Most people experience some shoulder pain from time to time, whether from repetitive motion, overextension or another injury source. When the pain doesn’t go away, however, it can cause significant issues in everyday life. Identifying the source of the problem is the first step to treatment.
There are multiple potential sources of shoulder pain. One possible problem area is the rotator cuff, which can tear or suffer from a condition called tendonitis. Understanding these two conditions can help you have a productive conversation with your doctor about your treatment options.
What Is the Rotator Cuff, and Why Is It Important?
The rotator cuff is a complex of four muscles that cover the top of the upper arm bone. The four muscles come together in the shoulder as tendons, and the covering they create is thick. The muscles begin at the shoulder blade and stretch to the humerus — the upper arm bone. The rotator cuff consists of these four muscles.
- Supraspinatus: This muscle begins over the spine of the shoulder blade and terminates near the rounded top of the humerus bone, known as the greater tuberosity.
- Infraspinatus: This muscle begins underneath the spine of the shoulder blade and connects to the back of the humerus.
- Teres minor: This muscle begins on the outer side border of the shoulder blade and connects to the smaller side of the humerus’ rounded top, known as the lesser tuberosity.
- Subscapularis: This muscle begins on the front of the shoulder blade, which sits directly above the ribs. It also connects to the lesser tuberosity.
With so many points of connection, the rotator cuff is a sensitive muscle group that can experience injury for many reasons.
Rotator Cuff Function
The muscles in the rotator cuff work together to facilitate crucial functions of the shoulder. Here are the duties performed and the muscles that work to make them happen.
- Stabilizing the top of the humerus in the shoulder: Facilitated by all four muscles.
- Lifting the shoulder up and sideways: Facilitated by the supraspinatus.
- Rotating the shoulder externally: Facilitated by the infraspinatus and teres minor.
- Allowing free movement of the humerus during elevation: Facilitated by the subscapularis.
Without all four rotator cuff muscles working in concert, the humerus bone would not be able to achieve stable movement within the shoulder joint.
What Is a Rotator Cuff Tear?
Rotator cuff tears are prevalent among adults, causing significant pain and potential disability. Around 2 million people each year have to visit their physician due to rotator cuff problems, including tears.
When a rotator cuff tears, the shoulder becomes destabilized and weak. This condition makes it difficult to do a wide variety of everyday activities, such as brushing your hair or even getting dressed.
During a rotator cuff tear event, the tendon’s attachment to the head of the humerus rips or possibly even severs. The majority of rotator cuff tears occur affect the supraspinatus, but one or more other tendons can experience problems as well.
While one isolated incident can tear a rotator cuff, many cases begin with the fibers of tendons fraying. If the individual continues to use the shoulder despite mounting pain, the tendon may tear. This injury often occurs when performing a strenuous activity like lifting a heavy box or another object. There are two types of rotator cuff tears.
- Partial tear: Also known as an incomplete tear, this type causes damage to the tendon, though it does not create complete severance.
- Full-thickness tear: Also called a complete tear, this type completely separates the tendon from the bone.
Naturally, a full-thickness tear is more likely to require surgical intervention than a partial tear.
What Causes Rotator Cuff Tears?
Two central occurrences can cause a rotator cuff tear: injuries and degeneration. Either can produce tears of varying severity.
Experiencing an impact to the arm or shoulder while outstretched can easily result in a tear. This type of injury commonly happens with athletes. Those who don’t participate in sports typically experience tears after lifting heavy objects with jerking motions or falling on an outstretched arm.
Like other parts of the body, the tendons in the rotator cuff deteriorate over time. This phenomenon is a natural result of aging, and it increases the likelihood of developing a tear over time. Multiple variables factor into developing a degenerative rotator cuff tear.
- Repetitive movements: When someone moves their shoulder in the same patterns over and over again, the strain can contribute to a tear. Repetitive motions can occur in sports, certain types of work and even household chores.
- Inadequate blood supply: Aging lessens the blood supply available to the rotator cuff. An insufficient blood supply impairs the body’s ability to heal damage to the tendons, and makes it easier to sustain a tear.
- Bone spurs: Bone spurs are another element of aging that influences rotator cuff tears. If they develop on the underside of the acromion — a bone attached to the scapula — spurs may rub on the tendons of the rotator cuff, causing a condition called shoulder impingement.
It is quite common for someone with a degenerative tear to worsen the condition with an acute injury. This compounded issue makes recovery more difficult, but it is still treatable.
What Is Rotator Cuff Tendonitis?
Rotator cuff tendonitis, also spelled tendinitis, is the term for irritation or inflammation of the rotator cuff muscles. The inflammation can range from moderate to severe. In cases of acute inflammation, a rotator cuff tendon can become trapped under the acromion, leading to severe chronic pain.
What causes rotator cuff tendonitis? The condition develops over time and can be a result of multiple activities, from sleeping on your shoulder to playing sports that require significant overhead reaching. Other names for shoulder tendonitis include:
- Tennis shoulder
- Pitcher’s shoulder
- Swimmer’s shoulder
In some cases, there is no apparent cause for rotator cuff tendonitis. Regardless of the source, shoulder tendonitis is usually treatable with appropriate intervention.
