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MusculoskeletalICD-10: M75.1Rotator cuff tears affect approximately 20-30% of the general population, increasing to over 50% in those over 80

Rotator Cuff Injury

A rotator cuff injury involves damage to the group of four muscles and tendons that stabilize the shoulder joint and enable arm movement. Injuries range from mild tendinitis and bursitis to partial or complete tears of the rotator cuff tendons. Rotator cuff problems are among the most common causes of shoulder pain and disability, particularly in adults over 40 and in individuals who perform repetitive overhead motions.

Symptoms

Dull, deep ache in the shoulder
Pain that worsens when reaching overhead, behind the back, or lifting
Difficulty sleeping on the affected side
Weakness when lifting or rotating the arm
Crackling or popping sensation (crepitus) with shoulder movement
Loss of range of motion in the shoulder
Sudden sharp pain and weakness following an acute injury

Causes

  • Repetitive overhead motions in sports or occupations (baseball, tennis, painting, carpentry)
  • Progressive wear and tear of the tendons with aging (degenerative tears)
  • Acute injury from a fall onto an outstretched hand or heavy lifting
  • Bone spurs on the acromion that rub against tendons (impingement)
  • Decreased blood supply to the tendons with aging

Risk Factors

  • Age over 40 (risk increases significantly with age)
  • Occupations involving repetitive overhead work (painters, carpenters, mechanics)
  • Sports requiring repetitive arm motions (baseball, tennis, swimming)
  • Family history of rotator cuff tears
  • Smoking, which impairs tendon healing and blood supply
  • Dominant arm (more commonly affected)

Diagnosis

  • Physical examination with specific tests (Neer test, Hawkins test, empty can test, drop arm test)
  • X-rays to evaluate bone spurs, arthritis, or calcification
  • MRI to visualize the rotator cuff tendons and assess tear size and location
  • Ultrasound as an alternative imaging method for tendon evaluation

Treatment

  • Rest and activity modification to avoid aggravating movements
  • Physical therapy focusing on stretching and strengthening the rotator cuff and scapular muscles
  • NSAIDs (ibuprofen, naproxen) for pain and inflammation
  • Corticosteroid injections for short-term relief of pain and inflammation
  • Arthroscopic rotator cuff repair surgery for complete tears or failed conservative treatment
  • Platelet-rich plasma (PRP) injections for partial tears
  • Reverse total shoulder replacement for massive irreparable tears with arthritis

Prevention

  • Strengthen shoulder and scapular muscles with regular conditioning exercises
  • Warm up before overhead activities and sports
  • Use proper technique in sports and occupational tasks
  • Take breaks during repetitive overhead work
  • Address shoulder pain early before it progresses to a tear

When to See a Doctor

  • Shoulder pain persists for more than a few weeks despite rest and home treatment
  • You experience sudden shoulder weakness or inability to raise your arm
  • Shoulder pain interferes with sleep or daily activities

Frequently Asked Questions

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Medical Disclaimer: This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider.

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