Nursing Field Notes / Musculoskeletal · Med-Surg Course
Rotator Cuff Injury 💪
SITS Muscles · Impingement · Conservative vs. Surgical Repair
NG-219
Musculoskeletal
ADHD-friendly visual edition
The rotator cuff is a team of 4 tendons that let the arm lift & rotate at the shoulder. When one is violently stretched or torn — suddenly (a fall) or slowly (years of overhead repetition) — the client gets shoulder pain with abduction or rotation. Care runs from RICE to arthroscopic repair depending on how bad the tear is.
📄 Simple Nursing original — opens in Drive →
🎯 SITS = the 4 musclesSupraspinatus · Infraspinatus · Teres minor · Subscapularis.
💥 Pain with abduction/rotationThe hallmark symptom — lifting the arm out to the side or twisting it hurts.
🧊 RICE, with a twistRest · Ice · Compress · Sling instead of elevate for the shoulder.
🔬 MRI/X-rayLook for bone spurs or a narrowed space between humerus & acromion.
🧨
CAUSE
STEP 1 · FOUR TENDONS, ONE JOBThe rotator cuff stabilizes the shoulder & drives its rotation — tear or stretch any one of its tendons and that motion hurts.
🎯 SITS — the 4 rotator cuff muscles
🧠 "SITS" — Supraspinatus (top, starts abduction) · Infraspinatus (back, rotates out) · Teres minor (back, rotates out) · Subscapularis (front, rotates in). Picture someone SITS-ting with their arm cradled — that cradle is the cuff.
💥 Acute cause — sudden & violent
- 🏋️ Lifting something heavy with poor mechanics
- 🤸 Falling on an outstretched arm (FOOSH)
- A tendon is violently stretched or torn in one moment
🧠 Sudden pop after a fall or a heavy lift = think acute rotator cuff tear until proven otherwise.
🔁 Chronic cause — years of the same motion
- ⚾ Baseball pitchers
- 🎾 Tennis players
- 🏊 Swimmers
- 🎨 Anyone with repetitive overhead work (painters, mechanics)
Repeating the same overhead motion for years wears the tendon down slowly instead of tearing it all at once.
🧠 "Overhead over and over." If the history is a repetitive overhead sport or job, think chronic, degenerative cuff wear rather than one traumatic event.
⚙️ Mechanism: impingement — squeezing the tendon in a tight space
Raising (abducting) the arm narrows the space between the humerus (arm bone) and acromion (tip of the shoulder blade). A worn or inflamed tendon gets pinched in that narrow space — that pinch is impingement, and it's why abduction & rotation hurt the most.
🔎
CLUES
STEP 2 · SPOT ITOne hallmark symptom, plus imaging that looks for the anatomy behind the pain.
💥 Hallmark: shoulder pain with arm abduction or rotation
- Pain worsens as the arm is raised out to the side (abduction) or twisted (rotation)
- Weakness lifting the arm, especially overhead
- Night pain, often worse lying on the affected shoulder
🧠 "Reach and it screeches." If raising or rotating the arm is what reproduces the pain, think rotator cuff before anything else in the shoulder differential.
🔬 Diagnostics
- X-ray — can show bone spurs
- MRI — best for soft tissue: shows the tendon tear itself & a narrowed acromiohumeral space (the gap between the humerus and the acromion, the bony tip of the shoulder blade)
🧠 X-ray = bone, MRI = the tendon & the space it's stuck in.
📊 Acute vs. chronic presentation
| Acute tear | Chronic tear |
|---|---|
| Sudden onset — fall or heavy lift | Gradual — years of overhead repetition |
| Sharp pain, often a "pop" | Dull ache that slowly worsens |
| Younger, traumatic mechanism | Older or repetitive-use athletes/workers |
🩺
CARE
STEP 3 · CONSERVATIVE FIRST, SURGERY IF NEEDEDMost rotator cuff injuries start conservative — surgery is reserved for full-thickness tears or failed conservative treatment.
🧊 Conservative management: RICE — with one shoulder-specific swap
| Letter | Standard RICE | Shoulder version |
|---|---|---|
| R | Rest | Rest — avoid aggravating overhead motion |
| I | Ice | Ice the joint to control pain & inflammation |
| C | Compress | Compression as tolerated |
| E | Elevate | Sling instead of elevate — a shoulder can't be "elevated" like a limb; immobilize in a sling to rest the joint |
🧠 "RICE, but the shoulder gets a sling, not a lift." Every other joint in this series gets elevated above the heart — the shoulder is the exception because there's nowhere higher to elevate it to. Support it in a sling instead.
💊 Additional conservative measures
- NSAIDs for pain & inflammation
- Physical therapy — strengthen the cuff & scapular stabilizers
- Corticosteroid injection for persistent inflammation
- Activity modification — avoid the repetitive overhead motion that caused it
🔪 Surgical management
- Arthroscopic rotator cuff repair — for full-thickness tears or when conservative treatment fails
- Post-op: sling immobilization initially, then gradual, PT-guided range of motion
- Teach: avoid lifting or reaching overhead until cleared by the surgeon/PT
🧠 Surgery repairs the torn tendon; it does not fix poor mechanics — PT afterward is what prevents the next tear.
🩹 Post-op / rehab priorities
1
🧷 Immobilize in sling as prescribed — protects the healing repair
2
🥶 Ice for pain & swelling control
3
🏃♀️ Gradual PT-guided motion — passive first, active later, per surgeon protocol
4
❌ No overhead lifting until cleared
⚡
QUICK RECALL
SAY IT OUT LOUD🎯 SITSSupraspinatus, Infraspinatus, Teres minor, Subscapularis
💥 Pain w/ abduction/rotationthe hallmark symptom
🧊 RICE + slingrest, ice, compress, sling instead of elevate
🔬 MRItendon tear + narrowed acromiohumeral space
🎯 Cover & check — 4 rapid-fire questions
Q1: Name the 4 rotator cuff muscles.
Supraspinatus, Infraspinatus, Teres minor, Subscapularis — "SITS."
Q2: What is the hallmark symptom of a rotator cuff injury?
Shoulder pain with arm abduction or rotation.
Q3: How does RICE change for a shoulder injury?
Rest, ice, and compression stay the same, but a sling is used instead of elevation.
Q4: What does impingement mean in this context?
Raising the arm narrows the space between the humerus and the acromion, pinching the tendon (often the supraspinatus) in that space and causing pain.