Shoulder arthritis secondary to rotator cuff tear: A reproducible murine model and histopathologic scoring system (2022)

Untreated rotator cuff tears can progress to a distinct form of shoulder arthritis, and the mechanism of this progression is poorly understood. Biomechanical, molecular and genetic factors may be at play, and a reliable animal model is needed to enable further research. The purpose of this study was to create a reproducible model of posttraumatic shoulder arthritis in the mouse, and to develop a scoring system for this model to enable future research on interventions, the role of various gene products, and the development of therapies to alter the natural course of the disease. Forty-five mice underwent operative ligation of the rotator cuff tendons and were followed for 45 weeks following surgery, with free cage activity post-operatively. Mice were sacrificed at various intervals from 2 to 45 weeks post-injury and histopathologic scoring was developed and tested by blinded reviewers using both quantitative computational analysis of coronal sections of the shoulder joint and semi-quantitative grading. The scoring system revealed a progressive, time-dependent set of tissue changes in the shoulder joint with features similar to human cuff tear arthropathy including acetabularization of the acromion and femoralization of the humeral head. This model establishes that osteoarthritis of the shoulder is distinct from osteoarthritis of the knee or hip, with different stages of degeneration and unique histopathologic features. Using the novel grading procedure and quantitative assessments presented here, future research using this model will enable investigators to test established and novel therapies and evaluate the role of inflammatory factors and gene products in shoulder arthritis. This study provides a reproducible mouse model of shoulder arthritis following isolated injury to the rotator cuff which elucidates characteristics of cuff tear arthropathy and provides a scoring system and venue for future research.

Original languageEnglish (US)
Pages (from-to)506-514
Number of pages9
JournalJournal of Orthopaedic Research
Volume35
Issue number3
DOIs
StatePublished - Mar 1 2017
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Zingman, A., Li, H., Sundem, L., DeHority, B., Geary, M., Fussel, T., Mooney, R., Zuscik, M. (2017). Shoulder arthritis secondary to rotator cuff tear: A reproducible murine model and histopathologic scoring system. Journal of Orthopaedic Research, 35(3), 506-514. https://doi.org/10.1002/jor.23383

(Video) No 1 Shoulder Impingement Exercises (98% Success Rate!) | FREE Exercise Worksheet!

Zingman, Alissa ; Li, Hiayan ; Sundem, Leigh et al. / Shoulder arthritis secondary to rotator cuff tear : A reproducible murine model and histopathologic scoring system. In: Journal of Orthopaedic Research. 2017 ; Vol. 35, No. 3. pp. 506-514.

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title = "Shoulder arthritis secondary to rotator cuff tear: A reproducible murine model and histopathologic scoring system",

abstract = "Untreated rotator cuff tears can progress to a distinct form of shoulder arthritis, and the mechanism of this progression is poorly understood. Biomechanical, molecular and genetic factors may be at play, and a reliable animal model is needed to enable further research. The purpose of this study was to create a reproducible model of posttraumatic shoulder arthritis in the mouse, and to develop a scoring system for this model to enable future research on interventions, the role of various gene products, and the development of therapies to alter the natural course of the disease. Forty-five mice underwent operative ligation of the rotator cuff tendons and were followed for 45 weeks following surgery, with free cage activity post-operatively. Mice were sacrificed at various intervals from 2 to 45 weeks post-injury and histopathologic scoring was developed and tested by blinded reviewers using both quantitative computational analysis of coronal sections of the shoulder joint and semi-quantitative grading. The scoring system revealed a progressive, time-dependent set of tissue changes in the shoulder joint with features similar to human cuff tear arthropathy including acetabularization of the acromion and femoralization of the humeral head. This model establishes that osteoarthritis of the shoulder is distinct from osteoarthritis of the knee or hip, with different stages of degeneration and unique histopathologic features. Using the novel grading procedure and quantitative assessments presented here, future research using this model will enable investigators to test established and novel therapies and evaluate the role of inflammatory factors and gene products in shoulder arthritis. This study provides a reproducible mouse model of shoulder arthritis following isolated injury to the rotator cuff which elucidates characteristics of cuff tear arthropathy and provides a scoring system and venue for future research.",

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(Video) Rotator Cuff Repair with NanoFx

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Zingman, A, Li, H, Sundem, L, DeHority, B, Geary, M, Fussel, T, Mooney, R, Zuscik, M 2017, 'Shoulder arthritis secondary to rotator cuff tear: A reproducible murine model and histopathologic scoring system', Journal of Orthopaedic Research, vol. 35, no. 3, pp. 506-514. https://doi.org/10.1002/jor.23383

Shoulder arthritis secondary to rotator cuff tear : A reproducible murine model and histopathologic scoring system. / Zingman, Alissa; Li, Hiayan; Sundem, Leigh et al.

