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Rotator Cuff

by Robert S. Dinsmoor

A structure composed of muscles and tendons in the shoulder. Inflammation or tearing of the rotator cuff is a common source of shoulder pain.

The shoulder has more than one joint, but the main one is a ball-and-socket joint. The head of the upper arm bone (humerus) is the “ball” that fits into the shallow “socket” of the shoulder blade (scapula). Four muscles and tendons form a “cuff” around the joint — the rotator cuff — and this holds the head of the humerus in place and helps keep the joint stable.

The rotator cuff is susceptible to injury. One such injury is rotator cuff tendinitis, also known as shoulder impingement syndrome, in which the tendons of the rotator cuff become pinched by surrounding structures and grow swollen and painful. The pain may be most noticeable when lifting the arm overhead or away from the body. Rotator cuff tendinitis is more common in people whose jobs or activities require them to reach their arms over their heads. Sports such as tennis, baseball, or swimming are frequent culprits.

Rotator cuff tendinitis may first be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), along with rest, gentle stretching, and strengthening exercises. Ice may also be used. If these measures don’t help, the doctor may recommend a corticosteroid injection into the joint to reduce inflammation. If symptoms still do not improve after 6–12 months, the doctor may recommend surgery to shave off bone that is aggravating the rotator cuff.

A potentially more serious injury to the rotator cuff is a tear. Tears usually occur to the tendons of the rotator cuff and may be partial or full tears. They often come on gradually as the result of overuse and increasing age. (They are thus more common in people over 40.) However, a rotator cuff tear can also be caused by a fall or other injury — in this case it can occur at any age. As with rotator cuff tendinitis, the risk of a rotator cuff tear is greater in people who lift their arms over their head for work or other activities. The pain may be especially acute when raising the arm or extending it to the side. The shoulder may also be weaker than it was before the tear.

Doctors advise that people with torn rotator cuffs rest the shoulder, apply heat or cold to the sore area, and take NSAIDs. Corticosteroid injections are another option. In some cases, a person may need to wear a sling for a few days to immobilize the shoulder. The individual may then begin an exercise program, often with the help of a physical therapist, to build strength and flexibility and reduce pain in the shoulder.

A rotator cuff tear, however, will not heal on its own. If the conservative treatments listed above don’t reduce pain and improve function in the shoulder, the doctor may recommend surgery to repair the tear, especially if a person needs good shoulder function for work or other activities.

Last Reviewed on February 23, 2011

Robert S. Dinsmoor is a medical writer and editor based in Massachusetts.

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