Rotator Cuff Injuries – causes, symptoms, and treatment

Autor: RAFAŁ CZEPUŁKOWSKI
Consultation MACIEJ PAWLAK
Date added 12.12.2024
Date of last revision 12.12.2024

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The rotator cuff, also known as the rotator ring, covers the anterior, posterior, and superior surfaces of the glenohumeral joint. It consists of the tendons of four shoulder girdle muscles: the supraspinatus, infraspinatus, subscapularis, and teres minor. Its main functions include stabilizing the humeral head within the joint, lifting the arm, and performing rotational movements in the joint.

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Rotator cuff injuries are among the most common shoulder joint disorders. Damage to the structure occurs due to trauma or progressive degenerative changes in the tendon or its attachment. These injuries cause pain and instability in the shoulder joint. The condition most commonly affects individuals over the age of 40 and younger people involved in sports.

Causes of Rotator Cuff Injuries

Rotator cuff injuries may result from degenerative changes in the tendons and muscles of the shoulder girdle. In such cases, the injury develops chronically and may initially be asymptomatic. In both sports and occupational settings, this type of injury can occur due to repetitive overhead activities. Athletes involved in sports that require frequent overhead movements, such as volleyball, basketball, handball, tennis, or swimming, are at higher risk. Similarly, individuals in professions that require overhead work, such as painting ceilings or construction work, may experience rotator cuff injuries.

Acute injuries, such as falling on an outstretched arm or lifting a heavy object with sudden shoulder rotation, can also damage the rotator cuff. Another type of tendon damage involves calcification, where inflammatory processes lead to calcium deposits within the tendon, causing severe pain and weakening its strength.

Main Causes:

  • Acute injuries – related to sports activities.
  • Chronic injuries – resulting from degenerative changes.
  • Symptoms of Rotator Cuff Injuries
  • Pain and restricted movement in the joint, accompanied by muscle weakness around the shoulder.
  • Pain during physical activities.
  • Shoulder pain may appear suddenly (e.g., after lifting a heavy object or twisting the shoulder) or gradually worsen over time.
  • Pain may occur during specific activities, especially when raising the arm, such as reaching for a high shelf or performing overhead tasks.
  • Nighttime pain disrupting sleep.
  • Occasionally, crepitus or a popping sensation in the shoulder.

Diagnosing Rotator Cuff Injuries

According to Dr. Joanna Niemunis Sawicka, a radiologist at Rehasport in Gdańsk, the diagnosis of rotator cuff injuries relies on a medical history, clinical examination, and imaging studies. Imaging techniques used to evaluate the rotator cuff include ultrasound (US), magnetic resonance imaging (MRI), and X-ray (RTG).

  • Ultrasound (US): Effectively reveals rotator cuff tendon injuries and can be performed dynamically during shoulder movement. It classifies injuries into partial or complete tendon tears, pinpoints the exact location of the damage, and identifies associated shoulder injuries. A key advantage is the ability to compare both shoulders simultaneously and administer targeted therapeutic injections.
  • Magnetic Resonance Imaging (MRI): Provides detailed visualization of rotator cuff pathologies, the long head of the biceps tendon, joint surfaces, and bone structures of the humerus. MRI also allows for precise assessment of vascular and nerve structures in the shoulder and the morphology of rotator cuff muscles.
  • X-ray (RTG): Useful for excluding other causes of similar symptoms or associated conditions, such as calcifications, traumatic changes, or degenerative changes.
    It is important to note that imaging studies alone are insufficient for a complete diagnosis without a clinical examination.

Treatment of Rotator Cuff Injuries

According to Dr. Maciej Pawlak from Rehasport in Gdańsk, rotator cuff injuries can be categorized based on their mechanism:

Traumatic injuries: Primarily affecting younger, active individuals.
Degenerative injuries: More common, often resulting from wear and tear.
Degenerative rotator cuff injuries are observed in half of the population over 70 years old. Many patients with degenerative injuries are asymptomatic and retain full shoulder function. Such injuries are considered a natural aspect of aging, similar to joint degeneration, and do not typically require surgical treatment unless they cause symptoms such as pain, restricted motion, or muscle weakness.

Current Standard of Care: Arthroscopic surgery: The gold standard involves reattaching the tendon to the greater tubercle under camera guidance using specialized implants. Recovery time varies depending on whether the injury occurred acutely in a younger individual or due to degenerative processes in an older patient.
Post-surgery, the arm is immobilized to allow optimal tendon-to-bone healing. Immobilization typically lasts 4–6 weeks, followed by a rehabilitation program lasting about six months.

Athletes, especially those participating in throwing sports like handball, volleyball, or tennis, can often return to their previous level of performance after surgery.

Rehabilitation for Rotator Cuff Injuries

Rehabilitation is divided into postoperative and conservative approaches, explained by physical therapist Magdalena Paszko from Rehasport in Gdańsk.

Postoperative Rehabilitation:

Begins within the first week after surgery, with an initial focus on protecting the operated site.
The first 4–6 weeks aim to reduce muscle tension around the shoulder girdle, work on surgical scars, and maintain a range of motion up to 90° flexion in the shoulder joint.
Gradual inclusion of exercises to increase the joint’s range of motion and strengthen the shoulder girdle muscles.
Manual therapy is continued to alleviate pain, reduce muscle-fascial tension, and improve joint mobility.
Rehabilitation duration varies based on factors such as the patient’s preoperative condition, pain levels, range of motion limitations, and age. Full rehabilitation typically takes around six months, with the final stage focusing on restoring full physical load and biomechanical efficiency.

Conservative Rehabilitation:

Applied when surgery is not indicated or when the physician recommends non-surgical treatment based on patient evaluation.
The process usually lasts about six months, aiming to reduce pain, improve range of motion, strengthen shoulder girdle muscles, and enhance biomechanics.
As with postoperative care, exercises are tailored to individual needs, and physical therapists use manual techniques to address muscle-fascial structures and the shoulder joint.

Sample Exercises for Rotator Cuff Rehabilitation:

Strengthening exercises for the posterior shoulder girdle.


Strengthening exercises for shoulder rotator muscles.


Stretching exercises for the anterior shoulder girdle.


Strengthening shoulder rotator muscles in a side plank position.


Strengthening shoulder rotator muscles in a front plank position.

Related Articles:

Explore other possible shoulder injuries and conditions.

References:

Autor
RAFAŁ CZEPUŁKOWSKI
RAFAŁ CZEPUŁKOWSKI

Specjalista do spraw content marketingu, dziennikarz sportowy i medyczny. Redaktor naczelny magazynu „Poradnik Zdrowie i Sport”, członek Dziennikarskiego Klubu Promocji Zdrowia, współtwórca wielu artykułów medycznych z zakresu ortopedii i urazowości w sporcie.

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Konsultacja merytoryczna
MACIEJ PAWLAK
MACIEJ PAWLAK

Lekarz w klinice Rehasport, specjalizuje się w ortopedii i traumatologii narządu ruchu z ukierunkowaniem na staw kolanowy, biodrowy i barkowy. Międzynarodowy trener chirurgii barku i kolana prowadzący praktyczne kursy dla ortopedów zarówno w Polsce, jak i za granicą.

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