In: Journal of Orthopaedic Research, Vol. 35, No. 3, 01.03.2017, p. 506-514.

Research output: Contribution to journalArticlepeer-review

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(Video) Rotator Cuff and Shoulder Pain Workshop 10-13-2020

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AU - Zingman, Alissa

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AU - DeHority, Becca

AU - Geary, Michael

AU - Fussel, Theron

AU - Mooney, Robert

AU - Zuscik, Michael

AU - Elfar, John

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PY - 2017/3/1

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N2 - Untreated rotator cuff tears can progress to a distinct form of shoulder arthritis, and the mechanism of this progression is poorly understood. Biomechanical, molecular and genetic factors may be at play, and a reliable animal model is needed to enable further research. The purpose of this study was to create a reproducible model of posttraumatic shoulder arthritis in the mouse, and to develop a scoring system for this model to enable future research on interventions, the role of various gene products, and the development of therapies to alter the natural course of the disease. Forty-five mice underwent operative ligation of the rotator cuff tendons and were followed for 45 weeks following surgery, with free cage activity post-operatively. Mice were sacrificed at various intervals from 2 to 45 weeks post-injury and histopathologic scoring was developed and tested by blinded reviewers using both quantitative computational analysis of coronal sections of the shoulder joint and semi-quantitative grading. The scoring system revealed a progressive, time-dependent set of tissue changes in the shoulder joint with features similar to human cuff tear arthropathy including acetabularization of the acromion and femoralization of the humeral head. This model establishes that osteoarthritis of the shoulder is distinct from osteoarthritis of the knee or hip, with different stages of degeneration and unique histopathologic features. Using the novel grading procedure and quantitative assessments presented here, future research using this model will enable investigators to test established and novel therapies and evaluate the role of inflammatory factors and gene products in shoulder arthritis. This study provides a reproducible mouse model of shoulder arthritis following isolated injury to the rotator cuff which elucidates characteristics of cuff tear arthropathy and provides a scoring system and venue for future research.

AB - Untreated rotator cuff tears can progress to a distinct form of shoulder arthritis, and the mechanism of this progression is poorly understood. Biomechanical, molecular and genetic factors may be at play, and a reliable animal model is needed to enable further research. The purpose of this study was to create a reproducible model of posttraumatic shoulder arthritis in the mouse, and to develop a scoring system for this model to enable future research on interventions, the role of various gene products, and the development of therapies to alter the natural course of the disease. Forty-five mice underwent operative ligation of the rotator cuff tendons and were followed for 45 weeks following surgery, with free cage activity post-operatively. Mice were sacrificed at various intervals from 2 to 45 weeks post-injury and histopathologic scoring was developed and tested by blinded reviewers using both quantitative computational analysis of coronal sections of the shoulder joint and semi-quantitative grading. The scoring system revealed a progressive, time-dependent set of tissue changes in the shoulder joint with features similar to human cuff tear arthropathy including acetabularization of the acromion and femoralization of the humeral head. This model establishes that osteoarthritis of the shoulder is distinct from osteoarthritis of the knee or hip, with different stages of degeneration and unique histopathologic features. Using the novel grading procedure and quantitative assessments presented here, future research using this model will enable investigators to test established and novel therapies and evaluate the role of inflammatory factors and gene products in shoulder arthritis. This study provides a reproducible mouse model of shoulder arthritis following isolated injury to the rotator cuff which elucidates characteristics of cuff tear arthropathy and provides a scoring system and venue for future research.

