Table of ContentsView AllTable of ContentsSymptomsWhen to See a DoctorCausesDiagnosisTreatmentPrevention
Table of ContentsView All
View All
Table of Contents
Symptoms
When to See a Doctor
Causes
Diagnosis
Treatment
Prevention
Rotator cuffpain is felt at the front and side of your shoulder and upper arm. Pain in this area often indicates injured, inflamed, or worn-down tendons in the rotator cuff.
The rotator cuff consists of four muscles that surround your shoulder blade (scapula) and connect to your upper arm bone (humerus). Tendons hold these muscles to the bone and allow you to lift and rotate your arm.
This article discusses rotator cuff pain. It details the symptoms of the three main causes of rotator cuff pain—atear,tendinitis, ortendinosis. It also explains the diagnosis and treatment of different rotator cuff injuries and when to see a specialist.
Verywell / Alexandra Gordon
Rotator Cuff Pain Symptoms
The symptoms of rotator cuff pain depend on the specific cause, but some overlap. Common symptoms may include:
In some cases, people with rotator cuff tears do not have any pain. Also, more severe tears can sometimes cause less pain than partial tears.Rotator cuff tendinosis does not always cause pain either, especially early on.
The Difference Between Tendinitis and Tendinosis
When to See a Healthcare Provider
What Causes Rotator Cuff Pain?
The three main causes of rotator cuff pain include:
Rotator Cuff Tendinitis
Rotator cuff tendinitis is most common in young athletes and middle-aged adults. It occurs when a normal, healthy rotator cuff tendon becomes injured or inflamed.
Sports and activities that require a lot of throwing or overhead arm motion often cause tendinitis. Tennis, swimming, baseball, volleyball, and weightlifting are some examples.
Certain chronic diseases are also associated with rotator cuff tendinitis. For example, diabetes and obesity may be risk factors.
Rotator Cuff Tear
A rotator cuff tear occurs when the tendon is torn from the arm bone. These tears are found mainly in middle-aged and older adults.
Obesity and smoking may also increase a person’s chance of tearing their rotator cuff.
Rotator Cuff Tendinosis
Rotator cuff tendinosis is a condition in which the tendons start to weaken and thin out due to aging.This is because, as we get older, there is a decrease in blood supply to the rotator cuff tendons.
As a result, when the tendons become stressed or injured, they do not recover or heal as well. These tendons are then more likely to tear or become inflamed.
Poor posture, smoking, repetitive overhead activity, and genes may also play a role in the development of rotator cuff tendinosis.
Recap
Symptoms can include weakness in the arm and throbbing pain while sleeping. In some cases, however, people with rotator cuff injuries have no symptoms.
Diagnosing Rotator Cuff Pain
At-Home Function Tests
You can perform some tests at home before your appointment if you’d like. Your healthcare provider will most likely repeat these tests during your visit, however, so it’s not necessary.
A few of these tests include:
Empty Can Test
The empty can test is used to check yoursupraspinatus, a muscle located on the upper part of your shoulder. This is a simple test to perform. The motion is the same as if you were dumping out a can of soda. For this one, you will need someone’s help.
If pain or weakness prevents you from keeping your arm in the “empty can” position, you may have a supraspinatus rotator cuff injury.
Lift-Off Test
The lift-off test is a shoulder test to determine if you have a tear in thesubscapularis. This muscle is located on the underside of your shoulder blade. It is responsible for rotating your shoulder inward. To perform the lift-off test:
If you are unable to lift your hand away from your low back, you may have a subscapularis rotator cuff injury.
Resistance Testing
One way of determining if a rotator cuff tear is the cause of your shoulder pain is to performmanual strength testingof your rotator cuff muscles. To do this:
If you are unable to hold this position and if it causes pain, you may have a rotator cuff tear.
Pain-Relief Test
Your doctor injectslidocaine, an anesthetic that numbs the area, into your shoulder joint. If you have rotator cuff tendinitis, the lidocaine will relieve the pain and your muscle strength will remain normal. If you have a rotator cuff tear, the pain will be relieved, but the muscle will remain weak.
Distinguishing between these two conditions is important because they require different treatments.
