Originally published March 26, 2021
Rotator Cuff Injuries: Signs & Symptoms
Raise your hand if you’ve experienced shoulder pain. If your hand isn’t stretched high above your head, there’s a decent chance you have a damaged rotator cuff. Shoulder weakness is the No. 1 sign of a rotator cuff injury, says Christopher Kim, MD, an orthopedic surgeon explains the essentials of rotator cuff injuries from simple tendonitis to full tears.
#1 Cause of Rotator Cuff Injuries: Shoulder Weakness
Like the shoulder itself, the rotator cuff is a complex set of working parts that allow you to lift and rotate your arms (hence the name). You can have a problem with one or many of the muscles and suffer from the same weakness. Sports medicine physicians like Dr. Kim run you through various tests to first confirm that it’s a rotator cuff injury and then sort out the severity of the damage.
“People come in with similar kinds of pain and often complain of the same thing,” Dr. Kim says. “We sort out where the weakness is really coming from to figure out which part of the rotator cuff it is, and how bad it is.”
You may not easily notice the weakness yourself if you can still raise your arm. But you might feel a pain, pop or click when you move your arm a certain way or sleep on it in bed. Other times, you don’t notice it until one shoulder gives out or is noticeably weaker when you try to lift something you normally have no problems with.
Rotator Cuff Tendonitis
Irritated and inflamed rotator cuff tendons can lead to tendonitis. It’s something that usually occurs over time, whether from sleeping on the same side of your body every night or performing repetitive motions that require you to raise your arm above your head. As you move, the space around your rotator cuff narrows and the tendons rub against other parts of the shoulder, causing more irritation and pain.
“This is what some refer to as impingement or bursitis,” Dr. Kim says. “We have a bursa, which is a little fluid-filled sac around the rotator cuff that allows things to glide over each other. Inflammation can cause it to swell with more fluid, which leads to pain.”
Rotator Cuff Tears
The tendons that attach the rotator cuff can also start to fray or lose their connection to the bone. Partial rotator cuff tears are when there is damage, but some of the tendon is still connected. Full-thickness, or complete rotator cuff tears, are completely disconnected and look like there is a hole where the muscle should attach to the bone.
“We characterize rotator cuff tears in lots of different ways. We can define it as more the wear-and-tear, degenerative tear that happens as we get older, which is common. There are also the traumatic tears, where you have a fall or an injury. Either of these can be partial or full,” Dr. Kim says.
Rotator Cuff Injury Risk Factors
Traumatic tears are more common in young adults, as the result of a fall. But the majority of rotator cuff tears are of the degenerative type — the normal wear and tear your body faces over time. You’re more likely to suffer a rotator cuff tear after the age of 40. People in their 60s, 70s and 80s have a good chance of tearing a rotator cuff without even knowing it, Dr. Kim says.
Common risk factors
- Age
- Repetitive motions (ex: lifting heavy objects or performing manual labor)
- Repetitive desk work (ex: using a mouse or keyboard all day)
- History of shoulder trauma or surgery
- Smoking
Rotator Cuff Injury Recovery and Treatment
There’s no specific shoulder stretch, exercise or routine for you to prevent a rotator cuff injury. But that’s typically the prescription for rotator cuff problems.
“Rotator cuff treatment is so variable. Not all rotator cuff injuries are treated the same. One full-thickness tear is different from another. Partial tears are different from full tears,” Dr. Kim says. “There are a lot of factors involved, but almost always our recommendations are non-surgical. You undergo therapy with a physical therapist or do your own home exercises. And then we discuss whether a steroid injection is beneficial or not in managing your pain.”
When these more conservative treatments aren’t effective, or you suffered a complete tear, rotator cuff repair surgery is needed.
“The majority of rotator cuff surgeries are all arthroscopic. It’s a less invasive surgery but recovery from a rotator cuff repair is actually quite long. It takes much longer for soft tissue to heal back onto bone,” Dr. Kim says.
“You’re typically in a sling for about six weeks. During that time, you come out of the sling two or three times a week for physical therapy. It’s usually three months before you start any strengthening exercises — light bands and things like that. And you typically go to therapy for five to six months before continuing to improve on your own at home. It’s usually about nine to 12 months total before it’s the best you’re rotator cuff is going to get.”
“The longer you have symptoms, the harder it often is to treat. And the injury has progressed,” Dr. Kim says. So as soon as you feel a twinge of shoulder pain or weakness, schedule a shoulder evaluation or visit the Bone & Joint Center to start a much shorter road to recovery.
ChristopherKim , MD
Dr. Christopher Kim is a fellowship-trained sports medicine orthopaedic surgeon. He decided to join The Iowa Clinic after meeting the kind and dedicated physicians and staff, and wished to share in the positive culture and mission of the clinic. He recognized that The Iowa Clinic was a place where he could provide the best possible care to his patients.
Throughout his career, Dr. Kim received training by the team physicians for the Winnipeg Blue Bombers (CFL) and Winnipeg Jets (NHL). He completed his fellowship training at Duke University, during which he served as team physician for the Duke Blue Devils Athletic program. Prior to joining the team at The Iowa Clinic in September 2020, he served as team physician to the Saint Louis University Billikens, a Division 1 College program in the A10 Conference.
Dr. Kim specializes in the treatment of shoulder and knee injuries, including surgery utilizing minimally-invasive and arthroscopic techniques. He chose to become a sports medicine surgeon because he enjoys treating athletic injuries, and finds sports medicine surgery interesting. The most rewarding aspect of his job is seeing patients getting back to their loved activities.
He moved to Iowa with his wife and three boys. They enjoy the outdoors, and spend time camping, cycling, and hiking. He is an avid sports fan, and enjoys watching college basketball and football.