The group of tendons and muscles that attach your bones in the shoulder joint, allowing for both stability and movement, is called rotator cuff. Damage to these tendons and muscles may occur from chronic overuse, acute injury, or aging. This damage can cause a great deal of pain, a reduced range of motion and even disability.

What Causes Rotator Cuff Pain?

Your shoulder is made of a ball and socket joint. The top of your arm bone, also called the humerus, creates a joint with the scapula, or shoulder blade. This rotator cuff holds the humerus head in the scapula and controls the movement.

Tendinitis

The rotator cuff tendons pass under a bony area when attaching to the top of the arm bone. These tendons can become inflamed and then frayed during repetitive arm movements. There are times that a bone spur can cause even more trouble. Tendinitis may also be called impingement syndrome. Causes may include:

• Sleep positions
• Keeping the arm in one position for extended periods of time, such as with hair styling or computer work
• Sports that require the arm to be moved overhead repeatedly, like baseball, tennis, swimming and weight lifting
• Aging
• Working with the arm up for long periods
• Poor posture

Tears

There are two ways that a rotator cuff may tear.

• Acute, sudden tears can happen if you fall with your arm stretched out. It can happen after a jerking, sudden motion or lifting something heavy.
• A chronic tear is when it happens over time. This is when you may have impingement syndrome or chronic tendinitis.  At a point the tendon can wear down and tear.

There are two types of rotator cuff tears:

• Partial tear where it doesn’t fully sever the bone attachments
• A complete, full tear that means it goes through the tendon completely. This can be as small as a pinpoint, or the entire tendon. With complete tears, the tendon becomes detached from its place on the bone. This tear will not heal on its own.

What Are the Accompanying Symptoms of Rotator Cuff Pain?

There are some things to consider when trying to determine what is causing your shoulder pain.

Rotator Cuff Tendinitis

• This is most common in women between 35-50.
• This will come with a shoulder that has a deep ache, that is even on the outside of the upper arm or deltoid muscle.
• There may be point tenderness over the injured area.
• Pain will be gradual, worsening with lifting the arm to the side or turning inward.
• This can lead to chronic tearing: when the rotator cuff is inflamed, it runs the risk of a blood supply loss, causing more death of tendon fibers. This will raise the risk that the tendon will fray, partially tear or completely tear.

Acute Rotator Cuff Tear

• Symptom may be a tearing sensation with severe pain that shoots from the upper shoulder, in the back and front, down the arm to the elbow. Movement range is decreased due to muscle spasms and pain.
• Acute pain from muscle spasms and bleeding. It may resolve in a couple of days.
• Large tears can cause the inability to raise the arm because of loss of muscle power and significant pain.

Chronic Rotator Cuff Tear

• Pain is often worse at night and can keep you from sleeping.
• Shoulder motion can decrease with a gradual weakness as the pain gets worse.
• There may be less ability to move the arm out to the side, because of pain. This means the arm can be used generally, but some movements will cause a great deal of pain.

When to See a Doctor

Not all shoulder pain will come from the shoulder. There is some angina or heart trouble that can show as shoulder pain. Diaphragm or gallbladder pain can sometimes be felt in the shoulder, often around the shoulder blade. Rotator cuff pain is worse when the shoulder is moved. If the pain in your shoulder isn’t affected by movement, you should seek immediate medical attention. If you are worried about your heart, call 911. Also seek help in the following cases.

• If the pain sticks, even with ice, rest and home care such as over-the-counter medications.
• If your pain is preventing you from doing normal activities at work.
• If the pain prevents reaching over your head.
• If the pain prevents you from enjoying a sport with the overhead motion.

It is a good idea to head to the hospital if you think there is a broken bone involved. If there is any numbness or changes in your hand and arm sensations, or your arm movement is suddenly limited, you should head to the doctor.

Treatment for Pain in Rotator Cuff

Follow the instructions your doctor gives you to properly care for your rotator cuff issues at home. This can help give you relief.

Tendinitis

Your doctor may recommend you rest your shoulder from activities that cause rotator cuff pain. Other suggestions may include:

• Ice packs at twenty minutes at a time, several times a day
• Medications such as ibuprofen or naproxen to reduce swelling
• Reducing or avoiding activities that bring your symptoms out or make them worse
• Physical therapy to strengthen and stretch your muscles
• Medicine injected into the shoulder for pain reduction
• Arthroscopy or surgery to remove tissue and bone parts that are inflamed or troublesome. This can relieve pressure on tendons.

Tears

Physical therapy and rest can help with a tear, if it doesn’t normally have a lot of demand placed on it.

A surgery may be necessary to repair the tendon if there is a complete tear. This also may be needed if symptoms aren’t getting better with treatments. Most of the time, arthroscopic surgery can be the answer. Larger tears may need a surgery with a larger incision, however.