Rotator Cuff Pain – Overview and More


Rotator cuff pain is usually caused by an inflammation of the tendon (tendonitis) or a ruptured tendon. The quality of pain can range from a dull, aching ache to a sharp pain that spreads up the forearm when spreading over the head or when sleeping on the affected side. Interestingly, the intensity of the pain does not necessarily correlate with the severity of the injury. Less commonly, rotator cuff pain can be the result of a condition called rotator cuff tendinosis, in which the tendons wear out or wear out as a result of aging and overuse.

The rotator cuff is made up of four muscles (supraspinatus, infraspinatus, minor circular, and subscapularis) that surround your scapula and attach to your shoulder (humerus) through its own tendon. These four tendons converge to form a "sleeve" or the overlying head of the humerus, allowing the arm to be lifted and rotated. Problems with any of these can cause rotator cuff pain.

Illustration by Alexandra Gordon, Get Meds Info

Symptoms of rotator cuff pain

Sharp or aching pain and swelling due to rotator cuff tendonitis or tear is usually localized to the front or side of the upper arm and upper arm. People often report having a hard time doing things like brushing their hair, fastening a bra behind their back, grabbing them from behind, or sleeping on an affected shoulder. Shooting pain at night is also common in people with rotator cuff tendonitis or tear. Some people wake up with shoulder pain.

Also, tendonitis or torn rotator cuff pain is often felt higher up the arm from the shoulder. This is due to the location of the nerves that run through the deepest parts of the shoulder .

In particular, strength deficits are very common with rotator cuff tears. For example, many people find it difficult to put dishes in the upper cabinets or climb into the refrigerator to pick up a carton of milk.

For both tendinitis and rotator cuff tear, people often experience shoulder pain that worsens with activities such as an overhead blow or throw.

Note that some people with rotator cuff tears experience no pain, and the severity of the tear (partial or complete) does not correlate with pain. In other words, a person with a partial tear may report severe pain, while a person with a complete tear may report no pain at all.

Like a rotator cuff tear, rotator cuff tendinosis is not always painful, especially early in the disease. If there is pain, it is often described as a dull, aching ache that worsens at night and with certain movements of the shoulders, such as when stretching the arm behind the back or behind the back .

When to contact a healthcare provider

Also seek medical attention if shoulder pain is associated with other unusual symptoms, such as shortness of breath, dizziness, or abdominal pain.

Other signs that warrant a visit to your doctor include:

  • Inability to raise an arm above the head or carry objects.
  • Any injury or trauma to the shoulder, especially if there is a deformation of the joint.
  • Persistent or worsening shoulder pain

Any severe shoulder pain and / or pain that comes on suddenly requires medical attention, as does any significant swelling or bruising around the shoulder joint or signs of infection such as redness and warmth.


Rotator cuff problems can be expected for those who regularly perform repetitive arm movements, such as baseball pitchers, but may come as a surprise to many others who also find these problems common.

Rotator cuff tendonitis

Rotator cuff tendonitis is more common in young athletes and middle-aged people. It occurs when the normal, healthy rotator cuff tendon becomes injured or inflamed, often as a result of repetitive overhead activity (such as painting, tennis, swimming, baseball, volleyball, or weight lifting). weights) .

Some chronic conditions are also associated with rotator cuff tendonitis. For example, diabetes and obesity can be a risk factor .

Rotator cuff tear

Rotator cuff tear (when a tendon breaks the bone in the arm) occurs mainly in middle-aged and older people. A tear can be caused by a shoulder injury (for example, a fall directly on the shoulder or a direct blow to the shoulder) or a chronic overextension of the rotator cuff muscles.

Obesity and smoking can also increase the chance of a rotator cuff tear .

Rotator cuff tendinosis

Rotator cuff tendinosis, a condition in which degeneration of the rotator cuff tendon occurs, occurs as a result of aging because the blood supply to the rotator cuff tendons decreases with age. As a result, when the tendons are stressed or traumatized, they also do not repair or heal. These weakened or worn tendons are more vulnerable to inflammation and tears.

Poor posture, smoking, repetitive activity overhead, and genes can also influence the development of rotator cuff tendinosis .


If, after reviewing your medical history, your healthcare provider suspects a rotator cuff problem, they will perform a series of tests to evaluate the rotator cuff tendons. They will then order pictures of your shoulder if a rotator cuff tear is suspected.

Functional tests at home

Various tests are used to evaluate the rotator cuff, some of which can be done at home before your visit. But if you feel uncomfortable, that's fine. Your healthcare provider will repeat these tests during your visit.

Some of these home tests include:

Empty bottle test

The empty bottle test is used to assess the condition of the supraspinatus muscle located at the top of the shoulder. This is a simple test to perform and its movement simulates an overturned soda can.

  • Sit or stand comfortably in the presence of a friend.
  • Raise the affected arm to the side so that it is parallel to the ground.
  • Extend your arm forward 30 to 45 degrees.
  • Rotate your hand so that your thumb is pointing toward the ground (as if you are trying to empty a soda can).
  • Ask a friend to gently push your hand down.

If pain or weakness prevents you from holding your arm in the empty can position, you may have a supraspinatus rotator cuff injury. If so, see your doctor to confirm the diagnosis.

Peel test

A tear test is a test on your shoulder to determine if you have a tear in the subscapularis muscle . This muscle is located at the bottom of the shoulder blade and is responsible for turning the shoulder inward. To complete the extraction test:

  • Stand up and place the back of your hand on your lower back.
  • Rotate your palm with your palm away from your back.
  • Try to move your hand away from your body.

