Shoulder Pain That Won’t Go Away: Is It Your Rotator Cuff?

Shoulder pain that hangs on for weeks is very often the rotator cuff. The good news is that many rotator cuff problems get better without surgery. The catch is that a few do not, and with those, timing matters. Here is what to look for.

What the rotator cuff does

The rotator cuff is four muscles and their tendons, wrapped around the top of the upper arm bone. Their job is to keep the ball of the shoulder centered in its socket while the arm moves. When a tendon is worn or torn, the ball stops tracking cleanly, and lifting the arm starts to hurt.

Signs it may be the rotator cuff

• an ache at night, often bad enough to stop you sleeping on that side
• pain reaching overhead or behind your back
• weakness lifting the arm

An exam that tests strength and movement in each direction, together with imaging, usually X-rays and an MRI, confirms it.

How rotator cuff tears happen

Some tears come from one moment, such as a fall or a heavy lift followed by sudden weakness. Others wear through gradually with age and years of overhead work or sport. The two are treated differently, which is why the history of how it started matters.

Not every tear needs surgery

A torn tendon does not usually knit back together by itself, but many partial and age-related tears stop hurting and work well again with rehabilitation. Tendinopathy, a worn and irritated tendon without a full tear, and many partial-thickness tears settle with physical therapy and changes to how the shoulder is loaded. For pain that has hung on, PRP and radial shockwave therapy are options for long-standing rotator cuff tendinopathy.

When repair makes sense

Surgery is considered for full-thickness tears in active people, for tears with sudden weakness after an injury, and for tears that stay painful and weak despite good rehabilitation. A tear caused by a specific injury is worth assessing early, because a torn tendon left alone can pull back and become harder to repair.

Rotator cuff repair reattaches the torn tendon to the bone, and it is done arthroscopically wherever the tear allows. Recovery takes several months: the arm is protected in a sling at first, then movement and strength come back in stages on a therapy plan. Some long-standing tears can no longer be repaired. For those shoulders, a reverse shoulder replacement is designed to let the arm lift again without the rotator cuff.

ELITE Sports Medicine treats shoulder pain and rotator cuff tears at its Port St. Lucie office at 1100 SW St. Lucie West Blvd., and at its Palm Beach Gardens office. Call 561-202-8886 or request an appointment.