinous cuff in the supraspinatus area, proximal to which there is a distinct hypertrophied falciform ligament.
Schematic drawing showing a supratubercular ridge, which may facilitate displacement of biceps tendon out of the intertubercular sulcus. When the arm is used constantly in the position of internal rotation, the tendon performs over the medial wall of the groove. The lesser tubercle now, from a mechanical viewpoint, functions as a trochlea. In this position, the tendon is working at a great mechanical disadvantage which results in attritional changes in the tendon, in the groove and in the adjacent soft tissues.
These alterations are enhanced if the groove is shallow Fig. In the face of a shallow groove, displacement of the tendon onto a fascial sling may occur. In addition, rupture of the cuff in this area is frequently encountered, as also are excrescences on either side of the bicipital groove, more so on its medial border Fig.
Left , Biceps tendon lies to inside of the lesser tuberosity. Right , Note the reduction in the height of the lesser tuberosity; also a well-formed fascial sling extending from the fibrous capsule to the remainder of the lesser tuberosity. The under surface of the biceps tendon reveals advanced degenerative changes. Left , Note defect in frayed biceps tendon and spur in the floor of the bicipital groove.
Right , When the tendon is in its normal position the defect in its substance fits snugly around the bony spur. In this region, note should be made of the course of the neurovascular bundle as it makes its way distally around the coracoid process under the pectoralis minor muscle and onto the subscapularis Fig.
Also of importance is the relationship of the circumflex nerve and the posterior circumflex vessels as they traverse the subscapularis across the inferior aspect of the capsule of the glenohumeral joint and continue posteriorly across the teres minor to reach the posterior border of the muscle Fig. Vessel under the pectoralis minor muscle. Course of the suprascapular nerve. The following observations were made in a study of 96 shoulder joints obtained post-mortem from 50 individuals.
Only individuals who were unaware of any disability were selected for this investigation. However, most of those over 40 years of age gave a history of having some temporary disability in one or both shoulders at some time in their lives. None had severe traumatic lesions followed by marked dysfunction.
There were 36 males and 14 females. The age ranged from 18 to 74 years. Many workers have described the degenerative alterations that occur in the musculotendinous cuff past middle life. The progressive nature of the process is best observed when the inside of the cuff is visualized in specimens of successive decades.
In this investigation, it was noted that in the specimens of the first four decades the cuff and its synovial lining were in close proximity to the articular cartilage of the humeral head. There was no evidence of tearing away of the cuff from its insertion Fig. However, in the fifth decade several specimens disclosed deltoid gradual pulling away of the cuff at its site of insertion. Inasmuch as these lesions did not involve the full thickness of the cuff, they are in essence partial tears.
The earliest lesions were noted in the supraspinatus and infraspinatus regions and in the subscapularis regions of the cuff. As a rule, the tears in the supraspinatus area also extend into the infraspinatus region Fig. With each successive decade after the fifth, the incidence and severity of the lesion increased. In this series there were 20 subscapularis tears or In the earlier decade, the fibers showed marked thickening and hyperplasia while in the later decade thinning and increased fibrosis were the more common characteristics.
Left shoulder. This specimen discloses no macroscopic evidence of degenerative changes. Note that the musculotendinous cuff with its synovial lining is in close proximity to the margin of the articular cartilage. Nowhere is there any recession of the cuff fibers. Top , T. Right shoulder. Large incomplete tear in supraspinatus area of the cuff. Note the recession of the cuff fibers and thickening of the torn fibers. Normal wear and tear of the rotator cuff, as well as aging, also increase the risk of injury.
Working to maintain healthy joints, avoiding overhead and repetitive strain on your shoulders, and maintaining proper posture can help you avoid painful shoulder injuries.
Depending on the severity of a rotator cuff injury, prescribed treatment can range from simple rest and immobilization to surgery. Because recovery from surgery to repair a torn rotator cuff can be slow, orthopedic surgeons tend to shy away from ordering these procedures with the exception of younger patients, those with major tears, or older patients whose jobs depend heavily on the shoulder function.
When rotator cuff problems cause shoulder pain, consider visiting your healthcare provider to have an examination and get an accurate diagnosis of your condition. You may benefit from the services of a physical therapist PT to help figure out the cause of your shoulder pain and to work on restoring normal shoulder range of motion ROM and strength. Your PT will ask you questions about your shoulder pain and problem. They may perform special tests for your shoulder to determine what structures are causing your pain and mobility issues.
Treatment for your rotator cuff may involve using therapeutic modalities to control the pain, and shoulder exercises will likely be prescribed to help you restore normal mobility of the joint. Your PT can teach you what to do now to treat your rotator cuff problem, and they should also show you how to prevent future problems with your SITS muscles.
You should consult a healthcare provider before starting any rotator cuff exercise program. Stop any exercise that causes acute pain or discomfort in your shoulder.
Knowing the four muscles of the rotator cuff and how they function is an important component to understanding your shoulder rehab.
Check with your PT to learn more about your shoulder pain and the rotator cuff muscles that help support your shoulder. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. American Academy of Orthopaedic Surgeons. Rotator cuff tears. Updated March Rotator cuff. Partial-thickness rotator cuff tear by itself does not cause shoulder pain or muscle weakness in baseball players. Am J Sports Med. Harvard Health Publishing.
What to do about rotator cuff tendinitis. Updated May 19, Your Privacy Rights.
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