Medically reviewed by Misty Seidenburg
Every year, an estimated two million people see their healthcare providers because of rotator cuff pain. Rotator cuff injuries are common and can often lead to significant shoulder pain and even disability without treatment.
Shoulder weakness due to rotator cuff tears can make it difficult to do everyday tasks from getting dressed to brushing your teeth. It’s important to listen to your body and know the signs of rotator cuff injuries and seek the proper treatment.
Physical therapy is commonly prescribed for individuals with rotator cuff pain and stiffness. For those with partial or complete rotator cuff tears, physical therapy before and after surgery is recommended to speed healing and improve outcomes.
The shoulder is a ball-and-socket joint made up of three bones: the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle.) The top of the humerus bone sits within a shallow socket (glenoid) in the shoulder blade.
The rotator cuff is the group of muscles and tendons that surround and support the shoulder joint, and keeps the arm in place in the shoulder socket. It also helps lift and rotate the arm. A lubricating sac called a bursa sits between the rotator cuff and the bone on top of the shoulder. This sac allows rotator cuff tendons to glide smoothly and freely as the arm moves.
Most rotator cuff injuries are caused by wear-and-tear from doing the same motions over and over. Reaching the arm over the head is one of the most common. Over time, this repetitive motion causes the structures of the rotator cuff to break down, leading to pain and mobility problems.
In some cases, acute rotator cuff injuries can occur from direct trauma to the body, like a slip and fall accident or a contact sports injury. Injuries can also occur from a single, unnatural movement, like lifting a heavy object up with a jerking motion. Here are three common rotator cuff injuries that cause pain, swelling, and movement problems.
Also known as impingement rotator cuff tendinopathy is pain and swelling of the tendons that connect the muscles to the shoulder bones. As the tendons become pinched during shoulder movement, pain, inflammation, and swelling can occur.
Rotator cuff tendinopathy symptoms include:
Bursitis is swelling of the fluid-filled sac (bursa) that cushions the area between the rotator cuff and the shoulder bone, caused by friction due to too much rubbing. The bursa swells with excess fluid causing symptoms. Pain and swelling are the most common signs of shoulder bursitis. Redness and warmth in the area may indicate an infection and should be checked out immediately.
Rotator cuff tendon tears can happen from a single, sudden event or develop over time due to prolonged wear and tear. A partial rotator cuff tear happens when the tendons become damaged or frayed. A complete tear (also known as a full-thickness tear) occurs when the tendon is completely torn in half or severed from the bone entirely.
Possible signs of a torn rotator cuff include:
If shoulder pain is affecting your daily life and your ability to perform routine tasks, see your healthcare provider and schedule a physical therapy evaluation to determine the cause and the appropriate course of treatment.
While rotator cuff injuries can happen to anyone, some people have a higher risk of injury due to repetitive stress. Individuals who play sports like tennis, pickleball, baseball, and swimming which require repeated shoulder movements are at risk.
For others, their work increases the risk of rotator cuff impingement and tears. Jobs that involve a lot of heavy lifting or reaching overhead can increase wear and tear on the shoulder and connective tissues. Construction workers, carpenters, painters, and healthcare workers, for example, should be proactive about reducing their risk of rotator cuff injuries by staying strong and mobile.
Also, as we age, nearly everyone will experience some level of rotator cuff damage due to normal, age-related wear and tear. Fortunately, it is possible to lower that risk with rotator cuff exercises and stretches to strengthen these muscles of the upper arm, shoulder, and chest.
Tell your physical therapist if you have shoulder pain or any of the other common signs and symptoms of a rotator cuff injury. The first step is a physical exam to examine the shoulder, evaluate your range of motion, and identify the location of your pain.
Your provider also assesses your arm and shoulder strength. X-rays, MRIs, and ultrasounds help them identify and evaluate rotator cuff damage. In some states, physical therapists are authorized to order these imaging tests. In other states, another healthcare provider can refer you for diagnostic testing.
The goal of treatment for rotator cuff injuries is to reduce pain and improve your mobility. There are several options to achieve these goals. The right plan for you depends on your symptoms, age, and lifestyle.
Patients can try the P.E.A.C.E. and L.O.V.E. protocol for treating soft-tissue injuries at home. If symptoms don’t improve within a few days, a referral to physical therapy may be the next step.
Physical therapy is safe and effective for treating shoulder tendinopathy and bursitis, and in some cases, tears as well. In fact, 80-85% of patients achieve pain relief and improved shoulder function without surgery, according to the American Academy of Orthopaedic Surgeons (AAOS.)
Physical therapy utilizes targeted rotator cuff stretches and exercises to improve flexibility and range of motion and restore movement and strength in the shoulder. Many patients notice a significant reduction in pain as the shoulder becomes stronger.
A rotator cuff injury treatment plan may also include other evidence-based healing modalities to provide immediate relief from pain and stiffness. Ask your physical therapist about the benefits of hands-on massage, instrument-assisted soft tissue mobilization (IASTM), cold therapy, and dry needling, and other therapies to break up adhesions and release tight trigger points that contribute to shoulder pain.
Every year more than half a million people have surgery to repair severe rotator cuff tears. Rotator cuff surgery may be necessary for individuals with large tears, and for those whose symptoms don’t improve after 6-12 months with physical therapy and other noninvasive treatments.
Physical therapy is beneficial for patients prior to and after surgery. The “better in better out” approach to perioperative care says that the stronger and healthier the body is prior to surgery, the better the patient’s rehabilitation will be. By improving your overall strength and fitness before your procedure, you can help to avoid complications and shorten your recovery to feel better sooner.
Physical therapy also helps with rotator cuff surgery recovery by strengthening the affected muscles, keeping scar tissue smooth and pliable near the injury, and increasing mobility and flexibility. Safe, supervised movement also increases blood flow to the area to promote tissue healing.
If you ignore rotator cuff symptoms, your condition can worsen significantly over time, leading to severe disability. Nonsurgical treatment may be an option for you. To schedule a shoulder pain evaluation and take the first step to becoming pain-free, find a physical therapy clinic near you.