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Rotator cuff injuries often caused by overuse.

Most of us have injured our shoulder at some time. The most common causes of shoulder pain are injuries to the rotator cuff.

Rotator cuff

Most people have heard of sudden rotator cuff injuries in athletes during a competitive event.

Most rotator cuff injuries, however, occur in people over age 40 because of chronic overuse of the shoulder. Manual labourers, people who work with their arms overhead (e.g., painters, drywallers), swimmers or people playing racquet sports are more likely to get chronic rotator cuff injuries.

The shoulder is designed to move in every direction. The rotator cuff refers to four muscles that hold the arm bone (humerus) to the shoulder. The rotator cuff muscles help keep the flexible shoulder joint stable and provide strength to lift up your arm.

The rotator cuff muscle can be torn when the muscle is stretched beyond its ability. This often occurs as a person falls on an outstretched arm or when a person lifts or catches a heavy object.

Partial muscle tears usually heal over time, but full muscle tears may require surgery to repair.

Sudden rotator cuff muscle tears need to be seen by a doctor immediately for proper management.

Often the arm is put in a sling, pain medications are given, and within a week or two a specialist (e.g., orthopedic surgeon) evaluates whether surgical repair is necessary.


Muscles are attached to bones with tough tissue called tendon. The rotator cuff tendons can get irritated, swollen and tender when they are injured or overused. This is called tendonitis.

People who get rotator cuff tendonitis are usually between 20 and 40 years of age and complain of a deep aching pain in the shoulder. The pain can interfere with sleep, work or regular daily activities. It is often worse when the arm is above the head or if a person lies on the injured shoulder.

A shoulder with tendonitis should not be kept immobile. As with muscle tears, restricted activity can lead to a weaker, less mobile shoulder. Pain medications such as antiinflammatories work well for these injuries. Ice packs can give some pain relief initially. Later, heat packs can help relax the muscles and reduce pain. Physiotherapy is usually helpful to strengthen the arm and ensure it stays mobile in rotator cuff tears or tendonitis.


Sometimes the rotator cuff tendons can be pinched in a narrow part of the shoulder joint. The pinched tendons become irritated and painful, especially with movements above the head.

These injuries are really a type of tendonitis that is also called impingement syndrome. Most doctors suggest that impingement should be treated by avoiding the painful activities, while also keeping the shoulder flexible. This is done by doing "range of motion" exercises.

One such exercise is called the pendulum. A person bends forward at the waist and gently swings the arm of the injured shoulder in large looping movements, stopping as needed when pain occurs. This works best after applying heat to the shoulder or when you are in a hot shower. Impingement that doesn't heal may sometimes be treated with steroid injections into the joint or even with surgery.

Your family doctor is key to identifying the type of injury and ensuring you get the right kind of treatment.

This column is for reference and education only and is not intended to be a substitute for the advice of an appropriate health care professional. The author assumes no responsibility or liability arising from arty outdated information, errors, omissions, claims, demands, damages, actions, or causes of actions from the use of any of the above.

Dr. Pinette is a Metis family physician in Manitoba. Contact him at
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Publication:Ontario Birchbark
Date:Jan 1, 2004
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