Prevention
Avoid repetitive overhead movements. Exercises to strengthen shoulder and arm muscles can also help prevent rotator cuff problems. Practice good posture to keep your rotator cuff tendons and muscles in their right positions.
Causes
The shoulder joint is a ball and socket type joint. The top part of the arm bone forms a joint with the shoulder blade. The rotator cuff holds the head of the arm bone into the shoulder blade. It also controls movement of the shoulder joint.
The tendons of the rotator cuff pass underneath a bony area on their way to attaching the top part of the arm bone. When these tendons become inflamed, they can become frayed over this area during shoulder movements. Sometimes, a bone spur narrows the space even more.
Rotator cuff tendinitis is also called impingement syndrome.
Causes of this condition include:
- Keeping the arm in the same position for long periods, such as doing computer work or hairstyling
- Sleeping on the same arm each night
- Playing sports requiring the arm to be moved overhead repeatedly such as in tennis, baseball (particularly pitching), swimming, and lifting weights overhead
- Working with the arm overhead for many hours or days, such as in painting and carpentry
- Poor posture over many years
- Aging
- Rotator cuff tears
Symptoms
Early on, pain is mild and occurs with overhead activities and lifting your arm to the side. Activities include brushing your hair, reaching for objects on shelves, or playing an overhead sport.
Pain is more likely in the front of the shoulder and may travel to the side of the arm. The pain always stops before the elbow. If the pain goes down the arm to the elbow and hand, this may indicate a pinched nerve in the neck.
There may also be pain when you lower the shoulder from a raised position.
Over time, there may be pain at rest or at night, such as when lying on the affected shoulder. You may have weakness and loss of motion when raising the arm above your head. Your shoulder can feel stiff with lifting or movement. It may become more difficult to place the arm behind your back.
Diagnosis
A physical examination may reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. There is usually weakness of the shoulder when it is placed in certain positions.
X-rays of the shoulder may show a bone spur or change in the position of the shoulder.
Your doctor may order other tests:
- An ultrasound test uses sound waves to create an image of the shoulder joint. It can show a tear in the rotator cuff.
- MRI of the shoulder may show swelling or a tear in the rotator cuff.
- With a joint x-ray (arthrogram), the doctor injects contrast material (dye) into the shoulder joint. Then an x-ray, CT scan, or MRI scan is used to take a picture of it. Contrast is usually used when your doctor suspects a small rotator cuff tear.
Treatment
Your doctor will likely advise you to rest your shoulder and avoid activities that cause pain.
Other measures include:
- Ice packs applied 20 minutes at a time, 3 to 4 times a day to the shoulder (protect the skin by wrapping the ice pack in a clean towel before applying)
- Taking medicines, such as ibuprofen and naproxen, to help reduce swelling and pain
- Avoiding or reducing activities that cause or worsen your symptoms
- Physical therapy to stretch and strengthen the shoulder muscles
- Medicine injected into the shoulder to reduce pain and swelling
- Surgery to remove inflamed tissue and part of the bone over the rotator cuff to relieve pressure on the tendons
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