Why Does My Rotator Cuff Hurt?

If you’ve ever felt a dull ache or pain in your shoulder, you may have experienced damage to your rotator cuff. Rotator cuff tears are common in both men and women, especially as you get older. 

If you have pain that doesn’t respond to stretching or anti-inflammatory medication, don’t get discouraged. There are a variety of treatment options that could reduce or relieve your pain so you can get back to your favorite activities. Read on to learn what the rotator cuff is, why it may cause pain, and what you can do about it.

The rotator cuff is essential for overhead arm movement and rotation and is more susceptible to injury as you age.

The rotator cuff is made up of four muscles and attached tendons that protect your shoulder joint. Together, these muscles enable you to lift your arm overhead and rotate it away from your body—motions necessary in certain sports (baseball or tennis) and everyday activities, like brushing your hair.

Because everyone uses their rotator cuff to some degree, anyone is susceptible to a rotator cuff injury. However, we know that your risk of developing a rotator cuff injury increases as you age. Interestingly, studies show that one-third of adults over the age of 60 without shoulder pain have rotator cuff tears. The incidence rate in adults over 70 is even higher. Nearly two-thirds of adults over 70—with no pain in the shoulder—have rotator cuff damage. 

A history of smoking, a family history of rotator cuff disease, and high cholesterol may also increase your chances of developing a rotator cuff injury. 

Damage can occur slowly over time or immediately during a traumatic injury to the shoulder.

Rotator cuff damage can occur suddenly or slowly worsen over the years, depending on the cause of your injury and how much you use your shoulder. Most commonly, a rotator cuff injury is caused by:

• Repetitive motion (doing something too much)
• An acute injury while lifting something heavy overhead (doing something too fast or with poor form)
• General “wear and tear” as you age
  

Your pain and treatment options may vary depending on the type of rotator cuff injury you develop. At MedStar Health, we frequently see patients experiencing pain in the shoulder that results from:

• Tendonitis in the rotator cuff, which can be painful but doesn’t involve any structural damage
• A partial tear, during which parts of the tendon slowly peels away from the cuff
• A complete tear, where one or more tendon completely separates from the bone
  
  

Rotator cuff injuries can cause dull, aching pain in the shoulder.

 If you have a damaged rotator cuff, it may lead to a dull, aching pain that:

• Radiates over the side of the shoulder and may extend down the upper arm
• Feels worse when the rotator cuff is engaged (such as while holding up a cup of coffee)
• Worse at night
• Is paired with weakness in the shoulder
  

Rotator cuff injuries do not generally lead to a numbing or tingling sensation in the forearm or hand. Those symptoms may indicate a nerve injury related to your neck or back and therefore would respond to different treatment approaches. 

In addition, it’s not unusual for someone to have a rotator cuff tear without any pain, as there are 17 total muscles in the shoulder that work together to help the shoulder function properly. If the rotator cuff is injured, the other muscles may compensate for it and mask the damage. If you have a partial rotator cuff tear that doesn’t impede your ability to do the things you enjoy, like playing catch with your grandson or painting, then there’s no need to seek treatment. But, rotator cuff injuries can worsen over time, so it’s important to keep an eye on your symptoms. 

Not everyone who has rotator cuff pain needs surgery.

If you have shoulder pain caused by a rotator cuff injury, it’s always helpful to try nonsurgical treatment options first to alleviate your pain. There is a wide range of options that can address the cause of your pain and get you back to pain-free living without surgery, including:

• Physical therapy to stretch and strengthen the rotator cuff
• Anti-inflammatory medications (oral or topical) that can reduce inflammation and relieve pain
• Cortisone shots that work directly at the source of the pain for those who are candidates
• Ice can help to reduce inflammation associated with pain
  

Some people with rotator cuff damage can manage or eliminate their pain using conservative treatment options above. If you’re able to continue doing the things you enjoy, there’s no need to seek surgery.

If pain worsens, surgery may be an effective option.

The tricky thing about rotator cuff injuries is that they don’t heal on their own. Therefore, it’s common for rotator cuff pain to worsen over time. When nonsurgical treatment options don’t improve your pain, it may be time to consider surgery. 

There are a variety of different surgical options for repairing rotator cuff damage. Surgical options range from minimally invasive arthroscopic surgeries that reattach torn tendons to complex shoulder replacement procedures that use artificial parts to rebuild the shoulder joint. Regardless of the treatment option that your doctor recommends, physical therapy plays a vital role in the healing process.

Seek care if your shoulder pain interferes with your quality of life.

You don’t have to live with shoulder pain caused by a rotator cuff injury. I’ve encountered patients that delayed care because they were afraid of surgery, only to find out that conservative treatment options relieved their pain. That’s the benefit of seeking care from a specialist—someone who has fellowship-training in treating shoulder and elbow pain is well-versed in many different treatment modalities to help you achieve your personal goals.

What to expect at a doctor's visit.

As a fellowship-trained orthopedist specializing in shoulder and elbow, patients come to me when shoulder pain keeps them up at night or from doing their day-to-day activities. During an appointment, you can expect:

• To answer questions about your pain, including when it started, how long it lasts, and where it bothers you
• A physical exam that will help me understand your limitations and weakness
• Imaging, such as an X-ray or ultrasound to rule out arthritis or bone injuries
• A conversation about your goals 
• Recommendations for treatment options that consider your lifestyle and personal preferences
  

Most importantly, a visit to a fellowship-trained specialist can help you understand your options so that you can get on with living your life without shoulder pain. We can always do something to help alleviate pain and restore function to your shoulder.