How to Diagnose Rotator Cuff Tear or Tendonitis
When you see a physician for shoulder pain and suspect a rotator cuff tear or tendonitis, your doctor will start by examining the shoulder in question. The doctor will determine where you feel pain or tenderness, and evaluate the shoulder’s range of motion by having you move the arm in a variety of directions. Additionally, they may order exams, including the following, as part of a rotator cuff tendonitis test.
- X-rays: These images can determine if you have a bone spur causing tendonitis.
- Magnetic resonance imaging: An MRI can reveal inflammation and signs of tearing.
- Ultrasonography: An ultrasound is another way to check for inflammation or tearing.
Many people experiencing shoulder pain do not know how to differentiate rotator cuff tear vs. tendonitis. What does a rotator cuff tear feel like? The most common symptoms of a rotator cuff tear include the following.
- Pain when not using the shoulder
- Pain when going to sleep, especially if lying on the affected shoulder
- A crackling or popping feeling upon moving the shoulder in specific ways
- Feeling weakness when trying to lift objects or rotate the arm
When an acute tear occurs, it generally results in severe pain. There may be an audible snap, followed by immediate loss of strength in the shoulder and upper arm.
In the case of a degenerative tear, weakness and pain are also present, but are typically less intense and have a slow onset. It is common for the pain to be quite mild and only appear when you use the arm and shoulder. Many people find over-the-counter medications can ease the pain at the onset of the condition.
With an untreated tear, the pain will continue to advance to the point where medication does not provide relief. Day-to-day tasks will become more difficult and painful over time.
When determining if you have a rotator cuff tear vs. tendonitis, your doctor will likely focus on pain level and functionality. The symptoms of tendonitis are typically mild to begin with and include:
- Audible clicking when using the shoulder
- Pain upon reaching or lifting
- Pain, swelling or tenderness present in the front side of the shoulder
- Pain when the shoulder is still
As shoulder tendonitis progresses, other issues arise, including:
- Difficulty reaching around the back
- Reduced range of motion and strength in the shoulder
- Pain at night that wakes you up or forces you to change position
Rotator cuff tendonitis typically takes a while to develop, but it can occur suddenly as the result of an injury. In these cases, it can closely mimic the symptoms of a rotator cuff tear, making it essential to get a prompt diagnosis from a physician to avoid further damage.
Treatment Options for Rotator Cuff Tears and Tendonitis
If you are experiencing pain in your shoulder, continuing to use it can worsen your condition, whether it is rotator cuff tendonitis vs. tearing. Tears can get larger and more difficult to repair over time, so it is crucial to get rotator cuff injury treatment as quickly as possible.
Regardless of which condition you have, the goal of treatment will be to reduce the pain you feel and restore as much function to the rotator cuff as possible. When your doctor is deciding how to treat rotator cuff tendonitis or tears, they will take into account several factors, including:
- Type and severity of the injury
- General health
- Activity level
Surgeries performed on rotator cuff tears are similarly effective, whether performed immediately after an injury or at a later time. That makes nonsurgical treatment the preferable first option in many cases.
The majority of tears and tendonitis cases can benefit significantly from nonsurgical treatment. The following options can reduce pain and increase function for most patients.
- Rest: As prolonged use of an injured shoulder can worsen the condition, doctors typically recommend resting the shoulder and avoiding activities that cause pain.
- Nonsteroidal anti-inflammatory medications (NSAIDs): Over-the-counter medications such as ibuprofen can reduce swelling and pain.
- Strengthening exercises: Your doctor will give you a list of exercises or refer you to a physical therapist. The goal of the exercises is to improve mobility, flexibility and strength. Strengthening muscles around the rotator cuff can reduce the risk of further injury and reduce pain.
- Steroid injection: In cases where rest, NSAIDs and exercises are not enough to relieve pain in the shoulder, your doctor may apply local anesthetic and cortisone. Although cortisone can be highly effective at reducing inflammation, it does not work well for everyone.
The main advantage of choosing a nonsurgical route is avoiding the risks associated with surgery, such as infection or complications with anesthesia. Surgery also has a lengthy recovery time. However, nonsurgical approaches are not effective for everyone.
Doctors typically don’t treat tendonitis with surgery unless it is to remove spurs on the acromion. Rotator cuff tears, on the other hand, may need surgery to heal properly.
When nonsurgical methods do not produce the desired results for a rotator cuff tear, your physician may shift the focus to surgical options. Consistent, continued pain is the primary indicator that surgery is necessary. Some of the other criteria for surgical intervention include:
- Symptoms persisting longer than six months
- A large tear with good quality of surrounding tissue
- Significant loss of function in the shoulder
- Marked weakness in the shoulder
- A tear caused by an acute injury
Surgery for a rotator cuff tear usually involves repairing the connection between the tendon and the humerus. An orthopedic surgeon can take multiple approaches, and the surgeon will go over the pros and cons of each technique according to your unique condition.
