Rotator cuff injury is one possible reason why shoulder pain may linger, worsen at night, or make everyday movements increasingly difficult. Perhaps reaching into a cupboard hurts. Maybe putting on a shirt, lifting a bag, or sleeping on one side has become uncomfortable. While occasional shoulder soreness may improve with rest, persistent pain should not simply be ignored.
The shoulder is one of the most mobile joints in the body. However, that mobility also means several muscles and tendons must work together to keep it stable and functioning properly. When the rotator cuff becomes irritated, strained, or torn, pain and weakness can interfere with both work and everyday activities.
At The Bone & Joint Centre in Kingston, Jamaica, we evaluate and treat a range of shoulder conditions, including rotator cuff problems. Understanding the symptoms can help you recognize when it may be time to have persistent shoulder pain assessed.
What Is a Rotator Cuff Injury?
The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint. Together, they help stabilize the shoulder and allow you to lift and rotate your arm.
A rotator cuff injury can range from irritation or inflammation of the tendons to a partial or complete tear.
According to the American Academy of Orthopaedic Surgeons (AAOS), rotator cuff tears generally develop in two ways. They may occur suddenly because of an injury, or they may develop gradually as the tendon wears down over time.
For example, a sudden fall onto an outstretched arm or an attempt to lift something heavy can injure the rotator cuff. On the other hand, repetitive overhead movement and age-related wear can gradually weaken the tendons.
Therefore, you do not necessarily have to remember a specific injury for a rotator cuff problem to be present.
Common Signs of a Rotator Cuff Injury
Shoulder pain can have many causes. However, certain symptoms are commonly associated with a rotator cuff injury.
These may include:
- A dull or persistent ache in the shoulder
- Pain when lifting your arm overhead
- Pain when lowering the arm
- Shoulder or arm weakness
- Pain that becomes worse at night
- Difficulty sleeping on the affected shoulder
- Difficulty reaching behind your back
- Pain or weakness while lifting objects
- A crackling or popping sensation during certain movements
- Reduced range of motion
In particular, night pain can be an important clue. Some people first realize there may be a problem because they can no longer sleep comfortably on one shoulder.
Additionally, weakness deserves attention. If activities such as combing your hair, getting dressed, reaching into a cupboard, or lifting an everyday object have become difficult, the problem may involve more than simple muscle soreness.
Why Does a Rotator Cuff Injury Happen?
There is no single cause.
Sudden Shoulder Injury
A fall, accident, sports injury, or sudden forceful movement can damage or tear a rotator cuff tendon. In these cases, pain may appear immediately. You may also notice sudden weakness or difficulty raising the arm.
If significant shoulder weakness occurs immediately after an injury, prompt medical assessment is advisable.
Wear and Tear Over Time
Many rotator cuff problems develop gradually.
As we get older, the tendons can become more vulnerable to degeneration. Consequently, an injury may develop without a dramatic accident or obvious moment when something “went wrong.”
The risk generally increases with age. In addition, people who repeatedly perform overhead movements may place greater stress on the rotator cuff.
Repetitive Work or Sports
Certain activities require repeated shoulder movement. For example, painters, carpenters, construction workers, athletes, gardeners and people who regularly lift objects overhead may place additional strain on their shoulders.
Similarly, sports involving repeated throwing, serving, swimming, or overhead movement can stress the rotator cuff.
However, a rotator cuff problem is not limited to athletes or people with physically demanding jobs. It can affect almost anyone.
Rotator Cuff Injury or Just a Sore Shoulder?
This is an important distinction because not every episode of shoulder pain means that you have torn your rotator cuff.
Shoulder pain may also be related to arthritis, bursitis, tendon inflammation, instability, another type of injury, or even a problem originating elsewhere.
Furthermore, some minor shoulder problems improve with rest and activity modification.
Persistent symptoms are different.
Consider seeking an orthopaedic assessment if the pain continues, keeps returning, becomes progressively worse, affects your sleep, or limits your ability to use your arm normally.
You should also seek medical attention after a significant shoulder injury, particularly if you experience immediate weakness or difficulty raising your arm.
Why Rotator Cuff Pain Can Be Worse at Night
One common complaint from people with rotator cuff problems is shoulder pain at night.
The discomfort may become particularly noticeable when lying on the affected side. As a result, someone who manages reasonably well during the day may struggle to find a comfortable sleeping position at night.
Night pain that persists or repeatedly interrupts sleep should not automatically be dismissed as a normal part of getting older.
