Identifying Rotator Cuff Injury and Pain

February 1, 2023

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When it comes to shoulder strain, even musicians are not spared. Rotator cuff injuries are common among athletes, such as baseball players, who make powerful throws, and swimmers and tennis players who continually use overhead motions. Likewise, musicians are liable to incur tears because of overuse.

Shoulder pain is one of the most frequent musculoskeletal complaints. An estimated three million people in the United States experience rotator cuff pain and injury every year, according to the Hospital for Special Surgery.

Conductors and timpani players are at high risk for shoulder injuries because of the repetitive upward swing of their arms. Excessive tension in the muscle also occurs in the neck and left shoulder of fiddlers—often due to inadequate or improperly fitted chin and shoulder rests. An excessively high elbow on the bowing arm predisposes them to right shoulder problems. Cellists have the same issue, if they do not rotate the cello slightly towards the right arm to facilitate bowing on the upper strings.

Since the shoulder has such a large range of motion, the ball and socket of the joint has a small contact area. Without the muscles and ligaments around it, the shoulder is an unstable joint. To stay in position while moving, the shoulder relies heavily on the rotator cuff muscles.

Some common rotator cuff injuries include:

• Tendinopathy
• Rotator cuff tears
• Shoulder impingement
• Bursitis
• Labral tears

There is a lubricating sac called a bursa between the rotator cuff and the bone on top of the shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can become inflamed and painful.

The cause of a partial or full rotator cuff tear is typically multifaceted, according to orthopedic specialists, and the major factors are age-related degenerative changes of the tendon and increasing and/or changing loads to the tendon. Trauma, such as a fall or shoulder dislocation, can lead to tears. The rotator cuff is only about five millimeters thick, so even a simple injury, like slipping on ice, can do significant damage.

A physician will check for tenderness in the shoulder, range of motion, and arm strength. A complete checkup will include an X-ray for arthritis or bone spurs and an MRI (ultrasound) will detect any tendon tears. When one or more of the rotator cuff tendons is torn, the tendon becomes partially or completely detached from the head of the humerus. A partial tear does not completely detach the tendon from the bone, but it is thinned. With a “full-thickness tear,” part of the tendon is completely detached from the bone.

Listen to Your Pain

Learn to listen to your body. Is it serious or will it go away with rest and over-the-counter pain medication? A rotator cuff impingement happens when there is irritation, inflammation, or compression of the tendons or bursa in the shoulder. An impingement can be caused by an injury, but it can also result from general wear and tear from daily life.

A tear in the rotator cuff will produce pain that is similar to an impingement but has one additional differentiating feature. If the pain is associated with weakness, it is likely caused by a tear. First and foremost, see your doctor. Be very cautious about applying heat or ice. For acute (recent and inflamed) soft tissue injury, apply ice within the first 24-72 hours of trauma to reduce muscle spasms and pain. Heat helps relax muscles, ease stiff joints, and improve circulation and blood flow.

The most important thing is knowing when to rest. It’s difficult for professional musicians to take time off, but it’s important to recover from an injury—and that means canceling rehearsals and performances. More gains will be made over the long run. It’s better to cancel a few weeks’ worth of concerts and recover more quickly than be forced to stop playing for an extended period.

Get “Major Athlete” Medical Treatment

If it’s serious, seek out the best treatment possible. Start with a reputable orthopedic surgeon who has treated athletes and musicians alike. Sports medicine clinics are popular. It’s likely the therapists have a variety of clients, from body builders to flutists.

Treatment often includes:

• Rest
• Nonsteroidal anti-inflammatory medicines
• Strengthening and stretching exercises
• Biofeedback
• Ultrasound therapy
• Corticosteroid injection
• Surgery (for severe injuries)

Easy stretching exercises are important to maintain length and movement in injured muscles and tendons. Under the guidance of a doctor or orthopedic surgeon, exercises should be preceded by gentle warmth to help relax the affected part. Stretching should be done only to the point of mild discomfort. This is best done under the supervision of a physical therapist. Keep in mind that the muscles being strengthened are small, and it is better to proceed slowly and cautiously than to risk re-injury.

Among the newer innovations in rehabilitation and conditioning is the Bodyblade method, which uses vibration to stabilize muscles and help patients regain strength and flexibility. (As with any regimen, consult a physician and physical therapist before beginning the exercises).

One of the most important reasons to strengthen rotator cuffs is to minimize the risk of age-related changes. As we age, degenerative changes occur that include a gradual loss of muscle mass and reduced elasticity of the rotator cuff tendons. These changes can be minimized or prevented with strengthening exercises. To maintain the health of the tissue, integrate biomechanics knowledge into your playing technique. Warm up before rehearsals and performances and consider strength training. If possible, do light and low stretching. Like any athlete, get massages regularly.

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