Imaging
If your provider thinks you might have a rotator cuff tear, they will likely want you to have amagnetic resonance imaging (MRI)test. The MRI is helpful because it can show both complete rotator cuff tears andpartial rotator cuff tears. The MRI can also show evidence of rotator cuff tendinosis,shoulder bursitis, andother common shoulder problems.
Other tests that may be used are anarthrogram(a type of detailed X-ray) and an ultrasound (which uses sound waves to see inside the body).
If a large tear is found, your primary care healthcare provider will refer you to an orthopedic surgeon. Sometimes large tears need surgery to repair them.
RecapDoctors use a variety of tests to diagnose rotator cuff problems. Imaging tests, such as an MRI, are especially important for figuring out the specific cause of your pain.
Doctors use a variety of tests to diagnose rotator cuff problems. Imaging tests, such as an MRI, are especially important for figuring out the specific cause of your pain.
Differential Diagnoses
Not all rotator cuff pain actually means you have an injury to that area. Doctors often want to rule out other possible causes of a person’s symptoms in order to help them make the right diagnosis. This is called adifferential diagnosis.
Some othermusculoskeletalconditions (those that affect the muscles and bones) that may have similar symptoms to a rotator cuff injury include:
These conditions can be distinguished from one another through imaging tests. An X-ray can show signs of osteoarthritis. An MRI can be used to diagnose a labral tear.
Besides musculoskeletal issues, several other health conditions can also cause shoulder pain within the rotator cuff region. These include a heart attack or heart disease,gallbladder disease, or nerve compression in the neck.
Aheart attackis a medical emergency. If you have other symptoms such as chest pain or discomfort, shortness of breath, fatigue, or lightheadedness, or if you think you may be having a heart attack, call 9-1-1 without delay.
To rule out a heart attack, doctors in the emergency room may order a blood test to check your cardiac enzymes. They will also do anelectrocardiogram(ECG or EKG). This measures your heart’s electrical activity.
Gallbladder disease can usually be ruled out with a normal abdominal exam and an ultrasound. An MRI of the neck can help sort out whether acompressed nerve rootis causing shoulder pain.
Treating Rotator Cuff Pain
The treatment of your rotator cuff problem depends on whether or not you have tendinitis, tendinosis, or a tear.
Rotator Cuff Tendinitis and Tendinosis
Avoid using an arm sling. Slings can increase the risk of a frozen shoulder. This is a condition in which pain and stiffness make the shoulder hard to move. It can take months to years to heal.
After about two to three months of the above strategies, most people report an improvement in their pain. However, if pain persists, be sure to talk to your healthcare provider. You may need an MRI to look for a rotator cuff tear.
Small rotator cuff tears are treated the same way as rotator cuff tendinitis. Often, physical therapy and a proper exercise program can improve the function of the shoulder joint to prevent pain that comes from a torn tendon.
However, sometimessurgeryis necessary. Young athletes with rotator cuff injuries often need surgery.
Rotator cuff repair surgery can be done as anopen procedureor a minimally invasivearthroscopicone. Your surgeon will recommend the approach that is best for you. This will depend on the exact location of your rotator cuff damage and how severe it is.
If you have surgery for a rotator cuff tear, you will needphysical therapy for several monthsafterward. This ensures that you heal properly and regain your shoulder function.
When Not to Have Rotator Cuff Surgery
How to Prevent Rotator Cuff Pain
There are a few things you can do to prevent developing a rotator cuff problem in the first place. These self-care strategies include:
Summary
Rotator cuff pain is very common, especially in athletes and as people age. The main causes are tendinitis, tendinosis, and tears in the tendons around the rotator cuff. Some people with these conditions have no symptoms at all.
