Johns Hopkins Health Alert
A Pain in the Rotator Cuff
In this Health Alert, Drs. Steven A. Peterson and Edward G. McFarland answer questions about rotator cuff pain.
Of all the joints of the body, your shoulder is capable of the widest range of motion. This amazing flexibility allows you do just about anything, from picking up a suitcase, brushing your teeth, and throwing a 90-mph fastball, to scratching your back, and hugging your spouse. All of this can dramatically change, however, when shoulder pain develops, and freedom of movement is affected. An estimated 20% of Americans will suffer from shoulder pain during their lifetime, with many having their damaged shoulder joint replaced surgically to relieve the pain and restore motion. Others will require rotator cuff surgery.
Q. Can the rotator cuff be torn?
A. Rotator cuff tendons have a very low blood supply, which leaves them vulnerable to degeneration as one ages. Rotator cuff damage increases naturally with age, typically in the dominant arm. Repeating the same type of shoulder actions can accelerate shoulder degeneration, whether it be swimming laps, washing windows, or carrying a heavy briefcase.
The interesting thing about rotator cuff tears is that while rotator cuff tears are a common shoulder pain source, as many as 5-40% of people without shoulder pain have a torn rotator cuff and never know it. Ignoring existing chronic shoulder inflammation or sustaining a sharp blow or fall on an outstretched arm may cause the rotator cuff to tear partially or completely.
An initial symptom is sharp pain in the shoulder that may radiate down to the elbow. Even so, the arm can still be moved in a normal range of motion. However, when the rotator cuff completely tears, the arm often cannot move in its normal range, and sometimes the arm cannot be raised from the side without assistance.
Q. What are the options for someone with a torn rotator cuff?
A. Many people think that because their rotator cuff is torn, they need to have surgery to restore use of their arm and get back shoulder flexibility. However, all partial tears of the rotator cuff do not require surgery. Even with a tear, some people will find that they still have reasonably good function and relatively little shoulder pain.
Good candidates for nonsurgical therapy for partial tears of the rotator cuff include those who:
- Are bothered by pain
- Are not concerned with regaining lost shoulder strength
- Will modify all activities that cause shoulder pain symptoms. When there is a complete tear of the rotator cuff tendon, the goal of rotator cuff surgery is to get the tendon to heal to the bone so that shoulder pain is reduced and strength and range of motion of the shoulder are increased
Good candidates for surgical therapy for a torn rotator cuff include those who have:
- Much shoulder pain or loss of function
- Failed nonsurgical management
- Tears that cause profound shoulder weakness
- Tears caused by acute trauma
Posted in Arthritis on July 27, 2009
Reviewed October 2011
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
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Prolotherapy using PRP (platelet rich plasma) - this is how it was characterized to me but I suspect the actual healing mechanism is a bit different but effectively the same - IS covered by insurance except for the blood kit which costs abut $250.
Prolo and PRP were perfomed on my sons hip (chronic condition, cliking/locking of hip with pain and the injury to the hip -- initially doctor thought it was just inflamation in joint but after na injury (baseball) decided it was the big tendon?/ligament? (labrum?)running from the front side of the hip to the back side. The prolo worked well (one treatment) got rid of much of the pain after about one week and restored mobility but not complete. We then had the PRP treatment done (son need to be able to play (catcher) in an international tournament in Italy - the PRP injections were given to him about 2 weeks before play began and while he still had considerable pain from the treatment he was able to play and performed well.
The PRP worked and he has no problems whatsoever with his hip after more than a year after teh treatment and agian the PRP is covered by insurance
Posted by: memiller49 | August 1, 2009 12:06 PM
I am a male, 73. Three years ago I made a quick fast movement with my right arm to the rear of my body trying to remove a wasp from the back of my right hand. Suffered with pain for about three months. Had great difficulty at times sleeping and tolerating certain movements. Finally made an appointment with a well known orthopedic group here in Cincinnati. On exam the doctor said I had a torn rotator cull but did not know how severe until further tests were done. (MRI - X-RAY) Results came back showing a total tear of the rotator cuff with some artheritis. With my age and moderate COPD the doctor explained the possibilities of surgery. My decision was to just live with it. About six months later the pain started to diminish. As of today it is like it never happened. I have no restriction of any kind of a movement to my right arm or shoulder. What Happened???
Posted by: papadoc4 | August 1, 2009 1:45 PM
I don't know what caused it but about 9 months ago I started experiencing pain and loss of motion in my right shoulder. It has gotten so bad that I can no longer even sleep on my right side and am teaching myself to do everything left handed. My doctor wants me to see an orthopedist and see if cortisone shots help. The pain is so severe that the thought of a needle touching the site brings shivers. Has anyone ever had relief of this pain by using cortisone?
Posted by: nychamps | August 1, 2009 6:09 PM
I had cortisone shots in my shoulder and it really helped me and it doesn't hurt. They use a small needle. And the pain of the shot is well worth it. I'd have it done it I were you. Good luck!
Posted by: conniesr | August 2, 2009 4:59 PM
At age 54, I hurt my shoulder playing basketball. I was out of shape, having not played for awhile. I suffered great discomfort in my shoulder for months, hoping it would just heal. I flew to Portland for a speaking engagement, my shoulder still very painful. Even getting in and out of a car was difficult. Miraculously -- and I choose the word carefully, but with no divine intervention suggested -- on the trip the pain suddenly disappeared. I noticed the lack of pain on the plane on the way home after a hectic two days. It was a stunning recovery, and I couldn't fathom it. Going over everything that I had done differently, the most significant change of activities was a big and very spicy meal at a Tai restaurant. I did more homework on the idea and found suggestions that some common asian spices could relieve joint inflammation. Twice since then, the same shoulder problem has occurred, to a milder extent. Each time, a spicy Tai meal has been followed by a complete recovery.
Posted by: birdmorn | April 4, 2010 8:52 PM
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My left shoulder: 80 percent tear of rotator cuff; 100 percent tear SLAP' My right shoulder: 100 percent tear of the rotator cuff.
Did physical therapy: that did not work.
Went for Prolotherapy and both shoulders and I am proud to say that I have full use of both shoulders with zero pain. I play golf three/four times a week. No pain. My strength in both shoulders are to the point that the orthopedic surgeon who administered prolotherapy could not move my shoulders during his strength tests.
Never had surgery.
Unfortuately, the Prolotheraphy procedures are not recognized by the insurance industry including Medicare.
Posted by: alantaylor62 | August 1, 2009 7:04 AM