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Rotator Cuff Tears and Weightlifting on Steroids

Rotator Cuff Location The rotator cuff is made up of 4 important muscles and tendons in the shoulder. The rotator cuff muscles are made up of the subscapularis, supraspinatus, infraspinatus and teres minor. These muscles connect the upper arm to the shoulder blade. The rotator cuff muscles play a vital role in upper arm movements and allow the arm to rotate through a wide range of motions. Sometimes the rotator cuff muscles can be injured, torn or rupture. The most common cause of rotator cuff injury are falls, heavy lifting, or repetitive throwing. In each of these cases, activities which include overhead arm activity such as throwing a baseball or lifting weights is a common risk factor. The majority of small tears do not require any type of surgical therapy.
When an individual develops rotator cuff tear, the typical symptoms include:


Pain is a common feature even with small tears of the rotator cuff muscles. The pain is localized around the shoulder and is common when the arms are lifted above the shoulders. The pain may also be severe so that the individual will be hesitant to elevate his/her arms. Initially the pain usually occurs while performing an activity but if there is a full tendon rupture, the pain may occur at rest. Most individuals will complain that they have pain with simple activity like combing their hair or shaving. Even lying on the side of the affected shoulder can be painful.

Tenderness along the shoulder is a common feature. Pressing deep in the recess of the shoulder joint will elicit tenderness.

When there is a full tear of the tendon or multiple tendon involvement, there is also associated weakness in the shoulder muscles.

The range of motion is always limited when there is moderate or severe tendon injury. With mild tears, the range of motion may be complete but the pain may worsen if the activity is not discontinued.

The majority of individual who develop a moderate to severe rotator cuff injury will not use the shoulder. Keeping the shoulder still to avoid pain is a common observation.

Rotator cuff injury can be off several types including:


Tendinitis of one or all four muscles. The tendon may become inflamed from overuse and is quite common in baseball players and individuals who play racquet sports. Tendinitis is also prominent in weight lifters.

Bursitis means fluid filling in the joint cavity. This is also a common occurrence in people who continuously over use their arms, esp. in sporting activities. The tendon becomes irritated, inflamed and leads to fluid accumulation.

When the tendinitis is left untreated, the tendon can develop tears. Initially the tears are small but can become large if the overuse of the arm is not discontinued. Continued used of the arm can lead to a full blown tear or rupture of the tendon.

Risk for rotator cuff injury

The following risk factors may make you prone to rotator cuff injury:


Age. As one gets older, the tendons become stiff and small tears can easily occur. The tears occurring in elderly people are usually small and can be managed by conservative treatment. Most of these individuals will complain of chronic pain in the shoulder.

Athletes are most prone to rotator cuff injuries. Repetitive motions, heavy overhead lifting, baseball pitchers and racquet sports which all require using the upper hand can also increase the risk of rotator cuff injury.

Construction workers are also more prone to rotator cuff injuries.

Weak muscles in the upper arm and shoulder can also lead to rotator cuff injuries. That is why it is highly encouraged that all potential novice weight lifters start off with small weights and progress gradually. Once a rotator cuff muscle has been injured, the full potential of the arm is almost never regained.


The diagnosis of rotator cuff injuries involves:


The physical exam is not specific for rotator cuff tears but may give the health care worker some clue to the diagnosis.

A plain x ray of the shoulder may reveal the presence of any bony or cartilage problems.

MRI is diagnostic for rotator cuff injuries. The test is painless, takes about 20 minutes but is costly.

If fluid is suspected in the joint, an ultrasound can be done.


For the majority of people, the first treatment of rotator cuff injuries is supportive therapy. This includes rest, pain control and entering an exercise program. The aim of exercise is to improve your posture, strengthen the muscles and increase the range of motion. The physical exercises must be done for at least 1-3 months before one can see an improvement. If any physician recommends surgery as the first treatment of rotator cuff injury, you should seek another opinion.

Steroid injections are often done to relieve pain. Only 1-2 steroid injections can be performed over a period of 1-2 years. If the steroids work, one will notice the pain relief in about a week and the pain relief will last for at least a month or longer.

Surgery is often recommended when there is a large tear in one of the tendons. Often surgery may be required to remove a bone spur or remove calcium precipitates in the joint. Most shoulder surgery today is done with a video scope, thus eliminating large incisions.

In very rare circumstances, more aggressive surgery may be required. However, before undertaking any type of shoulder replacement surgery, it is important that you get not one but a number of opinions. The results of shoulder replacement surgery are not great (do not always believe what the surgeon claims).

Home care

Individuals who develop rotator cuff tears should undertake some type of self care remedy to help ease the pain and regain function of the arm.

Resting of the shoulder is very important. Exercises that cause pain should be avoided and all heavy lifting should be discontinued until the shoulder feel better. Most cases of rotator cuff tears improve with 7-14 days of rest.

When an acute shoulder injury has occurred, the best recommendation is to apply some ice and heat. The ice should be applied for 20 minutes for at least 3-4 times a day for 2 days. Once the pain subsides, one can apply heat packs and start passive arm movements. The heat packs should only be applied for 20 minutes at a time.

The pain from a rotator cuff tear can be moderate and most people will need pain medications. Over the counter pain medications can help reduce the pain.

Once the pain has subsided, one should start with passive non weight bearing exercises. Keeping the shoulder immobile for more than 1 week is not recommended as one can develop what is called a frozen shoulder.

Enrolling in a physical therapy class is the best way to increase muscle strength and range of motion.

Unfortunately rotator cuff injury can not be completely prevented. However, if someone already has had an injury to the shoulder before, it is important to stop any activity that causes pain. Rest, ice and reducing the activity are key to preventing a full blown injury.


Krabak BJ, Alexander E, Henning T. Shoulder and elbow injuries in the adolescent athlete.
Phys Med Rehabil Clin N Am. 2008 May; 19(2):271-85, viii. Review.
Matsen FA 3rd. Clinical practice. Rotator-cuff failure. N Engl J Med. 2008 May 15; 358(20):2138-47.

Nho SJ, Yadav H, Shindle MK, Macgillivray JD. Rotator cuff degeneration: etiology and pathogenesis. Am J Sports Med. 2008 May; 36(5):987-93. Epub 2008 Apr 15. Review.

Opsha O, Malik A, Baltazar R, Primakov D, Beltran S, Miller TT, Beltran J. MRI of the rotator cuff and internal derangement. Eur J Radiol. 2008 Oct; 68(1):36-56. Epub 2008 Apr 2.

Rees JL. The pathogenesis and surgical treatment of tears of the rotator cuff.
J Bone Joint Surg Br. 2008 Jul; 90(7):827-32. Review.
Stephens MB, Beutler AI, O’Connor FG. Musculoskeletal injections: a review of the evidence. Am Fam Physician. 2008 Oct 15; 78(8):971-6. Review.

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