Rotator cuff pain is the No. 1 cause of shoulder pain — and it affects millions of Americans every year. Whether you reached for something overhead and felt a sudden twinge or you’ve been living with a dull ache that just won’t go away, understanding what’s happening inside your shoulder is the first step toward getting better.

Here’s what you need to know about rotator cuff pain, from what causes it to when it’s time to consider surgery.

What Is the Rotator Cuff?

The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint. Together, they hold the head of your upper arm bone firmly within the shallow socket of your shoulder.  These muscles, bones and tendons are responsible for nearly every motion your arm makes — lifting, reaching, throwing and rotating.

Because the shoulder is the most mobile joint in the body, the rotator cuff is under constant demand. That makes it vulnerable to both sudden injury and gradual wear over time.

What Causes Rotator Cuff Pain?

Rotator cuff pain can develop in a few different ways depending on your age, activity level and overall shoulder health. The most common shoulder pain causes include:

• Acute rotator cuff tear. A sudden fall, lifting something too heavy or an awkward twist of the arm can partially or completely tear one or more of the rotator cuff tendons. These injuries are common among athletes but can happen to anyone.
• Degenerative tear. As we age, tendons naturally weaken and lose elasticity. Degenerative rotator cuff tears are especially common in adults over 40 and often develop slowly, with pain gradually worsening over months or years.
• Rotator cuff tendinitis. Repetitive overhead motions — common in swimmers, tennis players, painters and construction workers — can irritate and inflame the tendons, leading to a condition called rotator cuff tendinitis. 
• Bursitis. The bursa is a small fluid-filled sac that cushions the rotator cuff from the bones above it. Inflammation of this sac, called bursitis, often accompanies rotator cuff issues and adds to shoulder pain and discomfort.
• Impingement syndrome. This occurs when the rotator cuff tendons get pinched between the bones of the shoulder during arm movements, causing pain and limiting range of motion.
• Frozen shoulder. Frozen shoulder is a condition where the flexible tissue, tendons and ligaments around the shoulder joint, becomes stiff and inflamed. Rotator cuff issues may trigger frozen shoulder since the reduced mobility may cause the area to stiffen without regular use. 

Rotator Cuff Pain Symptoms

The symptoms of rotator cuff pain can range from mild and nagging to severe and limiting. Common signs include:

• A dull ache deep in the shoulder, especially at rest or at night
• Pain when raising your arm overhead or out to the side
• Weakness when lifting or rotating the arm
• A crackling or popping sensation with shoulder movement
• Difficulty reaching behind your back
• Trouble sleeping on the affected side

One of the most telling rotator cuff symptoms is discomfort that gets worse with overhead activity and improves with rest — at least early on. Over time, if left untreated, even simple daily tasks like brushing your hair or reaching into a cabinet can become painful.

How Is Rotator Cuff Pain Diagnosed?

If you’re experiencing persistent shoulder pain, a thorough evaluation by an orthopedic specialist is the best way to understand what’s going on. Your provider typically will:

• Review your medical history and ask about your symptoms, activity level and how the pain started.
• Perform a physical examination, testing your range of motion and shoulder strength.
• Order imaging such as an X-ray (to check for bone spurs or arthritis) or an MRI (to evaluate the tendons and soft tissues in detail).

In some cases, a diagnostic ultrasound also may be used to get a real-time view of the tendons as the shoulder moves. An accurate diagnosis is essential, because the best treatment for rotator cuff pain depends heavily on the type, severity and location of the injury.

Rotator Cuff Pain Treatment Options

The good news: Most rotator cuff pain responds well to treatment, and many people recover without surgery. Treatment typically is tailored to the severity of the injury and how long symptoms have been present.

Nonsurgical Treatment

For a partial rotator cuff tear, tendinitis, bursitis or mild-to-moderate impingement, conservative treatment is usually the starting point:

• Physical therapy is the cornerstone of nonsurgical care. A structured program of stretching and strengthening exercises can restore range of motion, reduce pain and help compensate for a weakened rotator cuff.
• Rest and activity modification allow the inflamed or injured tissue time to heal. Your provider may recommend temporarily avoiding the overhead activities or motions that aggravate your symptoms.
• Anti-inflammatory medications such as ibuprofen or naproxen can help manage pain and reduce inflammation, particularly in the early stages.
• Corticosteroid injections deliver targeted anti-inflammatory medication directly into the shoulder joint or bursa. These injections can provide significant relief, especially when combined with physical therapy.

Surgical Treatment

When conservative treatment isn’t providing adequate relief — or when there’s a significant or complete tear — surgery may be the right path. Most rotator cuff repairs are performed arthroscopically, using small incisions and a tiny camera, which allows for a quicker recovery compared with traditional open surgery.

For patients with more complex shoulder conditions, such as a massive irreparable tear or a torn rotator cuff combined with severe arthritis, a reverse shoulder replacement may be recommended. Unlike traditional shoulder replacement, this advanced shoulder surgery reverses the position of the ball and socket to allow the deltoid muscle to take over the work of the damaged rotator cuff — restoring function and dramatically reducing pain.

When to See a Doctor for Rotator Cuff Pain

You don’t have to just live with shoulder pain. It’s time to make an appointment if you experience:

• Shoulder pain that has lasted more than a few weeks
• Significant weakness when lifting or rotating your arm
• Sudden, severe shoulder pain after a fall or injury
• Night pain that disrupts your sleep
• Difficulty performing routine activities at home or work

Catching rotator cuff issues early often means simpler, faster treatment. The longer a tear or injury goes untreated, the more likely it is to worsen — and the more difficult it can be to repair.

Getting the Right Care for Rotator Cuff Pain

Rotator cuff pain is common, but it’s not something you have to accept as a permanent part of life. With the right diagnosis and treatment plan — whether that’s physical therapy, an injection or advanced surgical care — most people can return to the activities they love.

Norton Orthopedic Institute specialists offer comprehensive evaluation and care for rotator cuff conditions, from conservative treatment to the latest surgical techniques. If shoulder pain is holding you back, request an appointment today.

Choose Norton Orthopedic Institute for Your Shoulder, Hip or Knee Replacement

• Same-day appointments are available with no referral required. When you’re ready to take care of the pain, you want to get started.
• Our fellowship-trained and board-certified orthopedic surgeons have the experience you can trust. They perform more than 800 hip replacements, 1,000 knee replacements and hundreds of shoulder replacements every year.
• Lower-cost, nonsurgical options, such as physical therapy, are considered and tried before we recommend surgery.
• Robotic-assisted surgeries provide added precision when placing your new joint and, with advanced, minimally invasive techniques, often allow you to go home the same day.
• Choose from 30 locations in Louisville and Southern Indiana for follow-up care.
• Norton Healthcare is the first health system in the nation to be recognized as an Advanced Orthopedic & Spine Center of Excellence by DNV.
• We help you get ready for surgery and support your recovery with educational programs available online and in person.
• Medicare, Medicaid and most major commercial insurance plans are accepted. Financial assistance also is available.
• Your free Norton MyChart account allows you to communicate with your provider, manage appointments, refill prescriptions and more from a mobile device or computer.