Recovery From Rotator Cuff Tear and Tendonitis
Rotator cuff tear recovery time is typically four to six months. For many patients, this time frame is long enough to restore shoulder mobility to normal levels.
Recovery time can vary if there are complications during or after the surgery. Some post-surgical complications that can lengthen rotator cuff recovery time include:
- The deltoid muscle detaching at the shoulder, impairing flexibility
- Surrounding nerves becoming injured
- Shoulder remaining stiff and painful when moved
- Infection of the surgical site
In the first week or two after surgery, treatment focus is on keeping swelling and inflammation down so the surgical site can begin to heal. Once the repaired connections between tendon and humerus are stable, the patient can begin rotator cuff tear exercises to improve strength and mobility.
How long does rotator cuff tendonitis take to heal? It often depends on the type of intervention you receive. Some people successfully recover with rest and activity limitations alone. If you require further treatment, such as physical therapy or cortisone injections, the answer to the question, “How long does rotator cuff tendonitis last?” becomes more complicated.
Recovery from rotator cuff tendonitis typically focuses on inflammation and pain management. When you start to feel symptoms of tendonitis, try placing an ice pack against the affected shoulder every four to six hours in increments of 15 to 20 minutes. If pain persists, take an NSAID. In combination with recommended exercises, this may be enough to facilitate recovery in a few weeks.
While healing from rotator cuff tendonitis, it’s essential to avoid lifting anything or using the affected shoulder to reach up, out or overhead whenever possible. The exercises your doctor or physical therapist recommends will ideally be the most motion the shoulder experiences during recovery.
Rotator Cuff Tendonitis Exercises for Recovery
With both rotator cuff tears and tendonitis, physical therapy is usually the starting point unless the injury is very severe. Whether your doctor refers you to a physical therapist or gives you a list of exercises to perform, the first thing to do is determine your current range of motion, so you know what your limits are. The medical professional may recommend a variety of exercises, which can include the following.
1. Pendulum Swing
To do this exercise, you will need a railing, sturdy chair or table. Put your uninjured shoulder’s hand on the object to improve stability as you complete the activity.
- Lean forward slowly while keeping your back flat, and let your injured arm hang freely.
- Gently swing the arm forward and backward.
- Gently move the arm side to side.
- Move the arm in small circles, switching from clockwise to counterclockwise several times.
2. Crossover Arm Stretch
To begin this exercise, stand up with your back straight and relax your shoulders as much as possible.
- Reach the affected arm up to shoulder height and bring it across your chest.
- Use the unaffected arm to hold your affected arm’s elbow.
- Repeat the exercise with the unaffected arm.
Note that this exercise should not result in pain, but rather in a stretching sensation. If you are experiencing pain, ask your doctor or physical therapist how to modify the exercise.
3. Standing Row
For this exercise, you will need a stretch band tied to create a ring around three feet long.
- Affix one end of the loop to a sturdy item and face the object.
- Grasp the other end of the loop and stand far enough away that the band has no slack.
- Pull on the band so that your arm forms a 90-degree angle with the elbow close to your torso.
4. Internal Rotation
This exercise also involves the use of a three-foot looped stretch band. It follows the same steps, but rather than performing a pulling-back motion, you move your arm side to side, bringing the forearm over your midsection.
5. Posterior Stretch
You’ll perform this standing exercise with no equipment.
- Hold the elbow region of your injured arm with the hand of your uninjured arm.
- Bring the hand of the injured arm across your body and rest it on the opposite shoulder.
- Push the affected arm up over your body with your uninjured hand, creating a stretching movement.
Finding the Right Balance
These and other tendonitis and rotator cuff exercises are simple enough to incorporate into each day, whether you end up receiving surgical intervention or stick solely with nonsurgical options. They can reduce rotator cuff tendonitis recovery time, but only if you do them correctly. You should not attempt to perform them without consulting a doctor or physical therapist first.
Performing physical therapy exercises without knowing the proper technique or the appropriate number of repetitions can end up causing more strain rather than helping. If you feel pain while performing a particular activity, it’s a sign that you need to adjust one or more elements of the exercise, or try a different one. Either way, it’s imperative to consult a health care professional before continuing.
Work With OrthoBethesda for Shoulder Injury
Whether you have a tear or tendonitis, you should not take rotator cuff injury treatment lightly. Appropriate treatment can preserve the function of the rotator cuff and improve your quality of life, but only if you select the right provider.
At OrthoBethesda, we have assembled a team of highly qualified and dedicated orthopedic surgeons, focused on providing each patient with the highest quality of care. Our team understands that each patient has unique needs, and we strive to take all factors into account when designing treatment plans for rotator cuff injuries.
Our doctors take a conservative treatment approach to avoid unnecessary surgeries and use cutting-edge technologies in cases where surgical intervention is the best option. To learn more and see what OrthoBethesda can do for you, schedule an appointment online, or call (301) 530-1010.