Fortunately, the majority of people get better using simple measures like avoiding certain activities and going to physical therapy sessions. However, some people with tears in the rotator cuff may need surgery.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopaedic Surgeons.Shoulder impingement/rotator cuff tendinitis.American Academy of Orthopaedic Surgeons.Rotator cuff tears.Factor D, Dale B.Current concepts of rotator cuff tendinopathy.Int J Sports Phys Ther.2014;9(2):274-288.Rechardt M, Shiri R, Karppinen J, Jula A, Heliövaara M, Viikari-Juntura E.Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: a population-based study.BMC Musculoskelet Disord. 2010;11:165. doi:10.1186/1471-2474-11-165Omid R, Lee B.Tendon transfers for irreparable rotator cuff tears.J Am Acad Orthop Surg. 2013;21(8):492-501. doi:10.5435/JAAOS-21-08-492Applegate KA, Thiese MS, Merryweather AS, et al.Association between cardiovascular disease risk factors and rotator cuff tendinopathy: A cross-sectional study.J Occup Environ Med. 2017;59(2):154-160. doi:10.1097/JOM.0000000000000929Kuhn JE.Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol.J Shoulder Elbow Surg.2009;18(1):138-160. doi:10.1016/j.jse.2008.06.004
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopaedic Surgeons.Shoulder impingement/rotator cuff tendinitis.American Academy of Orthopaedic Surgeons.Rotator cuff tears.Factor D, Dale B.Current concepts of rotator cuff tendinopathy.Int J Sports Phys Ther.2014;9(2):274-288.Rechardt M, Shiri R, Karppinen J, Jula A, Heliövaara M, Viikari-Juntura E.Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: a population-based study.BMC Musculoskelet Disord. 2010;11:165. doi:10.1186/1471-2474-11-165Omid R, Lee B.Tendon transfers for irreparable rotator cuff tears.J Am Acad Orthop Surg. 2013;21(8):492-501. doi:10.5435/JAAOS-21-08-492Applegate KA, Thiese MS, Merryweather AS, et al.Association between cardiovascular disease risk factors and rotator cuff tendinopathy: A cross-sectional study.J Occup Environ Med. 2017;59(2):154-160. doi:10.1097/JOM.0000000000000929Kuhn JE.Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol.J Shoulder Elbow Surg.2009;18(1):138-160. doi:10.1016/j.jse.2008.06.004
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Orthopaedic Surgeons.Shoulder impingement/rotator cuff tendinitis.American Academy of Orthopaedic Surgeons.Rotator cuff tears.Factor D, Dale B.Current concepts of rotator cuff tendinopathy.Int J Sports Phys Ther.2014;9(2):274-288.Rechardt M, Shiri R, Karppinen J, Jula A, Heliövaara M, Viikari-Juntura E.Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: a population-based study.BMC Musculoskelet Disord. 2010;11:165. doi:10.1186/1471-2474-11-165Omid R, Lee B.Tendon transfers for irreparable rotator cuff tears.J Am Acad Orthop Surg. 2013;21(8):492-501. doi:10.5435/JAAOS-21-08-492Applegate KA, Thiese MS, Merryweather AS, et al.Association between cardiovascular disease risk factors and rotator cuff tendinopathy: A cross-sectional study.J Occup Environ Med. 2017;59(2):154-160. doi:10.1097/JOM.0000000000000929Kuhn JE.Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol.J Shoulder Elbow Surg.2009;18(1):138-160. doi:10.1016/j.jse.2008.06.004
American Academy of Orthopaedic Surgeons.Shoulder impingement/rotator cuff tendinitis.
American Academy of Orthopaedic Surgeons.Rotator cuff tears.
Factor D, Dale B.Current concepts of rotator cuff tendinopathy.Int J Sports Phys Ther.2014;9(2):274-288.
Rechardt M, Shiri R, Karppinen J, Jula A, Heliövaara M, Viikari-Juntura E.Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: a population-based study.BMC Musculoskelet Disord. 2010;11:165. doi:10.1186/1471-2474-11-165
Omid R, Lee B.Tendon transfers for irreparable rotator cuff tears.J Am Acad Orthop Surg. 2013;21(8):492-501. doi:10.5435/JAAOS-21-08-492
Applegate KA, Thiese MS, Merryweather AS, et al.Association between cardiovascular disease risk factors and rotator cuff tendinopathy: A cross-sectional study.J Occup Environ Med. 2017;59(2):154-160. doi:10.1097/JOM.0000000000000929
Kuhn JE.Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol.J Shoulder Elbow Surg.2009;18(1):138-160. doi:10.1016/j.jse.2008.06.004
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