The rotator cuff is a set of muscles and tendons that attaches to the bones of the shoulder joint and keeps the shoulder stable during movements. You can raise and rotate your arm around the shoulder joint using the rotator cuff. It is important for actions such as lifting heavy objects, picking up stuff from a height, or scratching your back, and encompasses playing sports like baseball, swimming, or tennis.

If you’ve a hard time raising your arms over your head, it is likely that you are dealing with a rotator cuff injury. This might include inability to pick up a book placed on a high shelf or hit a shuttlecock while playing badminton, besides other activities. 

Also read: Common Shoulder Injuries Caused by Resistance Training

There are two broad types of rotator cuff injuries:

• Rotator cuff tendinitis: Irritation of the tendons and inflammation of the bursa, which is a lining of the tendons
• Rotator cuff tear: A tear in one of the tendons due to overuse or injury

Tendinitis

Tendinitis or tendonitis is caused due to many reasons:

• Keeping your arms in the same position for a long time while doing work or sleeping on the same arm daily
• Sports like swimming, tennis, and weightlifting that cause you to move your arm overhead
• Activities like painting and carpentry that involve repeated lifting of arms above the shoulder
• Suddenly lifting something heavy (acute tear)
• Inflammation due to a long-standing tear, which has not been treated properly
• Wear and tear due to aging

Symptoms of rotator cuff injury

• Dull ache deep in the shoulder
• Inability to fully lift arm above the shoulder for activities like combing hair, reaching the back
• Cracking sound from shoulder joint during certain movements
• Weakness in arm
• Sudden pain and limitation of movement while playing sports — this might be due to acute tear of the tendon or muscle fibres of the rotator cuff

Diagnosis

Your doctor should be able to diagnose the injury by taking a detailed history and doing a physical examination of the shoulder. He may ask  you to perform certain tasks, such as rotating your arm at the shoulder level and even raising your arm. If you experience pain while doing so, it may mean that your rotator cuff is inflamed. If your doctor suspects a tear,  an X-ray or MRI may be required.

Rotator cuff injury treatment

• Painkillers can be used to reduce pain and inflammation
• After acute pain subsides, physiotherapy is recommended to restore movements at the shoulder in a graded manner
• Corticosteroid injection can be prescribed, followed by physical therapy, if there is no response to painkillers and physiotherapy 
• Ultrasound techniques can be used if there are calcium deposits in the tendon
• Surgery (in case of recurring injuries or large rotator cuff tears) can be suggested in extreme cases

Also read: How Do You Deal with a Frozen Shoulder?

Prevention of rotator cuff injury

• Do shoulder muscle-strengthening exercises routinely
• Use a ladder or a stool if you want to reach for objects kept at a height
• Avoid sudden jerky movements of shoulders, especially the ones involving raising the arms overhead
• Increase the intensity of exercise in a graded manner while pursuing sporting activities like swimming, tennis, and weightlifting

References
1. Rotator Cuff Injury. Harvard Health Publishing 2018; published online Dec 19. https://www.health.harvard.edu/a_to_z/rotator-cuff-injury-a-to-z (accessed Apr 20, 2021).
2. Rotator Cuff Anatomy Explained 2019. Healthline 2019: published online Nov 26.  https://www.healthline.com/health/bone-health/rotator-cuff-anatomy (accessed Apr 20, 2021).
3. Rotator cuff problems. Medline Plus. https://medlineplus.gov/ency/article/000438.htm (accessed Apr 20, 2021).
4. Rotator Cuff Tear. WebMD. https://www.webmd.com/pain-management/rotator-cuff-tear#1 (accessed Apr 20, 2021).
5. Rotator Cuff Injury. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/rotator-cuff-injury (accessed Apr 20, 2021). 
6. Rotator cuff injury. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/symptoms-causes/syc-20350225 (accessed Apr 20, 2021).