Rotator Cuff Injuries: A General Overview
Introduction:
When we think of sports-related injuries, we typically think of sprained ankles and bone fractures– but shoulder injuries can also frequently occur based on the sport you’re partaking in. For example, in racket sports, injuries relating to the rotator cuff are among the most commonly diagnosed shoulder injuries. Let’s dive into some of these injuries.
What it actually is:
As the name suggests, rotator cuff injuries are injuries related to the rotator cuff, which is made up of muscles and tendons surrounding the shoulder. The injuries are usually one of three: rotator cuff tendinitis, rotator cuff tendinopathy, or rotator cuff tears. Other common ways to refer to the former are shoulder bursitis or shoulder impingement. Despite all three injuries being related to one another, it is important to establish their differences. Both rotator cuff tendinitis and tendinopathy are less severe than a full rotator cuff tear. In the case of tendinitis, the tendon is inflamed, but still completely attached to the bone. Rotator cuff tendinopathy on the other hand involves small tears and overall degeneration of the tendon attached to the bone. This can eventually lead to a partial tear or complete tear. Rotator cuff tears are the most severe of the three and are oftentimes associated with one or both of the former. Tears can be partial or complete, which indicates how much of the tendon is still attached to the bone itself. As the name suggests, complete tears are when the rotator cuff tendon is completely detached from the bone, whilst a partial tear means the rotator cuff is still somewhat attached.
Causes:
The most common cause of all three rotator cuff injuries is repeated overhead motions–the lifting of any portion of your arm above your head. As such, racket sports like badminton and tennis are common sources of rotator cuff injuries. People who work as painters or carpenters are also more likely to suffer from rotator cuff injuries. This is because repeated overhead motion causes trauma to the rotator cuff tendon, causing microtears that eventually lead to degeneration of the tendon or complete tears. Complete tears can oftentimes result from tendinopathy worsening. Aside from the general degradation of the tendon, an individual may abruptly tear their rotator cuff tendon if they fall on an outstretched arm.
Symptoms:
Tendinitis/Tendinopathy:
Decreased movement particularly in reaching overhead motions (being unable to reach for anything above the head level, as shown below)
Dull, aching pain (deep within the shoulder)
Occurs during a lying down position
Occurs during overhead motions
Can occur randomly as well
Shoulder Instability
Includes all the above symptoms and more
Patients normally describe it as a “loose” feeling, as if their shoulder could “give out” at any given moment
Shoulder may sometimes swell or bruise at a moment's notice
Partial/Complete Tears:
Shoulder instability
Includes numbness/tingling of the injured arm
The feeling of the shoulder coming out of place and/or giving out
Severe, sharp pains
Severely limited shoulder movement
Being unable to reach behind the body
Being unable to reach over the head
Of course, all symptoms of a partial tear will apply to a complete tear, but on a much more severe and painful scale in comparison.
Treatment:
In terms of reducing pain:
Icing the shoulder area
Using painkillers such as ibuprofen or Advil
Gentle stretches like the following:
Pendulum Swing - Lean forward onto an object, placing one hand on the object for stability. Then dangle your injured arm and allow it to gently sway back and forth. Move in a circular motion clockwise and counterclockwise if possible.
Crossover Arm Stretch - Stretch your injured arm across your chest and place your uninjured arm at the elbow, securing the injured arm in place.
Standing Row (Requires a stretch band) - Secure one end of a stretch band on a stationary, non-movable object (such as a doorknob). Stretch the stretch band until there is no slack in the band. Hold the other end of the band with your injured arm with your elbow at a 90-degree angle relative to your body. Gentle pull back your injured arm and repeat that motion.
In terms of treating tears:
The same stretches listed under “reducing pain”
Physical therapy
Steroid injection for pain reduction (if everything under “reducing pain” is ineffective)
Surgery to reattach the tendon to the bone (for severe cases)
Prevention:
There are two main ways to prevent oneself from getting these rotator cuff injuries and from worsening them.
1. Always getting enough rest - While this one may seem obvious, not enough people do it, considering how many people in sports like badminton or tennis get rotator cuff injuries. Allowing oneself enough rest is crucial, as it allows time for the microtears in the tendon to heal, which then eliminates any pain and prevents partial/complete tears from occurring.
2. Avoid Overhead Motions - This one is a bit tricky, as athletes and people who work as painters or carpenters need to perform these overhead motions quite often. However, for those who aren’t affected by these jobs, avoiding constant use of overhead motions may be beneficial in preventing the overuse of the rotator cuff tendon. If the motion is needed, consider only performing it when necessary and avoid it in excess.
3. Being cautious - As mentioned before, rotator cuff injuries may not just stem from the overuse of the tendon, but may also be the result of falling down on an outstretched arm. Of course, this applies to the prevention of all injuries, not just rotator cuff tears.
Conclusion:
All in all, while this may be uncommonly heard of, rotator cuff injuries occur far more often than people realize. Depending on our daily activities and sports, this may be a looming and persistent threat. Don’t worry though, the methods of prevention are very straightforward, easy to abide by, and have little to no cost in the long run. And even if you do end up getting one of these injuries, the effects won’t be permanent, given the injuries are addressed properly and receive the appropriate treatment.
Sources:
Understanding the two types of rotator cuff tears. Understanding the Two Types of Rotator Cuff Tears: J. Michael Bennett, MD, PA: Orthopaedic Surgeon. (n.d.). https://www.orthopedicsportsdoctor.com/blog/understanding-the-two-types-of-rotator-cuff-tears
Hecht, M. (2018, November 8). Tendinopathy: Definition, comparison to tendonitis, and treatment. Healthline. https://www.healthline.com/health/tendinopathy#outlook
Bass, E. (2012). Tendinopathy: Why the difference between tendinitis and tendinosis matters. International journal of therapeutic massage & bodywork. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/
Mayo Foundation for Medical Education and Research. (2023, May 11). Rotator cuff injury. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/symptoms-causes/syc-20350225
Rotator cuff tendinitis. Johns Hopkins Medicine. (2023, March 21). https://www.hopkinsmedicine.org/health/conditions-and-diseases/rotator-cuff-tendinitis
02-18-19. “Physical Therapist’s Guide to Rotator Cuff Tear.” Action Physical Therapy & Rehabilitation Inc., 19 June 2020, www.myactionpt.com/physical-therapist-s-guide-to-rotator-cuff-tear.
“Atraumatic Shoulder Instability.” Florida Orthopaedic Institute, www.floridaortho.com/specialties/shoulder/atraumatic-shoulder-instability/. Accessed 1 Jan. 2024.
Metrifit. “Sleep Should Be Part of Your Training Plan.” Metrifit Ready to Perform, Metrifit Ready to Perform, 21 Feb. 2020, metrifit.com/blog/sleep-should-be-part-of-your-training-plan/.
Jenkins, Steve. “Painting a Ceiling: A Guide to Achieving the Perfect Finish.” Homebuilding & Renovating, Homebuilding, 8 Sept. 2021, www.homebuilding.co.uk/advice/painting-a-ceiling.