Shoulder Pain, Hattiesburg, MS | Rotator Cuff Disease

What is Rotator Cuff Disease?

Rotator cuff disease refers to a spectrum of conditions affecting the rotator cuff—a group of four muscles and their tendons that stabilize the shoulder and allow for a wide range of arm movements. This condition can range from inflammation (tendinitis) to partial or full-thickness tears of the tendons.

Key aspects of Rotator Cuff Disease

Tendinitis: Inflammation or irritation of the tendons, often due to overuse, especially in repetitive overhead activities.
Bursitis: Inflammation of the bursa (a fluid-filled sac) near the rotator cuff, which can accompany tendinitis.
Partial Tears: The tendon is damaged but not completely severed.
Full-Thickness Tears: The tendon is completely torn, often resulting in significant weakness or inability to lift the arm.

Symptoms

Shoulder pain (especially overhead or at night)
Weakness in abduction and rotation
Limited range of motion
Clicking or popping sensations

Causes

Rotator cuff disease can be caused by repetitive overhead activities, acute trauma, or degenerative changes in older adults.

Diagnosis

Clinical tests (e.g., Jobe’s test) and imaging (MRI or ultrasound) help confirm tendon inflammation or tears.

Medical history and physical examination to assess pain, weakness, and range of motion
Imaging studies (MRI, ultrasound, x-rays, CT arthrogram) to visualize the rotator cuff and assess for tears or inflammation
Diagnostic injections may be used to confirm the source of pain

Treatment Options

Conservative care with physical therapy and NSAIDs
Corticosteroid injections for pain management
Surgical repair may be necessary for significant tears or when conservative measures fail, and can involve arthroscopic tendon repair or open surgery

Conservative Management

Rest and activity modification to avoid aggravating activities
Physical therapy focusing on rotator cuff strengthening and scapular stabilization
Non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief
Ice and heat application to reduce inflammation and pain and increase blood flow
Corticosteroid injections for persistent pain
Ultrasound or electrical stimulation therapy may be used in some cases to reduce pain and muscle spasms

Range of Motion and Stretching Exercises

Pendulum Swings: Lean forward and let the arm hang down, swinging it gently in circles.
Cane-assisted shoulder flexion: Use a cane to assist in lifting the arm overhead.
Cross-body stretch: Bring the arm across the body and hold it with the opposite hand.
Doorway stretch: Stand in a doorway and place the arm on the frame, leaning forward to stretch the shoulder.
Sleeper stretch: Lie on the side of the affected shoulder and gently push down on the arm to stretch the posterior capsule.

Strengthening Exercises

Isometric shoulder abduction/adduction: Stand against a wall and push the arm into the wall without moving it.
Theraband external rotation: Attach a resistance band to a door handle and pull it away from the body while keeping the elbow at the side.
Theraband internal rotation: Attach a resistance band to a door handle and pull it towards the body while keeping the elbow at the side.
Shoulder flexion with weights: Hold a light weight and lift the arm straight in front of the body.
Shoulder extension with weights: Hold a light weight and lift the arm straight behind the body.
Shoulder abduction with weights: Hold a light weight and lift the arm straight out to the side.
Shoulder scaption with weights: Hold a light weight and lift the arm at a 45-degree angle in front of the body.
Rotator cuff strengthening with weights: Hold a light weight and perform internal and external rotation exercises.
Wall angels: Stand with the back against a wall and slide the arms up and down while keeping the elbows and wrists in contact with the wall.
Scapular retraction: Squeeze the shoulder blades together while sitting or standing.
Shoulder shrugs: Lift the shoulders towards the ears and then relax them down.
Shoulder blade squeezes: Squeeze the shoulder blades together while sitting or standing.
Shoulder circles: Move the shoulders in circular motions to improve mobility.

Surgical Options

Arthroscopic repair: Minimally invasive procedure to reattach the tendon to the bone.
Open repair: Larger incision for more complex tears.
Debridement: Removal of damaged tissue.
Subacromial decompression: Removal of bone spurs or inflamed tissue to relieve pressure on the rotator cuff.
Scapular stabilization: In some cases, surgery may be needed to stabilize the shoulder blade.
Superior Capsular Reconstruction: A newer technique for irreparable rotator cuff tears, using graft material to reconstruct the superior capsule of the shoulder.
Tendon transfer: In cases of irreparable tears, transferring another tendon to restore function.
Reverse shoulder arthroplasty: A procedure for patients with severe rotator cuff tears and arthritis, where the ball-and-socket joint is reversed to improve function.

