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Rotator Cuff Injuries

There are four shoulder rotator cuff muscles:

  • Subscapularis
  • Infraspinatus
  • Supraspinatus
  • Teres Minor

These four muscles provide shoulder stabilization and shoulder motion. The most commonly injured rotator cuff muscle is the Supraspinatus which is responsible for moving the shoulder up and to the side and providing stability to the shoulder joint.

Rotator Cuff injuries may come on suddenly and be associated with a specific injury such as a fall (acute), or it may be something that gets progressively worse over time with activity that aggravates the muscle (chronic).

Acute Rotator Cuff Tear

A rotator cuff tear usually occurs with a sudden powerful raising of the arm against resistance, often in an attempt to cushion a fall or lift heavy objects. The muscle is overcome by the forces exerted on it, and the muscle tissue tears. Small rotator cuff tears (micro tears) can sometimes be treated with home care; however, large tears usually require surgical correction.

Symptoms

  • Sudden tearing sensation followed by severe pain shooting through the arm
  • Motion limited by pain and muscle spasm
  • Acute pain from bleeding and muscle spasm, though it often goes away in a few days
  • Point tenderness over the site of muscle rupture
  • Inability to raise the arm out to the side, although it can be done with help

Home Care 

There are many treatments you can use at home to help reduce shoulder pain and swelling due to a rotator cuff strain or small tear. If pain is persistent or significant, consult your medical physician.

It is very important that you rest the shoulder and apply a shoulder ice pack for 20-minute periods at least 3 times a day for the first 2 days after the injury. Helpful products include:

  • Shoulder sling or support - to place the shoulder in a comfortable position while resting
  • Shoulder ice packs - to ease pain by using them on an injured shoulder for 15 minutes for every hour of pain (ice for 15 minutes, off for 1 hour).
  • Shoulder moist heating pad - to bring good blood flow to the area after two days of ice treatments. A short ice treatment of 5-10 minutes after heat application may keep the region from swelling
  •  Topical pain gels for the shoulder - to decrease pain and swelling. Anti-Inflammatories such as ibuprofen, if you are medically able, can also help decrease pain and swelling.

The first exercises to be performed as the shoulder is healing and exercise is recommended are active range of motion exercises in which the shoulder is moved up and down, forward and backward, and in a circular motion without any resistance. Exercise should always be done in a pain-free state; don't ever exercise if pain is produced.

The next step in shoulder exercise is active range of motion against resistance in which you start using a "stretchy" exercise tube to provide resistance while you do the same type of motions. This type of exercise will help improve shoulder strength and stability. View shoulder exercise equipment.

Medical Treatment

If medical evaluation is necessary due to the severity or continuation of pain symptoms, the following types of evaluations may be necessary: 
  • X-ray imaging, MRI or CAT scans - These can determine the degree and amount of muscle tear and rule out shoulder fractures
  • Surgery - Early surgery (within 3 weeks) to repair the tendon is often needed, especially for younger, more active people.

Surgical Treatment

  • Usually for people younger than 60 years old
  • For complete muscle tears
  • If a person has a job that requires constant shoulder use, and they cannot perform their duties due to their pain level or risk of further tearing.
Surgery may be optional after failure to improve after 6 weeks of proper treatment.

Chronic Rotator Cuff Tears

This type of injury comes on over time due to specific occupations such as painters who must do excessive overhead work and specific athletes such as pitchers in baseball. Overuse of the muscle over time creates micro tears that can weaken the muscle and be a precursor to its becoming a larger, acute tear.

With chronic shoulder injuries, the level of pain or the limitation of activity is the deciding factor on whether to seek medical evaluation. In most cases, people seek care when they are "fed up" with their pain or inability to do certain tasks. A proper shoulder evaluation should include tests for range of motion, strength capacity, and an X-ray evaluation to rule out arthritic or more aggressive conditions. MRI scans may be helpful in diagnosing a rotator cuff tear.

Symptoms

  • Occur more often in a person's dominant arm
  • More commonly found among men older than 40 years
  • Pain usually worse at night and interferes with sleep
  • Worsening pain followed by gradual weakness
  • Decreased ability to move the arm, especially up and out to the side

Home Care

  • Exercise within pain free ranges of motion
  • Ice and heat applications for 20 minutes 1-2 times per day; ice usually relieves pain better than heat, although heat is more soothing to the senses.
  • Shoulder braces can be very helpful in compressing and supporting the painful shoulder, especially when worn during stressful activities such as work or sports. These types of braces help to prevent re-injury and are quite comforting to wear because the compression provides an excellent sense of well being.
  • Topical pain gels for the shoulder will help reduce shoulder pain and spasm.

Medical Treatment

If the need for surgery has yet to be determined, the following may be helpful:

  • Cortisone injections to reduce inflammation and pain. Usually these injections are limited to only a few due to the destructive effect cortisone can have on the bone tissues.
  • Physical therapy to help reduce inflammation. Ultrasound, electric muscle stimulation and diathermy can be very helpful.
  • Exercises and stretches to help increase range of motion and improve shoulder stability.

Surgery may be indicated when the common treatments listed above are not effective.

***The information, including opinions and recommendations, contained in the Web site is for general educational purposes only. Such information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. No one should act upon any information on this Web site without first seeking medical advice from a qualified medical physician with whom they have a confidential doctor/patient relationship.***


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