How to Treat a Rotator Cuff Injury

If one or more of the muscles or tendons in your rotator cuffs gets injured, it can become painful for you to move your arm. Since this pain can severely impact your quality of life, it's important to treat a rotator cuff injury correctly. To do this, assess whether you are dealing with a minor or major injury, which will help you decide between treating the injury at home with ice, rest, and over-the-counter pain killers or if you need medical care.

Method 1 - Treating a Minor Injury at Home

1

→ Determine if your injury can be treated at home. Some rotator cuff injuries are just mild pulls of the muscles that will heal with proper treatment at home. However, others are debilitating and require medical treatment to heal properly. If you have discomfort when you move your shoulder but are not in excruciating pain, you likely only have a mild injury. If the shoulder area is deformed or misshapen, has severe pain, or you can’t move it, you likely have a severe injury that requires immediate medical care.

→ Mild injuries often occur due to unusual stress being placed on the muscles, such as when you lift a large amount weight and your muscles ache afterword.

2

→ Reduce inflammation in the shoulder by icing it. Use an ice pack, a bag of ice cubes, or a bag of frozen vegetables. Put it on the injured area for 20 minutes at a time. Then make sure that skin comes back to its normal temperature before applying it again.

→ Place a towel between the ice pack and your skin, so that the skin doesn’t get too cold.

3

→ Manage your pain with medication. Minor injuries to the rotator cuff can cause some pain and discomfort. Use an over-the-counter painkiller, such as ibuprofen or naproxen, which will dull your pain and reduce inflammation in the injured area. Be sure to follow the directions on the packaging, including how much to take and how often you can safely take it.

→ If your pain cannot be managed successfully by an over-the-counter pain medication, you should contact your doctor and get a medical evaluation.

4

→ Rest the injured area. If your shoulder is injured, give it several days to heal before putting stress on it again. Don’t try to lift anything with your injured shoulder and keep that arm as immobile as possible. Put your arm in a sling to help immobilize the shoulder and to remind you that you shouldn’t be using that arm.

→ Also, avoid lying on that side when sleeping or resting.

→ Don’t carry a bag or backpack on your injured shoulder while it is healing.

→ If you need to hold something with the injured arm, keep the item close to your body. This will put less stress on the shoulder muscles.

Method 2 - Getting Medical Care for Severe Injuries

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→ Contact your doctor if you have severe or ongoing pain in your shoulder. While some minor rotator cuff injuries will heal without treatment from a doctor, others need expert care. If you have cared for your injury properly for several days and it’s not getting any better, you have severe pain that won’t go away with over-the-counter pain relievers, or the shoulder is swollen or not functioning, you need medical care.

→ If you have just injured your shoulder and the pain is extreme, go to an emergency room.

→ If you have been treating your shoulder but it is not getting better, make an appointment with your primary care physician.

2

→ Have testing done to identify the exact injury. When you go to your doctor’s office, they will do a physical exam, talk to you about your injury, and then will likely order imaging to be done. This will help them figure out what is causing your symptoms. There are a variety of imaging techniques that could be used, including:

→ MRI

→ X-ray

→ Ultrasound

→ Fluoroscopy

→ CT scan

3

→ Consult with your doctor about treatment options. After imaging is done, your doctor will tell you what they think is wrong with your rotator cuff. If the injury is minor, your doctor will give you a treatment plan to manage any discomfort and to promote healing. If your injury needs more care, they will likely refer you to a specialist or a physical therapist.

→ If you have injured your rotator cuff so much that movement causes severe pain, then you may have a serious or complete tear in one of the muscles. This type of injury usually requires surgical treatment. If your primary care doctor has identified this type of injury, they should refer you to a specialist, such as an orthopedic surgeon.

4

→ Complete physical therapy. Many people with rotator cuff injuries require physical therapy after initial treatment in order to regain full use of their shoulder. After resting your injured shoulder and allowing the muscles to heal, you will need instruction on how to start using the shoulder safely again. In most cases, your physical therapist with work on teaching you how to use your shoulder safely and effectively and building up strength in the shoulder so you can use it normally once again.

→ During your physical therapy sessions you will do a variety of stretches and exercises that will increase the flexibility and strength of your rotator cuff.

→ If you need to have surgery to repair your rotator cuff, physical therapy will need to be part of your recovery after surgery.

5

→ Get cortisone injections. If rest, icing, and physical therapy haven’t controlled your pain, then your doctor may suggest using cortisone, which is a steroid, to reduce your discomfort. However, having these steroid injections is only a temporary solution for pain that can’t replace actual treatments, such as surgery.

→ Cortisone injections are an outpatient procedure done in a doctor’s office.

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→ Have surgery to repair your rotator cuff, if necessary. If you have done a variety of treatments and your injury has not healed, or your injury was very severe in the first place, your doctor may suggest surgery as an option. This is most common for patients who have complete or almost complete muscle or tendon tears. There are several different types of surgery that may be suggested depending of your specific injury. They include:

→ Arthroscopic tendon repair

→ Open tendon repair

→ Tendon transfer

→ Shoulder replacement

Method 3 - Encouraging Healing and Function

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→ Begin movement cautiously but as soon as possible. Keeping your rotator cuff totally immobile for a long period of time can cause you to lose range of motion. However, it’s best to start stretching only after any swelling and pain is gone and you need to do specific movements to get it moving safely. Try stretching out the muscles in your shoulder with these stretches:

→ Doorway stretch

→ Crossover arm stretch: Lift one arm up and across your chest. Use the other hand to press the elbow of the first arm gently into the chest.

→ Passive internal rotation: Get a scarf and hold one end with one hand. Put the length of the scarf behind your back and grab the other end with the other hand. Pull the scarf to one side, lifting one arm away from the body and one arm behind the body. Repeat going the other direction.

→ Passive external rotation: Hold a scarf in front of you with one end in each hand. Stretch it out across your body and then pull it to one side, lifting one arm away from the body and one arm in front of the body. Repeat by moving your arms in the opposite direction as well.

→ Sleeper stretch: Lay on your side with your lower arm at 90 degrees from your body and your elbow bent up at 90 degrees. Take your other hand and grab the lower wrist. Gently push in down towards the ground, keeping the lower elbow bent.

2

→ Work on strengthening the muscles. Some minor rotator cuff injuries are caused, at least in part, by lack of strength in the rotator cuff muscles. To prevent future injuries, work on strengthening the muscles after your shoulder is totally healed. Exercises that can help to strengthen your rotator cuff include:

→ Side-lying external rotation: Lay on your side with your upper arm bent at 90 degrees at the elbow. Keep your elbow bent and rotate the forearm away from the ground until it it upright.

→ High-to-low rows: Stand in front of a pull-down cable exercise machine. Grab the handle and pull down, moving your arm from a straight position, to a bent-elbow position, and then to a position where your elbows are as far back as possible.

→ Reverse fly

→ Lawn mower pull

3

→ Return to physical activities gradually. Even after your shoulder feels better, don’t just go right back into activities that will put a lot of stress on the rotator cuff. For example, don’t go from a shoulder injury to playing softball right away, even if your shoulder is pain free. You need to give your rotator cuff muscles time to build back up their strength and flexibility.

→ Start with activities that are easy on the shoulder or that can be adjusted to put less strain on the rotator cuff, such as stretching and strengthening routines.

4

→ Stretch your rotator cuffs before playing sports or doing physical activities. When you do go back to highly physical activities, be sure to stretch the rotator cuff muscles out before doing anything that will put stress on them.

→ This will prepare the muscles for work and will reduce your chance of another injury.