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(Video) Innovative New Treatments and Techniques for Shoulder Injuries: Patrick St Pierre, MD

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Zingman A, Li H, Sundem L, DeHority B, Geary M, Fussel T et al. Shoulder arthritis secondary to rotator cuff tear: A reproducible murine model and histopathologic scoring system. Journal of Orthopaedic Research. 2017 Mar 1;35(3):506-514. https://doi.org/10.1002/jor.23383

FAQs

Can a rotator cuff tear cause arthritis? ›

Rotator Cuff Tear Arthropathy

If one or more of these tendons is heavily torn, this may cause the humeral head to rub against other bones and develop arthritis.

What percentage of rotator cuff tears require surgery? ›

When does a partial rotator cuff tear need surgery? It is very uncommon to operate on a partial rotator cuff tear. In cases of deep partial tears — when more than 90 percent of the tendon is torn — surgery is recommended only if the symptoms can't be controlled with nonsurgical treatments.

What exercises should you avoid with a supraspinatus tear? ›

Avoid any extreme ranges of motion in your shoulders. Exercises like behind-the-neck shoulder presses, upright rows, or any exercises that require you to use your upper arms behind your torso. When attempting any exercises with an injured shoulder, make sure you keep your range of motion limited to what's comfortable.

Can full thickness rotator cuff tear heal without surgery? ›

Even though most tears cannot heal on their own, you can often achieve good function without surgery. If, however, you are active or use your arm for overhead work or sports, surgery is most often recommended because many tears will not heal without surgery.

How can you tell the difference between a rotator cuff tear and arthritis? ›

A major difference between rotator cuff injury and arthritis is that rotator cuff injury is generally caused to one arm while arthritis normally occurs in both the joints. Pain or no pain, if you have trouble moving your shoulder joint, it is sign enough to see your physiotherapist.

What is the average age for rotator cuff surgery? ›

In general, female patients who underwent rotator cuff repair were significantly older than their male counterparts (average age, 60.6 years for women and 56.1 years for men; p = 0.0034).

What are 2 warning signs of a rotator cuff tear? ›

Signs of a rotator cuff tear include:
  • Difficulty and pain caused by raising your arm.
  • Popping or clicking sounds or sensations when moving your arm.
  • Shoulder pain that worsens at night or when resting your arm.
  • Shoulder weakness and struggling to lift items.
28 Jan 2021

What happens if you wait too long for rotator cuff surgery? ›

A Lengthy Delay in Rotator Cuff Surgery May Increase the Odds of Needing a Revision. Rotator cuff tears are common, affecting more than 3 million people in the US every year. Most patients recover with non-surgical management, but if that fails, surgical repair – typically shoulder arthroscopy – is necessary.

What shouldn't you do with a rotator cuff tear? ›

Some of the exercises that people should stay away from include: Throwing a ball in an overhead fashion, particularly heavy balls. Avoid swimming, in particular, the strokes that involve an overhand motion. Lifting weights that place stress on the shoulder and rotator cuff.

How long do supraspinatus tears take to heal? ›

It takes six to eight weeks for the tendon to heal to the bone. Complete recovery time varies by size of the tear. For a small tears, full recovery time is about four months, for large tears, six months.

Does a torn rotator cuff hurt all the time? ›

Rotator cuff tendon tears often cause pain at night. The pain may even wake you. During the day, the pain is more tolerable, and usually only hurts with certain movements, such as overhead or reaching toward the back. Over time, the symptoms become much worse, and are not relieved by medicines, rest, or exercise.

When should you not have rotator cuff surgery? ›

If you have a partial thickness or complete non-retracted rotator cuff tear surgery is NOT your best option. Research has shown that surgery for a partial tear produces no better outcomes than just physical therapy (6). Failure after surgery is common.

Can you live with a full thickness rotator cuff tear? ›

For patients with chronic full-thickness rotator cuff tears, quality of life scores can predict treatment outcomes, and most patients will recover well without surgical intervention. “We all know that cuff tears are common, and they affect people's quality of life.

How long can you go with a torn rotator cuff before surgery? ›

Rotator cuff tears usually produce symptoms of weakness and pain especially on trying to lift the arm. When an acute injury results in a rotator cuff tear consideration should be given to a surgical repair within six weeks of the injury to avoid atrophy of the muscle and tendon.

