Rotator cuff injury

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Diagnosis

During the physical exam, health care providers will press on different parts of the affected shoulder and move your arm into different positions. They'll also test the strength of the muscles around your shoulder and in your arms.

Imaging tests may include:

  • X-rays. Although a rotator cuff tear won't show up on an X-ray, this test can visualize bone spurs or other potential causes for your pain — such as arthritis.
  • Ultrasound. This type of test uses sound waves to produce images of structures within your body, particularly soft tissues such as muscles and tendons. It allows a provider to assess the structures of your shoulder during movement. It also allows a quick comparison between the affected shoulder and the healthy shoulder.
  • Magnetic resonance imaging (MRI). This technology uses radio waves and a strong magnet. The images obtained display all structures of the shoulder in great detail.

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Treatment

Conservative treatments — such as rest, ice and physical therapy — sometimes are all that's needed to recover from a rotator cuff injury. If your injury is severe, you might need surgery.

Therapy

Physical therapy is usually one of the first treatments suggested. Exercises tailored to the specific location of your rotator cuff injury can help restore flexibility and strength to your shoulder. Physical therapy is also an important part of the recovery process after rotator cuff surgery.

Injections

A steroid injection into the shoulder joint might be helpful, especially if the pain is interfering with sleep, daily activities or physical therapy. While such shots often provide temporarily relief, they also can weaken the tendon and reduce the success of future shoulder surgery.

Surgery

Many different types of surgeries are available for rotator cuff injuries, including:

  • Arthroscopic tendon repair. In this procedure, surgeons insert a tiny camera (arthroscope) and tools through small incisions to reattach the torn tendon to the bone.
  • Open tendon repair. In some situations, an open tendon repair may be a better option. In these types of surgeries, your surgeon works through a larger incision to reattach the damaged tendon to the bone.
  • Tendon transfer. If the torn tendon is too damaged to be reattached to the arm bone, surgeons may decide to use a nearby tendon as a replacement.
  • Shoulder replacement. Massive rotator cuff injuries may require shoulder replacement surgery. To improve the artificial joint's stability, an innovative procedure (reverse shoulder arthroplasty) installs the ball part of the artificial joint onto the shoulder blade and the socket part onto the arm bone.

Video: Tendon transfer to repair rotator cuff

The rotator cuff is a group of muscles and tendons that hold the shoulder joint in place and allow you to move your arm and shoulder. Problems occur when part of the rotator cuff becomes irritated or damaged. This can result in pain, weakness and reduced range of motion.

Sometimes one or more tendons become detached from the bone. In some cases, a surgeon can reattach the tendon to the bone using a thread-like material called a suture.

But sometimes the tendon is too badly damaged to be reattached. In that case, the surgeon may consider a "tendon transfer." This is a procedure in which a tendon from a different location is used to repair the rotator cuff.

The tendon most commonly transferred is the latissimus dorsi tendon in the back. For a latissimus dorsi transfer, the surgeon makes two incisions: one in the back and one in the front of the shoulder.

In the back, the surgeon detaches one end of a latissimus dorsi tendon and attaches a suture to that end. In the front, the surgeon creates a flap in the deltoid muscle, which covers the shoulder. He or she inserts a tool to grasp the end of the latissimus dorsi tendon. The surgeon brings the tendon under the deltoid to its new position.

Sutures are used to connect the transferred tendon to any remaining rotator cuff as well as bone. The surgeon tightens the sutures to pull the tendon against the bone and ties it securely in place. In some cases, anchors are inserted into the bone to help hold the sutures in place.

The surgeon closes the flap in the deltoid muscle. The incisions are then closed in the front and back.

Video: Reverse shoulder replacement

The rotator cuff is a group of muscles and tendons that hold the shoulder joint in place and allow you to move your arm and shoulder. Problems with the rotator cuff may cause weakness or pain and restrict movement. It may also cause damage to the shoulder joint.

