Jul 29

Rotator Cuff Injuries: Causes, Prevention, and Treatment

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As I did a search on Rotator Cuff injuries, I was amazed at the common occurrence in so many sports – for example, swimming, volleyball, baseball, basketball, tennis, and golf. According to research, two major reasons in sport activities lead to the inflammation or impingement: Overuse and Incorrect technique.

The Rotator Cuff

Four tendons attach muscles from the shoulder blade and ribs to the upper arm bone (humerus). Since these tendons help to rotate the arm within its socket this sleeve of tendons is called the Rotator Cuff.

Tendons in the Rotator Cuff can be injured easily because they move within a tight space. When the shoulder is turned or lifted at the limit of its natural range of movement, the tendons in this tight space are moved too. Occasionally, the Rotator Cuff tendons can bump or rub against a bony knob (acromion) above them or against a ligament at the front of the shoulder. This friction is known as impingement syndrome and causes inflammation in the Rotator Cuff. It is most likely to cause inflammation if the shoulder movement is rough and/or repetitive.

Inflammation can lead to three problems:

Rotator Cuff Tendonitis – Inflammation of a single tendon causes pain only during specific movements, when the muscle that pulls against that tendon is being used or when you are reaching upwards.

Shoulder bursitis, also called subacromial bursitis – Bursitis occurs when inflammation spreads into the pocket of fluid that lubricates the rotator cuff tendons. Pain is often worse at night and occurs when you move your shoulder in almost any direction, particularly if you are reaching upwards.

Rotator Cuff tear – The tendon may tear after it has been weakened by inflammation.

Several types of shoulder use can trigger Rotator Cuff injury outside the sports scenario, which people may not be familiar with. The information here may be helpful to you as coaches or staff members.

Push-off with Arms

  • People with weak quadriceps muscles in the thighs often compensate by pushing off with the arms when rising from sitting position. During the push-off, the shoulder’s socket and humerus function like an upside-down mortar and pestle, crushing and grinding the Rotator Cuff tendons.
  • Events such as head-on automobile accidents, house painting, filing, building construction, and auto mechanic work can cause Rotator Cuff problems.
  • Abrupt movements, such as pulling to start a lawn mower, can tear a weakened tendon. The shoulder is not built for this use.
  • Falls onto an outstretched arm, head-on automobile accidents may cause the injuries.
  • Elderly people are prone to these problems and have a more difficult time recovering due to the shoulders having a less robust blood supply.


  • Sports collisions can crush the tendons.
  • Push-ups (used in training) and other activities can cause injury of the Rotator Cuff.
  • Repetitive Reaching – Over-head arm positions narrow the tight space that the Rotator Cuff tendons must pass through. Many sports skills depend on repetitive reaching in training. Therefore athletes experience the over-use syndrome in training.
  • Forceful or Abrupt Over-head Arm Movements – Tears are particularly common in athletes in throwing sports, racquet sports, swimming, and wrestling (some examples). In addition, the shoulder can be injured more easily if it is ‘out of shape.’ The narrow space that envelops the Rotator Cuff tendons becomes even narrower if the shoulder muscles are weakened or tight. When this happens, routine shoulder movements are more likely to cause tendon friction.


Rotator Cuff tears that affect a significant portion of the tendon cause weakness of the shoulder and pain in the shoulder and upper arm, limiting the ability to hold the arm out to one side, to lift an object, or to reach up or out. When turning the arm in lifting, the tendons are more likely to rub against surrounding structures. For this reason, the shoulder symptoms may be worse when trying to comb the hair or slip the arm into a sleeve. One may also experience a dull and aching shoulder pain at night. However, difficulty in using the shoulder because of pain does not always mean that there is a tear.


A Rotator Cuff injury is usually diagnosed by physical examination. The doctor rotates the arm at the shoulder and then raises the arm. If this type of motion causes pain, the Rotator Cuff may be inflamed.

If the athlete has noticeable weakness, further testing to check for a tear is needed. The doctor may inject a numbing medicine into the shoulder to help distinguish actual weakness of the tendon from the muscle ‘giving way’ because of pain.

If a tear is suspected, a magnetic resonance imaging (MRI) scan can confirm the diagnosis. An alternative method is the shoulder arthrogram, which is a diagnostic test without putting a needle into the joint. Although this method is performed less frequently today.

Expected Duration

Without proper treatment, symptoms of a Rotator Cuff injury or tear can persist for months or years, and usually become worse over time. Most rotator cuff injuries respond to treatment within four to six weeks, especially if an injection is part of the treatment. It is important protocol to have 100% medical clearance before resuming the activity and training. Frequently, injured athletes return too early because of ‘feeling isolated’ from team members or due to coaching pressure.


In many cases, Rotator Cuff injuries can be avoided. Here are some recommendations.


  • Avoid reaching over the head repeatedly – use a step stool or ladder during projects.
  • Avoid using the arms to push off from a chair.
  • For people in poor physical shape or with arthritis in the knees, incorporate exercises to strengthen the quadriceps muscles in the thighs, so that it is not necessary to use the arms to get up from sitting.
  • Elderly people, who are dependent on their arms to rise out of a chair can raise the seat of their favourite chair with a thick, folded blanket or a short platform to make it easier to get up.


  • Exercises that strengthen the Rotator Cuff muscles are an important part of prevention and should be included in the training program.
  • Physical therapy that strengthens the Rotator Cuff muscles can make the shoulder less vulnerable to injury.


  • Tendonitis, bursitis, and small Rotator Cuff tears in the shoulder can be treated effectively with an injection of a corticosteroid medicine followed by physical therapy exercises to restore shoulder movement and strengthen the Rotator Cuff muscles.
  • If the doctor determines calcific tendonitis (calcium deposits), other treatments may be helpful.
  • There is some evidence that treatment of the shoulder with ultrasound or a procedure called lithotripsy, which uses powerful ultrasound waves known as shock waves, may help to break up calcium deposits and speed healing.
  • Surgery may be necessary for frequently recurring rotator cuff injuries or large tears in a rotator cuff tendon. Either arthroscopy (camera-assisted surgery) or traditional open surgery can be used.

Call A Professional

A doctor should evaluate shoulder symptoms that last for more than one week.


People with a Rotator Cuff injury typically recover well with treatment. However, it is common to injure the same shoulder again, especially if the athlete does not change the way the shoulder is used.


I (Coach Monika) have trained athletes in 3 sports from Beginner to Olympic level: Gymnastics, Swimming, and Athletics (track & field). It was not ‘luck’ that I did not have a single athlete in these sports suffer a Rotator Cuff injury throughout my entire career! It was my preventive design with corrective exercises in the daily training regime, proper and correct Warm-up and Cool-down exercises with sufficient time allotted to the process, and ‘being a known stickler’ for correct training technique.

Rotator Cuff diagram

Rotator Cuff tear diagram










Additional Information

National Institute of Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse

National Rehabilitation Information Center (NARIC)

American Academy of Orthopaedic Surgeons (AAOS)

National Athletic Trainers’ Association
National Athletic Trainers’ Association

American Orthopedic Society for Sports Medicine

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