How should I sleep with shoulder arthritis? ›

Side sleepers should lie on the side that is not painful and place a thick pillow under the arm of the painful shoulder to keep it elevated. Shift the shoulder back instead of letting it slump forward if possible. When back sleeping, place a pillow under each arm.

Can surgery fix arthritis in shoulder? ›

Shoulder Arthritis Treatment Options

If these treatments don't provide the desired relief, surgery may be necessary. Surgical options for shoulder arthritis include: Shoulder arthroscopy -- a minimally invasive procedure that allows for a small incision through which your doctor can debride (clean out) your shoulder.

Is shoulder arthritis a disability? ›

If you can prove that your shoulder injury is serious enough that it leaves you unable to perform fine and gross movements, you may be eligible for disability. Symptoms you must have that cause severe chronic pain and limits movement include: Chronic joint pain or stiffness.

What is end stage shoulder arthritis? ›

End-stage arthritis is the progressive wearing down of the cartilage that is present between the bones of a joint causing the bones to come in contact with each other and painfully rub against each other during movement of the joint. This results in severe pain with loss of movement and function.

What does arthritis in shoulder feel like? ›

Shoulder arthritis is inflammation in your shoulder joint. Over time, arthritis leads to cartilage loss. Symptoms include pain, stiffness, decreased range of motion and popping, clicking and grinding noises in your shoulder joint.

What is shoulder arthritis called? ›

Your rotator cuff connects your shoulder blade to the top of your arm through a collection of tendons and muscles. Injuries to the rotator cuff are common and can lead to a form of shoulder arthritis called rotator cuff tear arthropathy.

Should a 70 year old have rotator cuff surgery? ›

In conclusion, arthroscopic rotator cuff repair in patients over 70 years of age showed good clinical results and high satisfaction rate and can thus be considered a valid option of treatment after failure of conservative approach.

Who is a good candidate for rotator cuff surgery? ›

Candidates for rotator cuff surgery typically have symptoms for at least six months. That is unless they have a very large tear. Significant loss of range of motion or weakness may also qualify you for surgery.

Will a cortisone shot help with a torn rotator cuff? ›

Cortisone is a powerful anti-inflammatory that can be injected into the shoulder area to help treat a variety of shoulder conditions, including tendinitis, bursitis, rotator cuff impingement or tear, frozen shoulder, and degenerative or inflammatory arthritis.

What does a shoulder rotator cuff tear feel like? ›

Be described as a dull ache deep in the shoulder. Disturb sleep. Make it difficult to comb your hair or reach behind your back. Be accompanied by arm weakness.

Can a rotator cuff tear heal with physical therapy? ›

While physical therapy itself cannot heal a torn rotator cuff tendon, it does strengthen the shoulder muscles and restoring shoulder mechanics. By strengthening all the surrounding muscles, therapy can help compensate for the damaged tendons and improve the mechanics of the shoulder joint.

Does rotator cuff pain radiate down the arm? ›

Rotator cuff disease: Pain can begin to radiate from your shoulder into the side of your upper arm. Torn rotator cuff: Shoulder pain may radiate down your arm to the area of the elbow. Dislocated shoulder: The pain from a dislocated shoulder can radiate down the upper arm.

Is rotator cuff surgery considered a major surgery? ›

It is well known that rotator cuff surgery is a major operation where the rotator cuff tendons (Figure 1) are sewn back to the upper arm bone (humerus) (Figures 2 and 3). The other major reason patients have pain after rotator cuff surgery is due to stiffness of that shoulder.

Will my shoulder ever be the same after rotator cuff surgery? ›

"Although patient satisfaction is generally very high after surgical repair of a torn rotator cuff, the data suggest that long-term shoulder function -- in particular, shoulder strength and dynamic joint stability -- may not be fully restored in every patient," says Michael Bey, Ph.

What aggravates a rotator cuff injury? ›

The symptoms are usually aggravated by raising the arms overhead or in activities that require reaching behind the body, such as retrieving an object from the back seat of a car. Furthermore, reaching behind the back to fasten underclothing or to pass a belt may aggravate the arm and shoulder pain.

Why is rotator cuff pain worse at night? ›

Tearing and injury to the rotator cuff become more likely as tendons in the shoulder naturally wear down over time. Due to gravity, laying down can cause the rotator cuff to stretch and pull, leading to significantly worsened pain at night.

