The rotator cuff is a group of muscles and tendons that surround the shoulder joint and hold the humeral head in the joint. Injury to the rotator cuff can cause a dull ache in the shoulder, especially during sleep, when sleeping on the affected side.

Rotator cuff injuries are more common in people who perform very large movements while at work, such as painters, carpenters, baseball or tennis players.
The risk of rotator cuff injury increases with age.
Many people recover from rotator cuff injuries with medical gymnastic exercises that increase flexibility and tone in the scapulohumeral joint.
Large rotator cuff injuries may require surgical suture, tendon transfer or shoulder prosthesis.

Without treatment, rotator cuff injuries can lead to complete loss of shoulder motion and decreased arm strength.
Sometimes, putting the shoulder at rest, by immobilizing it, can cause fibrous scar tissue, which further reduces joint mobility, leading to the condition called frozen shoulder.

WHAT IS PREVENTION?
If you are at risk of developing a rotator cuff injury due to strenuous activities and hobbies, or if you have had a rotator cuff injury in the past, stretching exercises for the rotator cuff can relieve symptoms.
Stretching exercises should address both the anterior and posterior shoulder muscles.

HOW CAN THE DIAGNOSIS BE MADE?
During examination of the shoulder, there are several clinical tests that indicate damage to one or more of the rotator cuff tendons. Physical examination can be associated with imaging investigations such as:
Radiography- through Rx we can visualize the existence of calcium deposits or arthrosis of the acromioclavicular and scapulohumeral joints.
Ultrasound- we can visualize lesions of muscles and tendons, we can also visualize these structures dynamically during some movements and we can make a comparison with the tendons and muscles of the healthy shoulder.
MRI- we can get the same images as ultrasound, but much more detailed.

CONSERVATIVE TREATMENT
Such as: rest, icing and medical recovery are sometimes necessary to recover from minimal rotator cuff injury, but in severe cases surgery may be required.
Injections- if conservative treatment cannot reduce pain, then cortisone infiltration may be necessary, especially if the pain decreases sleep quality or interferes with daily activities. These, done in small amounts, may help temporarily, but over time can lead to tendon damage.
Medical recovery is often the first-line treatment, stretching exercises can increase flexibility and tone in the shoulder. Medical recovery is also an important part of the recovery process after rotator cuff surgery.

SURGICAL INTERVENTIONS
There are several types, such as:
– arthroscopic suture – which is done with the help of a video camera, through minimal incisions;
– classic incision repair – in some situations it is necessary to suture the rotator cuff through a classic incision, when the surgeon makes a large incision to reattach the affected tendon to the bone. Compared to arthroscopic surgery, classic incision surgery restores the tendon in the same amount of time, but recovery is much faster with arthroscopic surgery.
– tendon transfers – if the injured tendon is too badly damaged to be reattached to the humeral head, the surgeon may decide to use an adjacent tendon to replace it.
– Shoulder prostheses – are necessary in cases of massive rotator cuff injuries and will improve joint stability. They are achieved by replacing the humeral head and glenoid with appropriate implants.