Often, tendons can be repaired. However, if the tendons are severely damaged, an operation called reverse shoulder replacement may be a better way to improve the joint's function and reduce pain, especially if the joint is affected by arthritis.

This operation is also called reverse arthroplasty. "Arthro" means joint; "plasty" means to mold surgically.

The top of the arm bone fits into a socket on the shoulder blade. In a typical shoulder replacement, a plastic lining is attached to the socket to allow smooth movement. The surgeon removes the top of the arm bone and inserts a metal stem with a ball on the end. However, if the rotator cuff is severely damaged, the joint may not be stable or work properly.

In a reverse shoulder replacement, the normal ball-and-socket structure is reversed. An artificial ball is attached to the shoulder blade. An artificial socket is attached to the top of the arm bone. The large deltoid muscle that covers the shoulder is typically able to move the arm.

General anesthesia will be given so you will sleep through the surgery.

An incision or cut is made in the front of the arm and shoulder. The surgeon separates muscles and cuts through tissue to expose the joint.

The upper arm bone is removed from the socket. The top of the arm bone is cut off and prepared to receive an artificial part. The socket is also prepared. A plate is screwed to the socket and a half-sphere attached. The metal stem is inserted in the arm bone, and a plastic socket is attached to the top.

The new socket is fitted against the new ball to allow smooth movement. The tissue is sewn together around the joint, and the incision is closed.

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Lifestyle and home remedies

The pain from a minor rotator cuff injury often diminishes on its own, with proper care. Stop doing what caused the pain and try to avoid painful movements. Limit heavy lifting or overhead activity until the shoulder pain subsides. Icing the shoulder may help it feel better. Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) also may be helpful.

Preparing for your appointment

You'll probably start by seeing your family doctor or sports medicine physician. If your injury is severe, you might be referred to an orthopedic surgeon. If you've been treated for a similar problem in the past, you may need to bring past records and imaging studies with you to your appointment.

What you can do

Before the appointment, you might want to write a list that answers the following questions:

  • When did you first begin experiencing shoulder pain?
  • What movements and activities worsen your shoulder pain?
  • Have you ever injured your shoulder?
  • Have you experienced any symptoms in addition to shoulder pain?
  • Does the pain travel down your arm below your elbow?
  • Is the shoulder pain associated with any neck pain?
  • Does your job or hobby aggravate your shoulder pain?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • Where exactly is the pain located?
  • How severe is your pain?
  • What movements and activities aggravate or relieve your shoulder pain?
  • Do you have any weakness or numbness in your arm?
By Mayo Clinic Staff

Rotator cuff injury care at Mayo Clinic

Request an appointment
Symptoms & causesDoctors & departments
May 11, 2023
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  2. Rotator cuff tears. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/rotator-cuff-tears. Accessed Jan. 4, 2022.
  3. Ferri FF. Rotator cuff disease. In: Ferri's Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed Jan. 4, 2022.
  4. Simons SM, et al. Presentation and diagnosis of rotator cuff tears. https://www.uptodate.com/contents/search. Accessed Jan. 4, 2022.
  5. Martin SD, et al. Management of rotator cuff tears. https://www.uptodate.com/contents/search. Accessed Jan. 4, 2022.
  6. AskMayoExpert. Rotator cuff surgery. Mayo Clinic; 2020.
  7. Azar FM, et al. Campbell's Operative Orthopaedics. 14th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Jan. 4, 2022.
  8. Krych AJ (expert opinion). Mayo Clinic. Jan. 12, 2022.
  9. Stewart RK, et al. Outcomes of subacromial balloon spacer implantation for massive and irreparable rotator cuff tears: A systematic review. The Orthopaedic Journal of Sports Medicine. 2019; doi:10.1177/2325967119875717.
  10. Braswell-Pickering EA. Allscripts EPSi. Mayo Clinic. Nov. 3, 2021.

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Rotator cuff injury