A rotator cuff strain is an injury to one or more of the rotator cuff muscles or tendons in the shoulder. It commonly occurs in throwing and racket sports and can range from mild to severe. In more severe cases, this may involve a partial or complete tear.
Symptoms
Symptoms of a rotator cuff strain may include:
- Sudden shoulder pain at the time of injury
- Pain when lifting the arm or reaching overhead
- Weakness in the shoulder
- Pain that may radiate down the arm
- A snapping or popping sound at the time of injury
- Difficulty sleeping on the affected shoulder
- Signs of shoulder impingement, especially with overhead movement
Read more on the diagnosis
When should I see a doctor?
- Seek medical attention if your pain persists for more than 2-3 days.
- You are unable to work due to the pain
- Are unable to reach up or to the side with the affected arm after 2-3 days, or move the shoulder and arm at all.
What is a rotator cuff strain?
A rotator cuff strain is an injury to one of the four rotator cuff muscles or tendons in the shoulder: supraspinatus, infraspinatus, teres minor and subscapularis. These structures work together to provide dynamic stability to the shoulder joint, helping to keep it stable during movement, particularly in overhead throwing and racket sports.
The shoulder joint has a large range of motion compared to the hip and often moves at high speeds. As a result, it is more prone to injury of the muscles and tendons. The supraspinatus and infraspinatus are the most commonly affected rotator cuff muscles, particularly in activities such as cricket bowling, baseball pitching, swimming and kayaking.
What causes a rotator cuff strain?
Rotator cuff injuries are more common in older athletes, particularly those with a history of long-term overuse. This can lead to degeneration of the tendon (wear and tear).
- In throwing sports, injury often occurs during the rapid deceleration of the arm after release, rather than during the acceleration phase.
- This is why it is important to strengthen the muscles at the back of the shoulder, not just the muscles used for throwing.
Treatment for a rotator cuff strain consists of:
Treatment involves reducing pain and inflammation, allowing the tissues to heal, followed by a structured rehabilitation programme. In more severe cases, where a tear is present, recovery may take longer.
What can the athlete do?
Essential first aid for a rotator cuff injury includes rest and applying the PRICE principles: protection, rest, ice, compression and elevation.
Apply ice or a cold therapy compression wrap to reduce pain and swelling. Early use may help limit inflammation and improve comfort.
Apply cold therapy for 10–15 minutes every 1–2 hours initially, reducing frequency as pain improves.
A sling may be useful for more severe injuries. If you need to continue daily activities, it can help support and rest the shoulder, but should be removed at night.
Once the acute stage has settled, gentle mobility and strengthening exercises can begin, provided they are pain-free.
If symptoms persist and the injury becomes more chronic, alternating heat and ice may help. In later stages, heat can be used to relax muscles and improve movement.
- More on rehabilitation
What can a Sports Injury professional do?
A doctor may prescribe pain relief and anti-inflammatory medication for a rotator cuff injury.
Imaging studies such as X-rays, MRIs or CT Scans can confirm the diagnosis and rule out a fracture.
Sometimes you might be referred for a steroid injection directly into the site of injury. This will help reduce any inflammation and allow you to proceed with rehabilitation.
They will prescribe a full rehabilitation program, which should include stretching and strengthening exercises.
Shoulder, including cross-friction massage to the rotator cuff tendon, may be applied, particularly in long-term chronic injuries.
Do I need rotator cuff surgery?
If your injury is quite severe, and you are young and active, then surgery may be indicated to repair the tear. People who are more likely to need surgery include:
- Athletes under 60 years old.
- Patients with complete tears of the rotator cuff tendon or muscle.
- If conservative treatment of rest, ice, exercises, and other treatments is not having the desired effect after 6 weeks
- Professional sportspeople who want the shortcut to making sure the injury heals in the shortest possible time.
- If your job requires constant shoulder use, then surgery for a severe injury may be preferable.
Recovery time for a torn rotator cuff will vary depending on several factors. Conservative treatment has a 40-90% success rate at fixing the problem.
Surgery often has good results, with some studies citing a 94% satisfaction rate with surgery, resulting in lasting pain relief and improved function. However, very extensive tears often have a poor surgical outcome. Age is also a factor. If you are older, it will take longer to heal.
Rehabilitation & exercises
The aim of shoulder rehabilitation exercises is to restore full mobility, improve strength and return the shoulder to full function. First, focus on mobility and stretching. Then progress to strengthening and sport-specific exercises. All exercises should be pain-free.
More on rotator cuff strain
References & further reading
- Namdari S, Baldwin K, Ahn A et al. Performance after rotator cuff tear and operative treatment: a case-control study of major league baseball pitchers. J Athl Train 2011;46(3):296–302.
- Kuhn JE, Dunn WR, Sanders R et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg 2013;22(10):1371–9.
- Ainsworth R, Lewis JS. Exercise therapy for the conservative management of full-thickness tears of the rotator cuff: a systematic review. Br J Sports Med 2007;41(4):200–10.
- Levy O, Mullett H, Roberts S et al. The role of anterior deltoid re-education in patients with massive irreparable degenerative rotator cuff tears. J Shoulder Elbow Surg 2008;17(6):863–70.
