Rotator Cuff Injuries

Rotator cuff injuries are a common type of shoulder injury, especially among athletes or those with jobs that require physical labor. Chances are, you know someone who has experienced a rotator cuff injury--you may have experienced it yourself to some degree.

If you are a sports fan, you may have heard of your favorite player being taken out of the season due to a rotator cuff injury. While they can certainly be severe in nature, rotator cuff injuries can also be minor and can occur due to a variety of reasons both on and off the field. For instance, one can sustain a rotator cuff injury from playing football for many years or even due to reaching out to break a fall and landing on one’s arm. The major cause for rotator cuff injury, however, is simple wear and tear of over years of use or repetitive movement involving the shoulder. In any case, the first step to the path of recovery is to understand the rotator cuff itself. The next step, not any less important, is to employ the good habits learned in physical therapy as a means to recover and maintain a healthy shoulder.

The rotator cuff is a group of muscles and tendons that surround the shoulder joint. It plays a stabilizing role for the shoulder joint and is responsible for the lifting and rotation of your arms. Oftentimes doctors may tell you to imagine the head of the upper arm bone as a golf ball and the shoulder blade as a golf tee. This should help you visualize the versatility that the shoulder joint is capable of handling. In addition, the rotator cuff acts as a sleeve of sorts, as it can enable the “ball” to spin and roll while remaining attached to the tee.

Two main type of rotator cuff injuries exist: impingements and tears. The main difference is that while a tear is due to an actual tear to the muscle itself, an impingement is due to the rotator cuff muscle swelling and causing pinching between the arm and shoulder bones. These types of injuries can alternatively be classified as acute or chronic. An acute injury is classified as a tear or strain in the rotator cuff that results from a single event such as falling, while a chronic injury is the result of overuse and fatigue, often seen in elderly patients and athletes. Acute injuries are more likely to recover in a shorter time period when given sufficient rest and treatment, though chronic injuries are a bit longer-lasting. Nonetheless, both tears and impingement, acute or chronic, can be treated with a combination of rest, rehabilitation, and physical therapy.

The most common symptoms of an injury to the rotator cuff present as stiffness, weakness, loss of range of motion, and/or varying levels of shoulder pain. Most patients may mention heightened pain in the shoulder at night and a stiffness in the morning when they get out of bed. In addition, lifting the arm overhead or away from you may be difficult and painful. If you are experiencing any or a combination of these symptoms, it may be time to visit a medical professional. In a typical doctor’s appointment, the doctor will typically take a patient background and perform a physical exam in which they physically examine the rotator cuff with stress maneuvers. Such tests may involve asking the patient to hold their arms out in various degrees and applying a downwards force to isolate the origin of the pain. In more severe cases X-rays, MRIs or ultrasounds may be necessary to pinpoint where the injury or pain is coming from.

Once a medical professional has confirmed that a patient is indeed dealing with a rotator cuff injury and not something else, there are a wide range of potential treatment options. Depending on the severity and cause of the original injury, less severe rotator cuff injuries often respond well to rest and rehabilitation. If these options do not work, injections or surgery may be recommended, although the latter is typically reserved for patients with full tears of the rotator cuff muscle. However, for most patients there is a typical order to which recovery takes place. The first step involves pain control and allowing your muscles to rest, achieved through the use of anti-inflammatory medications and wearing a brace that limits shoulder movement. It may be important to note, however, that extensive immobilization is not generally recommended as it may further complicate the injury. The next step is to restore the strength of the muscles with some sort of physical therapy in which therapists will aim to help return the rotator cuff to its original strength and flexibility, as well as addressing any muscle imbalances that may have occurred as a result. In the last step, the patient gradually returns to his/her normal daily activities while incorporating small changes that aim to prevent further distress. For athletes this might be a different throwing motion or lifting motion with an additional stress on correct form.

Rotator cuff injuries can be long and unpleasant since we use and rotate our shoulders in almost everything we do. Not only is it an uncomfortable process to recovery, but it is also an especially inconvenient one. There are many steps you can take in your daily lives to prevent injury and ensure long-lasting, pain-free shoulders. One approach is to view the rotator cuff and the shoulder as part of a comprehensive, not isolated, system. It may not be the best approach to simply focus on strengthening the shoulders to prevent injury. In fact, overdoing it in training or lifting may be putting you back on the path to injury. Instead, consider that the shoulder, shoulder blade, the back, and the hips are all connected, and isolating one part may cause imbalances in other areas. All in all, do not hesitate to consult a professional if you are feeling discomfort or pain in the shoulder. A physical therapist or an experienced trainer will be able to properly address areas of concern and suggest a healthy exercise program. After all, the shoulder joint is involved in almost everything we do. We should undoubtedly want to ensure the longevity of such an important part of our body.


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Richard Yoon