Should I wear a sling for rotator cuff injury? ›

It is best to not use a sling with a rotator cuff injury if possible. You can do gentle pendulum motions by leaning forward and letting the arm hang and gently swing in small circles or back and forth. Do gentle stretching exercises often throughout the day to keep moving.

How long do you have to wear a sling after rotator cuff surgery? ›

Patients are often advised to wear a sling or brace for the first 4–6 weeks after rotator cuff repair surgery to prevent them from performing any physical activities involving the affected shoulder (3).

When should I consider shoulder surgery? ›

Signs that you might need shoulder surgery

A frozen shoulder that hasn't improved despite six months or more of treatment. A rotator cuff disorder that hasn't improved despite three to six months of treatment (depending on the severity of your pain and rotator cuff problem) A complete tear of your rotator cuff.

How should you sleep with a torn rotator cuff? ›

Lying on your back is probably best for your rotator cuff. While you have more places to put your arms without damage, keeping them at your sides is preferable. If you put your arms up over your head, you may stretch the muscles and tendons of your rotator cuff.

Is heat good for rotator cuff pain? ›

If you have a rotator cuff injury then you can simply treat it using a heating pad given that it is not a torn muscle. How does it work? When heat is applied to an injured cuff rotator, it increases the blood flow to the tissue. This, as a result, eases down the inflammation and speeds up the healing process.

Where is pain located with torn rotator cuff? ›

Rotator cuff injuries often result in a dull ache that can be felt deep in the shoulder. It can occur due to specific movements, such as lifting or lowering the arm. Some people experience discomfort during rest as well. Sleeping is often disturbed by pain, especially when lying on the affected shoulder.

What kind of doctor treats rotator cuff? ›

If you suspect a rotator cuff tear or other serious shoulder injuries, it's advised that you make an appointment to see an orthopedic doctor. There are many options for treatment, but they are generally more effective if the injury is diagnosed early.

What percentage of rotator cuff tears require surgery? ›

When does a partial rotator cuff tear need surgery? It is very uncommon to operate on a partial rotator cuff tear. In cases of deep partial tears — when more than 90 percent of the tendon is torn — surgery is recommended only if the symptoms can't be controlled with nonsurgical treatments.

How do you survive rotator cuff surgery? ›

8 Tips to Speed Recovery After Rotator Cuff Surgery
  1. Wear a sling. To speed recovery, it is important to keep your shoulder immobilized initially after surgery so your tendon can heal. ...
  2. Sleep carefully. ...
  3. Ask for help. ...
  4. Watch for complications. ...
  5. Do the physical therapy. ...
  6. Keep comfortable. ...
  7. Be mindful of your movement. ...
  8. Pace yourself.

What happens 2 weeks after rotator cuff surgery? ›

First two weeks:

At this point, there should be no active movement of the shoulder, and there should be nothing placed in the hand while the arm is in the sling. Patients who are compliant with the sling and range of motion exercises typically have fewer complications later in the process.

What happens if you don't repair a full thickness rotator cuff tear? ›

Without any treatment—either rest and rehabilitation or surgery—rotator cuff disorders may get worse. Over time, you may have more pain. You may lose range of motion and strength in your shoulder, making it harder to do your daily activities.

Do you need surgery for a full thickness rotator cuff tear? ›

Even though most tears cannot heal on their own, you can often achieve good function without surgery. If, however, you are active or use your arm for overhead work or sports, surgery is most often recommended because many tears will not heal without surgery.

How much can you lift after rotator cuff surgery? ›

Therapy will continue for several weeks to months, depending on how you are progressing. Your work restrictions will be updated to lifting up to 5 pounds and no overhead use with your operative arm.

How long is a hospital stay for rotator cuff surgery? ›

Hospitals typically don't offer same-day shoulder surgery as an option. You will usually have to stay at the hospital for anywhere from 1 to 3 days after your operation so that they can keep an eye on you.

What is the most painful shoulder surgery? ›

Rotator cuff repair is the most painful surgery in the first postoperative days.

How long after rotator cuff surgery can you sleep in a bed? ›

This is really going to depend on your exact surgery and how quickly you recover in general. However, a good rule of thumb is 4-6 months before you can go back to sleeping however you want.