If you cannot lift your lower back arm, you suspect it could be a rotator cuff injury to the subscapularis muscle.

Resistance test

One way to determine if a rotator cuff tear is causing shoulder pain is to perform a manual force test on the rotator cuff muscles. To do this, follow a simple procedure:

  • Sit comfortably in a chair.
  • Bend your elbow 90 degrees and bring your elbow toward you.
  • Have someone push your hand toward your belly.

If you can't hold this position and are in pain, you may have a rotator cuff tear.

Pain relief test

Some healthcare professionals (primarily orthopedic surgeons or sports medicine professionals) sometimes use a lidocaine injection test to distinguish rotator cuff tendonitis from a tear. It is important to distinguish between these two conditions because they affect the overall treatment plan.

During this test, lidocaine is injected into the shoulder joint. If a person has rotator cuff tendonitis, lidocaine will relieve pain and muscle strength will remain normal. If a person has a torn rotator cuff, the pain will decrease, but the muscle will remain weak.


If a rotator cuff tear is suspected, an imaging test will be ordered. Magnetic resonance imaging (MRI) is most often used to diagnose a rotator cuff tear, but arthrograms and ultrasounds can also be used. MRI is helpful because it can show complete rotator cuff tears and partial rotator cuff tears. An MRI can also show signs of rotator cuff tendinosis , shoulder bursitis, and other common shoulder problems .

If a large tear is found, your healthcare provider will refer you to an orthopedic surgeon as you may need surgery.

Differential diagnosis

It is important to understand that rotator cuff pain cannot actually be attributed to rotator cuff damage. Some other conditions that can mimic a rotator cuff injury include:

The good news is that these other conditions can be distinguished from each other using imaging tests; For example, an X-ray can show signs of osteoarthritis and an MRI can be used to diagnose a broken lip.

In addition to musculoskeletal problems, some other conditions can also cause shoulder pain in the rotator cuff area, such as a heart attack or heart disease, gallbladder disease , or compression of a nerve in the neck.

When it comes to ruling out a heart attack , which is a medical emergency, in addition to a brief medical history and physical exam, your healthcare provider may order heart enzymes (blood tests) and an EKG. Gallbladder disease can usually be ruled out with routine abdominal and ultrasound examinations. An MRI of the neck can help determine if a pinched nerve root is causing shoulder pain.

In the end, there is a big difference to shoulder pain, which is why it is important not to self-diagnose, but to see a doctor for a full examination.

Watch out

Treatment for a rotator cuff problem depends on whether you have tendinitis, tendinosis, or a tear, and the severity of the tear.

Rotator cuff tendonitis and tendonitis

Treatment of rotator cuff tendonitis and tendinosis is usually straightforward and involves six main strategies :

  • Avoid activities that make pain worse, such as holding on to the head or behind the back.
  • Keep your arm down in front of and close to your body (avoid bandaging your arm as you risk freezing your shoulder )
  • Ice to reduce the initial inflammation of tendonitis (apply a cold pack to the shoulder for 15 to 20 minutes every four to six hours)
  • Take anti-inflammatory drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs).
  • Apply heat and a light massage to the shoulders before home exercises or physical therapy sessions.
  • Consult a physical therapist about stretching and range of motion exercises .

After two to three months of using the above strategies, most people report pain relief. However, if the pain persists, be sure to speak with your doctor. You may need an MRI to look for a rotator cuff tear.

Rotator cuff tear

The good news is that not all rotator cuff tears require surgery . In fact, small rotator cuff tears are treated in the same way as rotator cuff tendonitis. However, when surgery is the best treatment, it is often better to start sooner rather than later, as the rotator cuff muscle can weaken (atrophy) and retract (pull back) over time. This can make recovery less successful or even impossible. Therefore, it is recommended that you discuss your treatment options with your orthopedic surgeon as soon as possible.

For people choosing non-surgical treatments, there are several ways to relieve shoulder pain caused by a rotator cuff tear. Often with physical therapy and the right exercise program, people can improve shoulder function to prevent pain caused by a rotator cuff tendon tear .


There are several things you can do to prevent a rotator cuff problem from developing. These self-help strategies include:

  • Warm up before training
  • Learn to lift weights correctly (for example, using your legs and keeping your back straight)
  • Perform shoulder stretching and strengthening exercises, such as those recommended by the American Academy of Orthopedic Surgeons.
  • Practice correct posture
  • Give up smoking
  • Maintain a healthy body weight

Get the word of drug information

Rotator cuff problems are common, especially with age. In fact, rotator cuff tears end as expected, even in people who have little to no shoulder pain.

The good news is that, often through simple measures like avoiding certain activities and physical therapy, most people get better.

Frequently asked questions

  • Baseball , tennis , rowing, weight lifting, basketball, golf, and swimming are most commonly associated with rotator cuff tendonitis and other wear-related injuries. Sports that pose a high risk of rotator cuff injury from falls or collisions include soccer , lacrosse, and ice hockey.

  • Most rotator cuff tears are unlikely to get better without repair. Pain relievers and physical therapy can relieve pain and some loss of movement, but only surgery can restore range of motion.

  • It is generally accepted that sleeping on one side can exacerbate or intensify rotator cuff pain on that side. However, studies have shown that this is not the case: in one study, sleeping on your side was not associated with shoulder pain and sleeping on your back or stomach with your arms bent in a T-shape.

  • At first, you will most likely feel pain when you raise your arms above your head, for example to dry your hair. The pain can get worse over time. This is especially common at night and can even wake you up.

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