Rotator cuff injuries classically present with pain around the lateral aspect of the shoulder that can get worse with activity. Sometimes this pain may radiate to the elbow. The pain may be worse at night and can cause difficulty sleeping. These symptoms occur due to inflammation around the shoulder that accompanies a torn rotator cuff. Some patients may have limitations with range of motion of the shoulder. Certain activities may be difficult and can increase pain in the shoulder, such as lying on the injured shoulder, carrying an object, or simply lifting the affected arm. Weakness is also common and can limit the ability to feel comfortable performing these activities.

Rotator cuff injuries occur most commonly in people over the age of 40 and the risk increases as we age. Athletes who compete in certain sports with repetitive overhead motions, such as baseball pitchers, tennis players and swimmers, are more likely to develop a rotator cuff injury.

The rotator cuff can get injures in various ways. The main mechanisms include:
1. Acute injury – Results from a sudden event during a sport, a fall, or a traumatic incident, such as a motor vehicle accident. With an acute injury, you will notice an immediate onset of pain and loss of function that wasn’t present prior to the injury.
2. Chronic overuse – Occurs due to repetitive motions that damage the rotator cuff tendons over time. Examples include certain sports activities, such as throwing a baseball, swinging/serving a tennis racquet, and swimming, or work-related activities such as lifting heavy objects or working overhead.
3. Degeneration – Degenerative changes and tears of the rotator cuff tendons occur as we age. This is a natural consequence of normal wear and tear. Some people with these types of injuries can compensate for the changes and may not have any symptoms related to the pathology.

Rotator cuff injuries can be diagnosed with findings from a clinical examination and imaging techniques. Physical examination of the affected shoulder may reveal physical deformities, abnormal weakness, or muscle wasting. Changes to passive and active range of motion, as well as strength of the affected shoulder may be present on exam. Special physical examination tests can help determine which parts of the rotator cuff are affected as well as the severity of the injury.
If necessary, muscle and tendon damage can be further examined through multiple imaging techniques, including X-rays, ultrasound, and magnetic resonance imaging (MRI) of the affected shoulder.

Rotator cuff injuries do not always require surgical treatment. Various factors contribute to the success of non-surgical options, including the patient’s level of physical activity, type of rotator cuff injury, and tear size. Non-surgical treatment often involves rest, activity modification, inflammation control, ice/heat, and physical therapy to provide pain relief and improve physical function. Injection therapy may also play a role in certain types of injury.
Surgical treatment to address the tear may be indicated if non-surgical treatment options fail to improve the symptoms. Arthroscopic rotator cuff repair is a commonly used minimally invasive surgical procedure. The torn rotator cuff is repaired surgical with the help of a small camera. The camera is inserted through a series of small incisions around the shoulder allowing for visualization and assessment of the damaged area. The other incisions allow for several small instruments to access the shoulder and repair the injury. Minimally invasive arthroscopic surgery has the advantage of reduced post operative pain and quicker return to sports and activity compared to an open repair of the tear.