Ask the doctors: Treatment for rotator cuff injuries depends on severity

Dear Doctors: I tripped on a tree root and almost did a face-plant. I landed on my hands with my arms stretched out, and now my right shoulder has started aching. My boyfriend thinks it’s a rotator cuff injury. I’ve only heard of that in baseball players. What is it? What is the treatment?

Dear Reader: Your rotator cuff is the group of muscles and tendons that help anchor the bone of the upper arm, known as the humerus, within the shoulder joint. This is a ball-and-socket joint, the architecture of which allows the arm to have a wide range of motion. Working together, the muscles and connective tissues of the rotator cuff hold the rounded end of the humerus – that’s the ball – in place as it moves within the shallow cup of the shoulder blade “socket.” They also contribute to the strength and stability needed to lift and rotate your arm.

Injuries to the rotator cuff can occur in a fall onto an outstretched arm, as happened in your case. This can damage not only the tendons, but also may bruise or tear the muscle. The area can also sustain harm due to repetitive overhead arm motions, which is why the injury is often seen in baseball and tennis players, swimmers and golfers. Professions such as house painting or construction work, and improper technique when lifting heavy weights, also put people at increased risk.

The most common symptom is a dull ache deep within the shoulder joint. This can be accompanied by weakness in the muscles of the arm and a reduced range of motion. Lifting a weight or rotating the arm can intensify discomfort. Pressure on the shoulder, as when sleeping on your side, may be painful. In some cases, damage to the connective tissues in the shoulder joint can create a sensation of friction during motion or cause a popping or crackling sound.

Diagnosis begins with a close examination of the shoulder joint to assess pain and identify areas of weakness or impaired motion. Imaging tests, such as an MRI or an ultrasound, may be recommended.

Treatment depends on the scope of the damage. In minor injuries, the connective tissues may be irritated or inflamed but are not torn or severed. In those cases, the person will be asked to rest and limit activities that involve the affected shoulder.

Nonsteroidal anti-inflammatories (such as ibuprofen) may be used to manage pain and swelling. Stretching and strengthening exercises can be helpful, as can ultrasound therapy and physical therapy. In some cases, corticosteroid injections may be used to manage inflammation. In more serious injuries, the connective tissues become frayed or torn or can completely detach from the bone. Depending on the extent and severity of the damage, surgery may be necessary.

After a fall, and with the onset of your symptoms, it’s a good idea to have your shoulder evaluated by your health care provider. Treatment can improve a rotator cuff injury. But when ignored, it is easy for these types of injuries to worsen.

Send your questions to askthedoctors@mednet.ucla.edu.