Anatomy Overview

The rotator cuff is a critical anatomical structure in the shoulder that plays a central role in stability and movement. It consists of four muscles and their tendons, which surround the shoulder joint, keeping the head of the humerus (upper arm bone) firmly within the shallow socket of the scapula (shoulder blade).

Affected Areas

Supraspinatus tendon (most commonly affected): Located on the top of the shoulder, responsible for arm abduction.
Infraspinatus tendon: Located on the back of the shoulder, responsible for external rotation of the arm.
Teres minor tendon: Located below the infraspinatus, also responsible for external rotation.
Subscapularis tendon: Located on the front of the shoulder, responsible for internal rotation.
Bursa: A fluid-filled sac that reduces friction between the rotator cuff tendons and the shoulder joint.
Bones involved include the humerus, scapula, clavicle, and acromion (the bony prominence on the shoulder).

Frequently Asked Questions

Question	Answer
Can a rotator cuff tear heal on its own?	Small tears may improve with therapy, but larger tears often require surgical intervention.
How long is recovery after surgical repair?	Recovery can take 4-6 months or more, depending on tear size and rehabilitation.
What are the risks of rotator cuff surgery?	Risks include infection, stiffness, re-tear, and nerve injury.
Can I return to sports after treatment?	Most patients can return to sports after rehabilitation, but it may take several months.
What is the best way to prevent rotator cuff disease?	Regular shoulder exercises, proper technique in sports, and avoiding repetitive overhead activities can help prevent rotator cuff disease.
Is rotator cuff disease common?	Yes, it is one of the most common causes of shoulder pain, especially in athletes and older adults.
What is the difference between tendinitis and a tear?	Tendinitis is inflammation of the tendon, while a tear involves a rupture of the tendon fibers.
Can I lift weights with rotator cuff disease?	Weightlifting may be possible with modifications, but it's best to consult a healthcare provider before resuming activities.
What is the role of physical therapy?	Physical therapy is crucial for rehabilitation, focusing on strengthening and restoring range of motion.
Are there any non-surgical treatments?	Yes, options include physical therapy, NSAIDs, corticosteroid injections, and activity modification.
What is the prognosis for rotator cuff disease?	With appropriate treatment, many patients experience significant improvement in pain and function.
Can rotator cuff disease recur?	Yes, especially if risk factors are not addressed or if the shoulder is subjected to repetitive stress.
What lifestyle changes can help?	Maintaining a healthy weight, avoiding smoking, and engaging in regular shoulder exercises can help manage and prevent rotator cuff disease.

Prevention Strategies

Shoulder strenthenging and flexibility exercises
Avoid repetitive overhead activities without breaks
Maintain good posture to reduce shoulder strain
Use ergonomic tools and techniques in work and sports
Gradually increase intensity and duration of activities
Avoid heavy lifting without proper technique
Incorporate rest days into training programs
Use proper warm-up and cool-down techniques
Avoid sleeping on the affected shoulder
Modify activities to reduce strain on the shoulder

Related Conditions

Shoulder impingement: Compression of rotator cuff tendons under the acromion.
Shoulder arthritis: Degenerative changes in the shoulder joint.
Shoulder instability: Excessive movement of the shoulder joint.
Labral tears: Injuries to the cartilage that deepens the shoulder socket.
Frozen shoulder (adhesive capsulitis): Stiffness and pain in the shoulder joint.
Subacromial bursitis: Inflammation of the bursa under the acromion.
Calcific tendinitis: Calcium deposits in the rotator cuff tendons.
Shoulder fractures: Breaks in the bones of the shoulder.
Tendinopathy: Degeneration of the rotator cuff tendons.
Shoulder dislocation: Displacement of the humeral head from the glenoid cavity.
Acromioclavicular joint injury: Injury to the joint between the collarbone and shoulder blade.
Thoracic outlet syndrome: Compression of nerves or blood vessels in the neck and shoulder region.
Scapular dyskinesis: Abnormal movement of the shoulder blade.
Rotator cuff arthropathy: Degenerative changes in the rotator cuff tendons.