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St. Mary's Center for Orthopaedics

Rotator Cuff Injury & Conditions

Rotator cuff tears are a common source of shoulder pain. The rotator cuff is comprised of four muscles and several tendons that work to lift and rotate the shoulder, allowing people to perform tasks such as putting items away, swinging a tennis racquet and many other everyday activities. This intricate combination of tendons and muscles makes the shoulder susceptible to injury through normal wear and tear. The risk of rotator cuff tears increases with age. The aging process can cause the tendons and muscles to degenerate and weaken.

The decision on how to treat rotator cuff tears is very individualized. Some rotator cuff tears can be treated with non-surgical methods. If necessary, surgical procedures have become less invasive, resulting in good outcomes with improved recovery times.

What is a Rotator Cuff Injury?

Rotator cuff injuries result from falling, lifting and repetitive arm activities – especially those done overhead, such as swimming, lifting weights, playing tennis or throwing a baseball. Rotator cuff injuries require individualized treatment and attention from a physician who specializes in advanced solutions for shoulder conditions.

There are several reasons people have pain in their rotator cuff:

  • Wear and tear: As people age, especially those over 40, everyday activities begin to take a toll on the rotator cuff. Gradually, the collagen (fibrous protein) in the rotator cuff muscles and tendons begins to break down, leading to a greater chance of injury.
  • Sudden trauma: Breaking a fall with an arm or an arm injury during sports, can tear or bruise the rotator cuff tendon or muscles.
  • Repetitive stress: Repeated overhead motion of your arms can lead to inflammation and even tearing of the rotator cuff muscles and tendons. This often afflicts those in the building trades, such as painters and carpenters. It can also affect overhead athletes, such as swimmers, baseball players and tennis players.
  • Pulling and lifting: Straining and tearing the rotator cuff tendons and muscles can occur if you lift an object that is too heavy or you improperly lift an overhead object.

What are the Symptoms of Rotator Cuff Injury?

Symptoms include the following:

  • Deep ache in the shoulder, perhaps also felt in outer part of the shoulder
  • Pain at night that interferes with sleep
  • Gradual weakness and decreased shoulder motion develop as the pain worsens
  • Decreased ability to move arm out or to the side

What are Treatment Options for Rotator Cuff Injury?

Surgical and non-surgical treatments are the two main courses of action for treating rotator cuff injuries.

Non-surgical Treatments:

  • Rest: Resting the injured joint is the first step to swelling and pain reduction. Be sure to keep using the arm gently. Keeping it immobilized can lead to a painful condition called frozen shoulder.
  • Ice: In the first 24 hours of an injury, apply ice to reduce swelling and pain.
  • Heat: After 24 hours have passed, a heating pad or hot compress can help.
  • NSAID anti-inflammatory medication: Reduce pain and swelling.
  • Physical therapy and exercise: Gentle exercises and stretches designed to strengthen the muscle can treat many rotator cuff injuries.
  • Steroids: Cortisone can be injected directly into the rotator cuff to reduce inflammation and pain, but steroid injection should be used under the careful direction of a doctor. Multiple injections should be avoided.

Surgical Treatments:

Most rotator cuff injuries are treated non-surgically. Surgery is recommended when non-operative treatments have provided minimal or no improvement of your symptoms. Surgery may also be recommended for painful injuries or for people who rely on their arm strength for work or sports. There are several types of surgeries that can be performed for rotator cuff tears. The type of surgery depends on the size, shape and location of the tear. Partial rotator cuff tears may only require debridement. This surgical procedure simply trims the tendon. Three common surgical approaches include Open Surgical Repair, Mini-Open Repair, and Arthroscopic repair.

  • Open Surgical Repair is the original type of surgery for rotator cuff tears. During Open Surgical Repair, the surgeon opens the shoulder complex to gain access to the torn rotator cuff. The surgeon will make an incision over the  shoulder and detach a small portion of the deltoid muscle for the surgery. An acromioplasty is often performed at the same time. An acromioplasty removes bone spurs from underneath the acromion.
  • A Mini-Open Repair of the rotator cuff is a variation of the Open Surgical Repair. The Mini-Open Repair uses much smaller incisions. The deltoid muscle is not detached in this procedure. Instead, the surgeon views and evaluates the joint using an arthroscope. An arthroscope is a very small surgical instrument that allows a surgeon to view inside of a joint. With this technology, your surgeon will only need to make small incisions and will not need to open the joint fully.
  • Arthroscopic Repair is a technique commonly used to reconstruct ligaments or remove damaged tissue and bone spurs. Arthroscopy is less invasive than traditional surgical methods. It has a decreased risk of infection and a shorter recovery period.

What is the Recovery Time Following Surgery?

A patient’s shoulder will need several weeks to heal from the surgery.  Arm movements will be restricted for a short period of time following the procedure. The patient will most likely wear an arm sling for four to six weeks. An occupational or physical therapist will gently help move the patient’s arm at first, and then the patient will progress to strengthening exercises.

Generally, most individuals regain functional movement and strength by four to six months after surgery. Recovery time will depend on the extent of the condition and the type of surgery.

Overall, arthroscopic shoulder surgery requires a shorter length of time for recovery than open joint surgery. It also has a reduced risk of infection, less blood loss, and less pain and stiffness because only small incisions are used and less surrounding tissue is affected or exposed. Most individuals achieve good results with rotator cuff repair. All methods of surgery appear to produce equal results.