Common Causes of Rotator Cuff Pain (and How to Help Your Shoulder Feel Better)

Rotator cuff pain is among the most common shoulder complaints. In fact, nearly two million people see their doctors every year because of rotator cuff injuries, according to the American Academy of Orthopaedic Surgeons.

Everyday activities like washing your hair or putting away groceries can be made difficult by rotator cuff pain. Many cases of rotator cuff injuries can be treated or even prevented.

Keep reading to learn about the conditions that cause pain in the rotator cuff, how this type of injury is diagnosed and treated, and how you can prevent future damage to your shoulder.

What Is a Rotator Cuff?

The shoulder joint is made up of a ball and a socket surrounded by muscles and tendons called the rotator cuff. The four muscles that comprise the rotator cuff form a covering around the humerus and attach it to your shoulder blade.  (Fig. 1)

The bursa sac—found between the rotator cuff and acromion bone—allows the rotator cuff tendons to glide smoothly when you raise or rotate your arm.

Common Causes of Rotator Cuff Pain

There are many different causes of shoulder pain, but when it comes to the rotator cuff, there are two main culprits: 

• Acute Shoulder Injuries
• Repetitive or Degenerative Shoulder Wear and Tear

An acute injury is an event that happens suddenly, like a fall with your arms outstretched or lifting something too heavy. But the most common rotator cuff injuries are related to the gradual degeneration of the rotator cuff tendons that can happen with age and specific activities.

Over time, the tendons can become inflamed, causing rotator cuff tendinitis or shoulder impingement syndrome. The bursa sac can also become inflamed, causing a condition called bursitis. 

Types of Rotator Cuff Tears

Rotator cuff tears typically occur where the tendons attach to the bone. A tear is most likely to happen in your dominant arm (the one you use most). 

There are two different types of rotator cuff tears:

• Partial Rotator Cuff Tear
• Full-Thickness Rotator Cuff Tear

Partial Rotator Cuff Tear

With a partial tear, the tendon doesn’t completely detach from the bone. The tendon is partially torn or thinned but still attached to the bone.

Full-Thickness Rotator Cuff Tear

With a full-thickness tear, a part of the tendon completely detaches from the bone.

A massive rotator cuff injury is a large, full-thickness tear involving multiple tendons. This condition happens when tendons pulling far away from the bone due to retraction. These tears require urgent surgical treatment since they can be difficult to repair if tendons remain retracted for a long time.

Learn more about rotator cuff tears

Symptoms of a Rotator Cuff Injury

Depending on the type and severity of your injury, rotator cuff pain can come on suddenly or gradually get worse over time. The most common rotator cuff tear symptoms include:

• Dull ache in your shoulder or on the outside of your upper arm
• Rotator cuff pain that gets worse at night
• Shoulder pain that worsens when you raise your arms or put them behind your back 
• Stiffness in your shoulder joint (learn how it differs from frozen shoulder)
• Weakness in your shoulder joint
• Grinding sensation when rotating your shoulder

Who Is Most at Risk?

Rotator cuff injuries can happen to anyone, but some people are more likely to get injured than others. Risk factors include:

Age

There is an increased risk of rotator cuff tears in people over 40 years old, meaning your risk for this type of injury grows as you age.

Occupation

Occupational activities that require repetitive lifting or overhead arm motions for an extended period, such as painting and construction, can end up causing permanent damage to your rotator cuff over a period of time.

Sports

Rotator cuff tears are one of the more common sports injuries that athletes suffer, particularly those involved in baseball, tennis, or weightlifting.

Genetics

Patients with a family history of rotator cuff injuries might be more prone to sustaining the same type of injury.

How Is Rotator Cuff Pain Diagnosed?

Seeing a doctor for shoulder pain can help you understand the type of injury you’re dealing with and what can be done about it. They will examine your shoulder and may do an X-ray or MRI to look for signs of spurs, arthritis, or tears in the rotator cuff tendons. 

The questions a shoulder specialist might ask during your visit can include:

• Where is your pain located?
• When did the pain first start?
• Has the pain gotten any worse recently?
• Are you taking any medication for the pain?
• How much (and how often) do you exercise?
• Have you had any tests done previously to evaluate your pain?
• How bad is your shoulder pain on a scale of one to ten?

Rotator Cuff Tear Treatment

Conservative treatments—like rest and avoiding the activities that cause pain—are typically the first option for most rotator cuff injuries. Medications or injections may also be used for rotator cuff pain reduction. 

Your doctor may also prescribe stretches or occupational therapy for shoulder pain relief and to improve your flexibility. 

These non-operative therapies alone are enough to treat rotator cuff injuries in many cases. However, if you still have rotator cuff pain after trying these treatments, your shoulder specialist may recommend surgery.

Rotator Cuff Surgery

Surgical repair is sometimes recommended, especially when there is a large or complete tear, significant weakness, or persistent symptoms.

To relieve rotator cuff pain, the surgeon will open up the space through which the rotator cuff moves and remove any spurs or thickened bursa. If there is arthritis in the joint above the shoulder (or the AC joint), they may also remove a small section at the end of the collarbone.

This procedure can be done arthroscopically, a less invasive surgical method involving a small incision and a tiny camera called an arthroscope. Arthroscopic surgery can reduce recovery time and get you back to full activity sooner. 

How to Prevent Rotator Cuff Injuries

Your shoulders have more range of motion than any other joint in the body. The rotator cuff muscles are constantly working to stabilize your shoulder and allow you to move your arms easily. You can reduce your chances of a rotator cuff injury by strengthening and stretching those muscles.

A shoulder specialist can recommend exercises to keep your shoulders in good shape so that you can remain healthy and active.

Take the Shoulder Pain Quiz 

Dealing with rotator cuff pain? The specialists at Indiana Hand to Shoulder Center have you covered. 

Download our simple at-home quiz to assess your shoulder pain and jumpstart the diagnosis process. You can share what you learn with your provider at your initial appointment.

Get the Assessment

You might also like:

• Shoulder Impingement and Rotator Cuff Problems
• Neck, Shoulder, Arm, and Hand Flexibility Exercises
• Experiencing Pain When Moving Your Dominant Arm? It Could Be a Rotator Cuff Tear