The Rotator Cuff

What is the Rotator Cuff?
The ‘Rotator Cuff’ is a name given to the group of four muscles whose tendons wrap around your arm bone (humerus) at the shoulder to stabilise the arm within the socket while the arm moves. These muscles are named Supraspinatus, Infraspinatus, Teres Minor and Subscapularis (pictured right). 
These muscles act as stabilisers by strengthening the capsule and ligaments of the shoulder during any movement of the shoulder joint and outwards movements of the shoulder.

How do I know it is my Rotator Cuff that is making my shoulder sore? 
As physios we are professionally trained to assess the shoulder to determine what structure is causing your pain. The physio will look at the history of the condition, the cause of the injury and what functional movements cause you pain. This will help to make a diagnosis and define the treatment and rehabilitation strategy. In some cases if the damage is severe enough your physio or GP may refer for scans to help with assessing and treating your shoulder.
Rotator cuff injuries can occur due to a traumatic (acute) injury or of an unknown cause.

Acute Tear
Acute tear injuries occur as a result of a sudden powerful movement, often involving a twisting motion.

Symptoms include:

  • A sudden and painful tearing sensation in the shoulder
  • This can be followed by severe pain in the shoulder that can also radiate throughout the arm
  • Limited movement of the shoulder due to pain or muscle spasm
  • Specific tenderness over the point of rupture/tear
  • If there is a severe tear, you will not be able to raise your arm out to the side without assistance

Chronic Tear
Chronic Rotator Cuff problems commonly occur as a result of a poorly healed acute tear or long term damage due to a long period of repetitive shoulder activities. These conditions are often associated with a rotator cuff tendinosis. 
Symptoms include:

  • Deep ache in shoulder and on the outside of the arm
  • More often affiliated with the 40+ age group
  • Pain can be worse at night and affect sleep
  • Gradual worsening of pain with eventually shoulder weakness
  • As the chronic tear worsens in severity it becomes increasingly more difficult to lift your arm above your shoulders or even out to the side.

Shoulder injuries that have an unknown cause can be particularly frustrating for the patient, though unfortunately this is not uncommon. It is possible they could be demonstrating signs of shoulder impingement syndrome.

rotator-cuff-2Impingement Syndrome
Within the shoulder, the rotator cuff tendons and burase are situated in the space between the shoulder bone (acromion) and the arm bone (humerus). Each time you raise your arm this space decreases causing a small amount of rubbing or pinching of theses tendons and bursa as they slide within this space. This rubbing or pinching action is called impingement.

Impingement occurs to some degree in everyone’s shoulder, which is why almost half of people will die with having holes in their rotator cuff tendons. Day-to-day activities that involve using the arm above shoulder level cause a level of impingement that usually doesn’t lead to any prolonged pain. However continuously working with the arms raised overhead, repeated throwing activities, or other repetitive actions of the shoulder can cause impingement to become a problem. Impingement becomes a problem when it causes irritation or damage to the rotator cuff tendons or bursa.

Symptoms include:

  • Complain of shoulder and arm pain with overhead activates
  • Slumped or rounded shoulder posture
  • Limited movement in shoulder
  • Reproduction of pain with speciality tests

Why have I hurt my Rotator Cuff muscles?
As outlined above the causes of Rotator Cuff problems can vary greatly. Acute tears are often a result of trauma and as such often occur with a fall onto an outstretched hand or an impact to the rotator cuff muscles. Other causes of shoulder pain usually occur without trauma that often confuses the patient. These injuries historically involve the patients shoulder blade (scapula) being in a poor position and with repetitive tasks like reaching for your seatbelt or up into a cupboard can lead to the onset of shoulder pain.

rotator-cuff-3Posture and Scapular position 
Under normal circumstances the gap between the humerus and scapula is maintained by the balance of muscles surrounding the shoulder. An imbalance can occur when certain muscles become tight (the ones that pull your shoulders forwards) while others become weak (the ones that pull your shoulders back). This imbalance reduces the space for the tendons and bursa to slide within, thus increasing the risk of damaging your rotator cuff muscles, tendons and bursa.

The main muscles that become tight are pictured left. Many jobs today require people to work with their arms in a forward position. People more susceptible to this position for sustained periods include either desk or manual work, along with those who study. Sustaining these positions or ‘postures’ for substantial amount of hours will create the imbalance within these muscles surrounding the shoulder increasing the risk of injury.

What can I do to make my shoulder feel better?

  • First aid management
    • The fundamental of treating an acute is to reduce the initial inflammation. This includes resting the shoulder, applying ice to the affected area and medication, a NSAID, may be helpful to control the pain.
  • Physiotherapy management
    • The next step in healing a rotator cuff injury is to consult a physiotherapist. If still in the inflammation stage a physio can aid this stage with ice/heat, Ultrasound and taping techniques. Other aspect of physio is to regain range of movement, increase strength of the shoulder and most importantly identify the cause of the injury and correcting any abnormalities. For rotator cuff injuries this most commonly involves improving their posture and increasing scapula control during movement.
  • Surgical management
    • If pain and range of movement doesn’t resolve with physiotherapy,
    • If there is a large tear to one/or more of the rotator cuff muscles
    • And under 60 years of age

Several factors can influence the healing process. These include the type of injury, the severity and age. As we grow older our muscles, tendons and ligaments also grow old which means the healing process will take longer.

Is there anything I can do to avoid hurting my shoulder again?

  • Your physio will give you specific advice about which activities to avoid. This may include avoid heavy lifting or activities that require your arm constantly being lifted above your head
  • Continuing with your exercises even once the pain disappears. This will prevent a chronic injury occurring
  • If you are participating in sports that put your shoulder in risky positions your physio may teach you to

If you have any further questions about any of the topics discussed in this article, or to book an appointment to begin your road to recovery, talk to your friendly Gold Coast Physio today on (07) 5574 4303!

For more information, or to book (BOOK NOW) your initial consultation, talk to your friendly Gold Coast Physio today on (07) 55 271071.