In fact, the Mayo Clinic identifies disturbed sleep and difficulty performing activities such as reaching behind the back or combing the hair among the symptoms associated with rotator cuff injuries.
How Is a Rotator Cuff Injury Diagnosed?
An accurate diagnosis begins with understanding your symptoms and medical history.
During an orthopaedic examination, your doctor may assess where the shoulder is tender, how far you can move your arm, and how much strength you have during specific movements.
Your doctor may also evaluate whether another condition could be responsible for the pain.
Depending on the findings, imaging may be recommended.
X-rays
X-rays do not show the rotator cuff tendons themselves very well. However, they can help identify other possible causes of shoulder pain, including problems involving the bones or arthritis.
Ultrasound
An ultrasound can provide images of the soft tissues around the shoulder, including the rotator cuff tendons.
MRI
Magnetic resonance imaging, or MRI, provides detailed images of the shoulder’s soft tissues. Therefore, it can help determine whether a rotator cuff tear is present as well as its location and extent.
Your orthopaedic doctor will determine which tests, if any, are appropriate based on your symptoms and examination.
Does a Rotator Cuff Injury Always Require Surgery?
No.
A diagnosis of a rotator cuff injury does not automatically mean surgery.
In fact, many rotator cuff problems can initially be managed without an operation. Treatment depends on several factors, including the type and severity of the injury, your age, activity level, overall health, degree of weakness and how much the condition affects your daily life.
Nonsurgical treatment may include:
- Rest or modification of activities
- Avoiding movements that aggravate the shoulder
- Appropriate pain or anti-inflammatory medication
- Physiotherapy
- Exercises designed to improve movement and strength
- In some cases, an injection to help manage pain and inflammation
Physical therapy can play an important role because carefully selected exercises may help restore movement, flexibility and strength.
However, treatment should be individualized. Exercises that are appropriate for one shoulder condition may not be appropriate for another.
For this reason, avoid trying to diagnose or aggressively rehabilitate persistent shoulder pain solely through online exercises.
When Might Rotator Cuff Surgery Be Considered?
Surgery may be considered when pain or weakness continues despite appropriate nonsurgical treatment. It may also be considered for certain significant tears, particularly when an acute injury has caused substantial weakness or loss of function.
When surgery is appropriate, the goal is generally to repair the damaged tendon and restore shoulder function.
Some rotator cuff repairs can be performed using arthroscopic shoulder surgery. Arthroscopy allows an orthopaedic surgeon to examine and treat structures inside the shoulder using a small camera and specialized instruments inserted through small incisions.
However, not every tear requires the same approach. The appropriate treatment depends on the individual patient and the characteristics of the injury.
The American Academy of Orthopaedic Surgeons provides additional patient information about surgical treatment options for rotator cuff tears.
Why You Shouldn’t Ignore Persistent Shoulder Pain
It is tempting to adapt to shoulder pain.
You may stop sleeping on one side. You might use the other arm to reach overhead. Perhaps you avoid lifting certain objects or simply accept that some movements now hurt.
However, changing your routine does not necessarily address the underlying problem.
Additionally, some rotator cuff tears can become larger over time. According to the AAOS, worsening pain and decreasing strength in someone with a rotator cuff tear may indicate that the tear is progressing.
Therefore, persistent shoulder pain is worth investigating, particularly when it is accompanied by weakness or loss of function.
An earlier assessment can help determine what is causing the pain and which treatment options are appropriate.
Rotator Cuff Injury Treatment in Kingston, Jamaica
If you have persistent shoulder pain, weakness, night pain, or difficulty lifting your arm, an orthopaedic evaluation can help determine whether a rotator cuff injury or another shoulder condition is responsible.
At The Bone & Joint Centre in Kingston, Jamaica, patients can be evaluated for shoulder pain and other orthopaedic conditions. Depending on the diagnosis, treatment may include nonsurgical management, rehabilitation, or surgical treatment where appropriate.
Rather than simply learning to live with ongoing shoulder pain, consider having the cause properly assessed.
Contact The Bone & Joint Centre to schedule an orthopaedic consultation in Kingston, Jamaica.
This article, “Shoulder Pain That Won’t Go Away: When It Could Be a Rotator Cuff Injury,” is provided by The Bone & Joint Centre for general educational and informational purposes only. It is not intended to provide medical advice, diagnosis, or treatment and should not replace consultation with a qualified healthcare professional. Symptoms and treatment needs vary from person to person. If you are experiencing persistent or severe shoulder pain, sudden weakness following an injury, or other concerning symptoms, seek appropriate medical evaluation.