What are the long term effects of a torn rotator cuff? ›

Chronic tear

Symptoms of chronic rotator cuff tears, which usually go on for a long period of time, include: Pain that worsens at night and can hinder sleep. Progressive weakness with increasing pain. Reduced ability to move your arm in certain directions.

What happens if a torn rotator cuff is left untreated? ›

If left untreated, a rotator cuff tear can severely restrict function and range of motion. The tears can also increase over time. This may cause partial rotator cuff tears to progress to total tears.

What happens if a rotator cuff tear is not treated? ›

Without any treatment—either rest and rehabilitation or surgery—rotator cuff disorders may get worse. Over time, you may have more pain. You may lose range of motion and strength in your shoulder, making it harder to do your daily activities.

What happens to untreated torn rotator cuff? ›

Untreated chronic inflammation due to a partially torn rotator cuff tendon could lead to a full-thickness tear and eventually progress to shoulder arthritis at which point you may not be able to raise your arm overhead due to shoulder weakness and pain.

What are 2 warning signs of a rotator cuff tear? ›

Signs of a rotator cuff tear include:
  • Difficulty and pain caused by raising your arm.
  • Popping or clicking sounds or sensations when moving your arm.
  • Shoulder pain that worsens at night or when resting your arm.
  • Shoulder weakness and struggling to lift items.
28 Jan 2021

Can you live a normal life with a torn rotator cuff? ›

Non-operative management usually consists of pain control with anti-inflammatories or steroid injections, rest or activity modification, and physical therapy. Patients with “well-balanced” massive rotator cuff tears may still have good active motion and be able to perform their activities of daily living.

Can you wait too long for rotator cuff surgery? ›

The study concluded that surgical rotator cuff tear outcome wasn't compromised (regardless of the rotator cuff tear size) up to four months after injury. Most tears could also wait longer, but patients with massive rotator cuff tears who waited longer than 4 months had the worst outcome.

Will a cortisone shot help a torn rotator cuff? ›

Cortisone is a powerful anti-inflammatory that can be injected into the shoulder area to help treat a variety of shoulder conditions, including tendinitis, bursitis, rotator cuff impingement or tear, frozen shoulder, and degenerative or inflammatory arthritis.

What is the best treatment for rotator cuff injury? ›

Conservative treatments — such as rest, ice and physical therapy — sometimes are all that's needed to recover from a rotator cuff injury. If your injury is severe, you might need surgery.

Does a torn rotator cuff hurt all the time? ›

Rotator cuff tendon tears often cause pain at night. The pain may even wake you. During the day, the pain is more tolerable, and usually only hurts with certain movements, such as overhead or reaching toward the back. Over time, the symptoms become much worse, and are not relieved by medicines, rest, or exercise.

How long will I be off work for rotator cuff surgery? ›

You'll need rehab after rotator cuff surgery. This will start at 1 to 4 weeks and lasts 4 to 6 months. You cannot drive a car for 6 weeks, and it may take 4 weeks to return to work if you have a desk job. If you have to lift at work, you'll need to wait at least 3 months.

How long after rotator cuff surgery can you move your arm? ›

You should not do any reaching, lifting, pushing, or pulling with your shoulder during the first six weeks after surgery. You should not reach behind your back with the operative arm. You may remove your arm from the sling to bend and straighten your elbow and to move your fingers several times a day.

How do you treat a torn rotator cuff without surgery? ›

Non-Surgical Treatments for Rotator Cuff Tears
  1. Rest: We may recommend refraining from any activities or actions that aggravate your rotator cuff injury.
  2. Immobilization: A sling may be prescribed to help protect your shoulder and keep it still, giving the injury the time it needs to heal.

Where is pain located with torn rotator cuff? ›

Rotator cuff injuries often result in a dull ache that can be felt deep in the shoulder. It can occur due to specific movements, such as lifting or lowering the arm. Some people experience discomfort during rest as well. Sleeping is often disturbed by pain, especially when lying on the affected shoulder.

Should I wear a sling for rotator cuff injury? ›

It is best to not use a sling with a rotator cuff injury if possible. You can do gentle pendulum motions by leaning forward and letting the arm hang and gently swing in small circles or back and forth. Do gentle stretching exercises often throughout the day to keep moving.

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