The rotator cuff consists of the muscles and tendons in the shoulder. Four major muscles [subscapularis, supraspinatus, infraspinatus and teres minor] work together with their tendons to connect the upper arm with the shoulder blade, holding the ball of the humerus firmly in the socket of the scapula. This anatomical structure gives the shoulder more range of motion than any other joint in the body.
Rotator cuff injuries are fairly common, usually caused by falling, lifting or repetitive motion, especially overhead motion. Injury-inducing activities include repeatedly throwing an object overhead or placing items on high shelves. Injuries are more common among people whose jobs or hobbies place heavy demands on their shoulders, and among individuals with poor posture, or rounded and hunched shoulders. Also, studies show that as we age, our risk of a rotator cuff injury increases.
How do you determine whether you’ve damaged your rotator cuff or simply irritated it from an intense workout? The Mayo Clinic describes a few symptoms:

• Pain and tenderness in the shoulder, especially when reaching overhead, reaching behind the back, lifting, pulling or sleeping on the affected side
• Shoulder weakness
• Loss of shoulder range of motion
• Inclination to keep your shoulder inactive

The most common symptom is pain—the kind that, unlike workout-induced soreness, continues for days and flares up when you use the shoulder, even for simple things like combing your hair or putting on a jacket. With a severe rotator cuff injury, such as a large tear, the pain is continuous, in some cases radiating down the arm.
Rotator cuff injuries can result from any type of irritation or damage to your rotator cuff muscles or tendons, including:
Tendinitis. Tendons in the rotator cuff become inflamed due to overuse or overload. In some people, the space for the rotator cuff becomes narrowed due to the shape of their shoulder bones.
Bursitis. The fluid-filled sac [bursa] between your shoulder joint and rotator cuff tendons becomes irritated and inflamed.
Strain or Tear. Left untreated, tendinitis weakens a tendon, leading to chronic strain or tearing. Stress from overuse also can cause a shoulder tendon or muscle to tear.
Normal Wear and Tear. Most young athletes don’t have to worry about this, but the risk increases after age 40. Normal wear and tear on the rotator cuff can cause a breakdown of fibrous protein [collagen] in the tendons and muscles, making them more prone to breakdown and injury. With age, deposits may form within the cuff, or bone spurs might pinch or irritate the rotator cuff.
Poor Posture. When you slouch your neck and shoulders forward, the space occupied by your rotator cuff muscles becomes smaller. This can allow a muscle or tendon to become pinched under the shoulder bones, especially during overhead movements and activities.
Falling. Using your arm to break a fall or falling on your arm can bruise or tear a rotator cuff tendon or muscle.
Lifting or Pulling. Lifting an object that’s too heavy or doing so improperly—especially overhead—can strain or tear your tendons or muscles. Likewise, pulling something that is too heavy can cause injury.
Repetitive Stress. Repetitive overhead movement of the arms can stress rotator cuff muscles and tendons, causing inflammation and eventual tearing. This often occurs in athletes, especially baseball pitchers and tennis players.
At times, some of these causes can produce a severe problem. By following the guidelines below, you should be able to handle minor problems before they become major concerns. If you think you’ve irritated your rotator cuff, try these steps:
Rest Your Shoulder. Stop doing what caused the pain and avoid painful movements. Limit heavy lifting or overhead activity for four to seven days, until your shoulder starts to feel better. If pain continues after a week, you may need to see a doctor.
Apply Ice and Heat. Icing the shoulder reduces inflammation and pain. Use a cold pack, a bag of frozen vegetables or a towel filled with ice cubes for 15 to 20 minutes at a time—but do not put ice directly on the skin [it might cause frostbite]. Ice every couple of hours the first day or two. After two or three days, when the pain and inflammation have subsided, apply hot packs or a heating pad to the shoulder area to help relax sore and tightened muscles. Limit heat applications to 20 minutes.
Take Pain Relievers. Over-the-counter, nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen, can help reduce pain. Acetaminophen [e.g., Tylenol] is another effective pain reliever. Before taking any kind of medication, however, even over-the-counter drugs, you should consult your doctor.
Keep Your Muscles Limber. After a few days, do some gentle stretching exercises to limber up your shoulder muscles. Total inactivity stiffens joints. In addition, favoring your shoulder and not moving it for long periods of time can lead to “frozen shoulder,” a condition in which your shoulder becomes so stiff you can barely move it.
Once your injury heals and range of motion is restored, resume your exercise program at a moderate level. Don’t expect to start at the same level you had attained before the injury. You’ve been relatively inactive, so it will take time to get back to where you were. Second—and more important—it might have been the intensity and volume of work you were doing that caused the problem in the first place. Continue the program with caution. Include daily shoulder stretches and a balanced shoulder-strengthening program to prevent a recurrence of the injury. Have a trainer show you specific exercises that can help strengthen, stabilize and improve the rotator cuff.
If you follow these guidelines and the pain persists, see your doctor as soon as possible.
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