Preventing Rotator Cuff Injuries

It's true that baseball pitchers suffer rotator cuff tears -- or rather, fraying on the edges of some tendons -- because of the tremendous force they exert on their shoulders every time they throw the ball.

But overhead activity of all kinds is what tends to injure people: reaching high to paint a wall, change a light bulb, or serve a tennis ball. “Any time your arms are raised up over your head strains the rotator cuff,” said Duke orthopaedic surgeon Jocelyn Wittstein, MD. That is especially true when lifting heavier weight away from the body.

The first sign of a rotator cuff injury is often nagging shoulder pain when performing everyday activities such as reaching out to put on a coat sleeve, reaching for something on the back seat of the car, or simply shaking hands with someone. Injured shoulders can also be troublesome at night, when lying down allows the inflamed joint to swell. Occasionally, nighttime pain can get so bad that sleep is possible only in a reclining chair -- and some patients can’t sleep at all.

 The shoulder has more range of motion than any other joint. Most of its stability and movement relies on the small rotator cuff muscles and the larger muscles that surround the shoulder joint. While traditional weightlifting and aerobic exercise provide many benefits, they do little to strengthen the complicated assembly of muscles that keep the shoulder joint stable and healthy. 

You can keep your shoulder strong and flexible with exercises that target the small muscles that make up the rotator cuff. The key is to complement a program strengthening the larger muscles of the shoulder with a few key exercises just for the rotator cuff. These exercises will strengthen your rotator cuff and help prevent injury, whether you are active or inactive, young or old.

If you tear your rotator cuff, there are several treatment options. The type of treatment depends not only on the extent of the injury but also on your age and functional demands. While many complete rotator cuff tears benefit from surgical repair, surgery is not always necessary. 

People with a partial tear or who want to avoid surgery can benefit from physical therapy, which they are encouraged to continue at home. Sometimes, strengthening is all that’s needed, even if your rotator cuff is torn.

That’s because “four separate rotator cuff tendons surround the shoulder,” Dr. Wittstein explained. “If you have torn half of one tendon, you still have three and a half tendons left. If those are strong, it can often fully compensate for the torn part.”

However, rotator cuff tears that involve the full thickness of the tendon and remain painful may enlarge over time. “Those are the rotator cuff tears we are more likely to repair with surgery,” she says.

She added, “Many people with a small tear can have a pain-free, strong, healthy shoulder with full ability to do an overhead activity. That’s why keeping those muscles strong is so important.”