Your shoulder is one of the most mobile joints in the body and consists of an unstable ball and socket joint. This joint is controlled by four main muscles known as the “ROTATOR CUFF”, hence the word rotator cuff injury. The subscapularis, supraspinatus, infraspinatus and teres minor. Injury or irritation to any of these muscles as well as the tendons that connect these muscles to the bones, can result in significant loss of range of motion or pain.
Rotator cuff injuries vary from mild tendon pain ( rotator cuff tendinopathy), shoulder bursitis (inflammed bursa), calcific tendinopahy (bone forming within the rotator cuff tendon) through to partial and full thickness rotator cuff tears, which may require rotator cuff surgery.
So now we know what muscles affect and are related to our shoulder, now we need to know where these muscles sit in relation to other parts of our body.
As the name suggests, the rotator cuff muscles are responsible for shoulder rotation and form a cuff around the head of the humerus. Most importantly, they hold your arm (humerus) onto your shoulder blade (scapula). Most of the rotator cuff tendons are hidden under the bony point of your shoulder (acromion), which as well as protecting your rotator cuff can also impinge on your rotator cuff structures.
What Causes a Rotator Cuff Injury?
Your rotator cuff tendons are protected from simple knocks and bumps by bones (mainly the acromion) and ligaments that form a protective arch over the top of your shoulder.
In between the rotator cuff tendons and the bony arch is the subacromial bursa (a lubricating sack), which helps to protect the tendons from touching the bone and provide a smooth surface for the tendons to glide over.
However, nothing is fool-proof. Any of these structures can be injured – whether they be your bones, muscles, tendons, ligaments or bursas.
Rotator Cuff impingement is a result of poor shoulder biomechanics where your rotator cuff tendons are intermittently trapped and compressed during shoulder movements This causes injury to the shoulder tendons and bursa resulting in painful shoulder movements.
What are the Symptoms of Rotator Cuff Injury?
While each specific rotator cuff injury has its own specific symptoms and signs, you can suspect a rotator cuff injury if you have:
- an arc of shoulder pain or clicking when your arm is at shoulder height or when your arm is overhead.
- shoulder pain that can extend from the top of your shoulder to your elbow.
- shoulder pain when lying on your sore shoulder.
- shoulder pain at rest (with more severe rotator cuff injuries).
- shoulder muscle weakness or pain when attempting to reach or lift.
- shoulder pain when putting your hand behind your back or head.
- shoulder pain reaching for a seat-belt.
When the rotator cuff is injured, a variety of issues arise:
- Pain and spasm limit the range of motion of the shoulder.
- The muscles do not make the small adjustments within the joint to allow the humeral head to move smoothly.
- Fluid accumulation within the joint due to inflammation limits movement.
- There can be impingement on the rotator cuff muscles or the tendons that attach them to the bones. The tendons run through narrow bony spaces, and if there is a change in how the humerus and scapula move, these spaces can become even narrower.
- Arthritis and calcium deposits that form over time limit range of motion. These calcifications may occur along the bony edges of the joint or within the tendons of the rotator cuff muscles.
How to Treat a Rotator Cuff Injury?
Once you suspect a rotator cuff injury, it is important to confirm the exact type of your rotator cuff injury since treatment does vary depending on the specific or combination of rotator cuff injuries.
Your rotator cuff is an important group of control and stability muscles that keeps the shoulder ball centred over the small socket. This prevents injuries such as impingement, subluxations and dislocations.
We also know that your rotator cuff provides subtle glides and slides off the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapula) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.
Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence.
These are:
- Early Injury Protection: Pain Relief & Anti-inflammatory Tips
- Regain Full Range of Motion
- Restore Scapular Control
- Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
- Restore Rotator Cuff Strength
- Restore High Speed, Power, Proprioception & Agility
- Return to Sport or Work
For a more detailed rehabilitation program give us a call or book online to see one of our expert physiotherapists.
