Rotator cuff injury requires rest, pain relief, stretching

Q: I've injured my rotator cuff. What can I do to relieve the pain?

A: When people hear "rotator cuff injury," they often think of baseball pitchers. But most people with rotator cuff injuries are like you and me. Gradual wear and tear from everyday activities over many years makes all older adults vulnerable to such injuries.

What exactly is a rotator cuff?

Your shoulder is made up of your collarbone, upper arm bone and shoulder blade. A group of tendons - strong cords of tissue - tether muscles from your shoulder blade and ribs to your upper arm bone. They help you raise and rotate your arm. This group of tendons is your rotator cuff.

You can injure your rotator cuff through overuse of the shoulder joint, which can lead to inflammation or small tears in the rotator cuff. Inflammation may also occur in the bursa, a small cushion that reduces friction between tendons and bones.

Rotator cuff injuries cause pain in your shoulder and upper arm. The pain may be most noticeable when you reach up or out - when you comb your hair or slip your arm into a sleeve, for example.

When you first have the symptoms of a rotator cuff injury, your doctor is likely to recommend that you rest the shoulder. After you have done that for some time, your doctor may then recommend that you start gentle shoulder stretching and strengthening exercises.

But before you start an exercise program, you may need a corticosteroid injection to control pain and inflammation. Daily nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) help decrease pain and inflammation.

Your doctor may recommend working with a physical therapist. He or she can design an individualized program to help you increase your range of motion, strengthen your shoulder muscles, and stretch your muscles and ligaments to keep them supple.

For example, try this simple shoulder stretch. Say your left shoulder is injured. Stand with your feet hip-width apart. Take your left hand and put it on your right shoulder. Cup your left elbow with your right hand. Then gently pull your left elbow across your chest until you feel a mild stretch. Hold for 10 to 30 seconds. Return to the starting position.

Repeat 3 to 4 times. If your right shoulder is injured, perform the stretch on the other side: right hand on left shoulder, left hand cupping your right elbow. (I've put a photo demonstrating this stretch on my website, AskDoctorK.com.)

With a combination of corticosteroid treatment and physical therapy, your injury should heal within four to six weeks.

Surgery is not usually necessary unless you frequently injure your rotator cuff or have large tears in a rotator cuff tendon. When such large tears make it impossible for you to use your arm as you would like, surgery may be the only solution.

My patients with rotator cuff injuries have always been amazed by how many daily activities require a pain-free shoulder. Fortunately, after some weeks of discomfort, their shoulders become pain-free again.

• Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.