The rotator cuff is made up of four muscles
and tendons that surround the ball and socket joint of the
shoulder (Figure 1). The muscles lift and rotate the
arm. Tendons are thick bands of fibrous tissue that connect
muscle to bone.
- Injuries to the rotator cuff most
often affect the top muscle, or supraspinatus.
- The main injuries affecting the
cuff include a tendon tear (strain) or
tendinopathy (inflammation and degeneration of
- Sometimes, tendon problems come
from shoulder or rotator cuff impingement. Impingement
happens when the upper part of the rotator cuff gets
pinched between the ball at the end of the upper arm bone
(humerus) and the bones above it. This results in a lot
of friction, especially during overhead motion.
- A condition called bursitis occurs
when fluid builds up between the upper part of the
rotator cuff and the bones above it.
- Tears are more common in adults
than in younger athletes. Older people, especially those
over age 50, are especially at risk.
- Rotator cuff tears and/or immediate
inflammation usually occur:
- after a fall on the arm,
especially an outstretched arm
- with a blow or hit to the
outside of the shoulder or upper arm, especially if
the impact comes from the side.
- with heavy lifting, especially
if you are lifting something out and away from your
body or over your head
- with sports injuries such as a
- Overuse of the shoulder with
certain repetitive motions, such as reaching above the
head or shoulder and lifting out away from the body, can
lead to tendinopathy, impingement and bursitis.
- Throwing sports, lifting weights,
swimming, golf and certain repetitive motions at work or
home may cause rotator cuff problems.
- Arthritis of the bones above the
rotator cuff can also cause problems.
- Tendinopathy, especially if
you’ve had it for a long time, increases your risk
of tearing your rotator cuff.
- Shoulder inflexibility, weakness
and fatigue may increase your risk of rotator cuff
- Shoulder arthritis, especially
affecting the shoulder blade/collarbone joint above the
rotator cuff, can lead to tendinopathy and tears.
- Having had multiple steroid
injections in the shoulder increases the risk of
Shoulder pain also can be caused by other
- It may be the result of problems in
the neck such as a pinched nerve or a herniated disc
(when the gel-like disc between spine bones bulges
against spinal cord and nerves). This is especially true
if you also have numbness, tingling or problems with
feeling in your arm or hand.
- The source of shoulder pain that
extends below the elbow is not usually the shoulder and
is more likely coming from the neck.
- Fractures of the shoulder bones,
which may occur after falls or sports injuries, can
produce symptoms similar to those of a rotator cuff
- Rarely, blood vessel or blood clot
problems can cause shoulder pain. However, these also
usually cause swelling in your forearm and hand, dusky or
grey skin color, a feeling of heaviness in your arm or
problems feeling your arm.
- Lung problems such as an infection
or a tumor can refer pain to the shoulder.
SYMPTOMS AND SIGNS
- Tears happen suddenly and usually
cause immediate, severe pain at the top of the shoulder,
all around the shoulder and, sometimes, down to the
outside of the shoulder or down the upper arm.
- If you have had longstanding
shoulder pain that suddenly increases, you may have a
tear that can occur with chronic tendon problems.
- Pain, weakness or the inability to
move your arm out away from your body or above shoulder
level can signal a tear.
- Shoulder pain that wakes you up at
night is probably a tear.
- Overuse tendon problems
(tendinopathy) often start slowly and get worse over
time. That pain is similar to pain that occurs with a
tear but may be less intense. You may also feel a
crunching, grinding and catching in your upper
WHEN TO CALL YOUR DOCTOR
Call 911 if:
- You are alone, in severe pain and
cannot get yourself to the hospital.
- You have problems feeling your arms
or have weakness in both shoulders and arms after a neck
- You have other severe injuries that
are cause for concern.
Call your doctor right
away (day or night) if:
- You have severe shoulder pain that
started immediately after a fall or injury, especially if
you can’t lift your arm up or out away from your
- You have numbness, tingling or
problems feeling your affected arm, especially if you
also have neck pain.
- Your whole arm feels weak or
- You have other injuries that
- Your pain is not severe and you
want advice on diagnosis and treatment.
- Your pain has been there for weeks
or months and is only slowly getting worse or simply not
- You have no problems with numbness,
tingling, feeling your arm, or a lot of arm or shoulder
- You don’t have arm or hand
swelling or other symptoms.
SELF-CARE AT HOME
- If you fell or injured your
shoulder and have severe pain, consider using an arm
sling and avoid lifting the arm up or out away from the
body. Your arm should be bent at a right (90-degree)
angle when in a sling.
- Arm slings are often available
at drug stores.
- A homemade sling can be made
by wrapping a sheet or large handkerchief around the
arm and your neck and then tying the ends together
around your neck. Trim off any excess material with
- If your pain is mild to moderate,
avoid doing things that increase the pain. These may
include lifting your arm up, out and away from your body;
putting it above your head or reaching behind you.
- Avoid lifting things until your
doctor looks at your shoulder.
- Wrap an ice pack or cold pack
around the front of your shoulder and hold it in place
with plastic wrap or an elastic wrap. Do this three times
daily for 20 minutes at a time.
- You may take ibuprofen (Advil®
or Motrin®). (See the labels for dose and
- If you can’t find a
comfortable position in your bed, try sleeping in a
- You can do a few shoulder
exercises, provided they don’t cause much pain.
- Maintain shoulder motion by
bending over at the waist and hanging your arm
loosely down toward the floor. Swing your arm gently
in small circles. Progress gradually to larger
circles for one to two minutes in each direction. Do
this two times daily.
- If you have only mild to
moderate pain, you may “walk” your
fingers up the wall, pulling your arm with them
(Figure 2). Stand facing the wall with your
arm straight out in front of you. As your fingers
pull your arm up the wall, move closer to the wall
until your arm is above your head as far as pain will
allow it to go. Return to your original position by
walking your fingers back down the wall. Repeat the
exercise, this time facing away from the wall (your
body should be at a right angle to the wall), with
your injured arm out to the side. Do the exercise
five to 10 times in both positions once or twice a
- Keeping your shoulder flexible and
strong with exercises can help prevent injuries.
- A preseason throwing program can
help prevent shoulder injuries in throwing sports.
FOR MORE INFORMATION
- American Family Physician:
Management of Shoulder Impingement Syndrome and Rotator
- American Medical Society for Sports
Medicine: Rotator Cuff Tendonitis
- MayoClinic.com: Rotator Cuff Injury
- American Academy of Orthopedic
Surgeons: Rotator Cuff Tears
- Hutton K, Julin M: Shoulder
injuries. In Mellion M, Walsh WM, Madden C: The Team
Physician’s Handbook, Hanley & Belfus, Inc,
Philadelphia, p397-417, 2002.
- Sports Medicine Clinical
- Krabak B, Sugar R, McFarland E:
Practical nonoperative management of rotator cuff
injuries. Clinical Journal of Sport Medicine.
Last reviewed: November 2007
Last revised: November 2007
View Anatomic Index of
Authored by Christopher Madden,
Favorably reviewed by The American Medical Society for
Developed by SelfCareNet, Inc. Copyright (C) 2007. All
This content is reviewed periodically and is subject to
change as new healthcare information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.