How does rotator cuff pain manifest?

Rotator cuff pain is characterized by pain experienced during overhead activities, reaching to the side, or behind the back. The pain often persists at rest and at night, may radiate to the upper arm, and may be accompanied by weakness.

Acute traumatic rotator cuff tears result from injury and require prompt assessment.

Who suffers from rotator cuff pain?

Rotator cuff pain and injuries can affect anyone, not just athletes. Baseball or volleyball players, due to repetitive shoulder stress, frequently develop problems. A traumatic blow to the shoulder can cause intense pain and a potential tear in one of the rotator cuff muscles, affecting anyone.

Individuals whose jobs involve constant overhead reaching or heavy lifting may experience chronic pain. Degeneration of the rotator cuff can also occur naturally with age.

What causes rotator cuff pain?

Chronic shoulder pain can stem from various rotator cuff conditions.

Some conditions, such as impingement, bursitis, and tendinitis, cause reversible effects on the rotator cuff tendons.

Others, such as tendinopathy, partial tears, and full-thickness tears, cause irreversible damage to the rotator cuff tendons.

In cases of significant, untreated rotator cuff tears, shoulder joint arthritis, or rotator cuff arthropathy, may develop.

What are the treatment options?

Managing rotator cuff disease requires consideration of several factors. The first is differentiating between acute traumatic injuries and chronic degenerative conditions. The patient's age, dominant hand, activity level, and occupation inform the most appropriate treatment. Surgeons prioritize non-surgical treatment unless a traumatic accident or sudden injury has occurred; conservative treatments are attempted first.

Conservative treatments for rotator cuff disease include:

• Nonsteroidal anti-inflammatory drugs.
• Activity modification to reduce inflammation. For example, take a break from weightlifting. Pay attention to activities causing pain and avoid those movements if possible.
• Physical therapy focusing on range of motion, stretching, and light rotator cuff conditioning.
• Corticosteroid injections to reduce inflammation and relieve pain.

Surgical Treatment of Rotator Cuff Pain

If surgery is necessary, be aware that recovery is often quite painful.

Surgical management of most rotator cuff tears is typically an outpatient procedure. Shoulder surgeons use arthroscopic techniques involving three to five small incisions around the shoulder. A camera and tiny instruments are used to clean and repair the cuff.

Post-surgery, the arm is immobilized in a sling for six weeks. Full recovery takes approximately four to five months.

For massive tears progressing to arthritis and rotator cuff arthropathy, a reverse total shoulder arthroplasty is usually performed. This more complex procedure, requiring a qualified shoulder surgeon, involves open surgery to remove arthritic areas and "reverse" the ball-and-socket joint, allowing shoulder function without a rotator cuff.

How long does it take to heal from rotator cuff surgery?

Recovery is staged. The initial stage involves managing post-operative pain. While the arm will likely be immobilized for four to six weeks, most normal activities can resume a few days after surgery (driving and walking, using one arm). During recovery, physical therapy helps regain movement and strengthen the area. Recovery time varies, but full recovery usually takes four to six months. Resuming heavy lifting may take longer. Discuss this with your doctor and physical therapist before resuming strenuous activities or work.

What to expect from post-operative physical therapy?

Physical therapy is crucial in post-operative rotator cuff treatment. It begins with passive movement, carefully moving the arm to avoid stressing healing muscles and tendons. Then, active movements are introduced, showing how to move the arm. Finally, strengthening exercises with resistance are incorporated. Regular appointments and daily home exercises are typical. Rehabilitation usually lasts several months post-surgery.