The rotator cuff is a group of muscles that sit in and around the shoulder joint. They are very important for stability in the shoulder and upper limb actions. We continuously use them throughout our day so at times they can become injured. If this is the case there are many options on how to manage pain, and return back to full function.
What muscles make up the rotator cuff?
The rotator cuff consists of four muscles. These muscles sit on the inside and outside of the scapula and attach to the head of the humerus. Supraspinatus sits on top of the scapula in a fossa. Infraspinatus and teres minor sit on the outside of the scapular and subscapularis sits on the inside of the scapula. All these muscles join together to form a common tendon attaching to the humerus.
What is the rotator cuff’s role?
With any movement of the shoulder, the four rotator cuff muscles work together to stabilize the shoulder joint, making sure the head of the humerus sits in the correct position. Additionally, each muscle has its function, working to allow different shoulder movements.
Supraspinatus works along with other muscles to abduct the shoulder, that is move it laterally away from the body. Both infraspinatus and teres minor work to externally rotate the shoulder, whilst subscapularis internally rotates the shoulder.
Common injuries/presentations involving the rotator cuff:
People may develop rotator cuff injuries for a variety of reasons ranging from trauma, overload/overuse of the shoulder and also from degenerative changes with aging.
The two main injuries sustained to these muscles are rotator cuff tears, either of the muscle or tendon and rotator cuff tendinopathy.
Tears can be sustained through acute injuries. This is common when falling onto an outstretched hand or through shoulder dislocation as the rotator cuff is stretched/pulled in the direction of the dislocation. Tears can also occur through repetitive actions/load going through the rotator cuff, to the point where micro tears can form and then worsen. Unlike acute tears, these tears form over time. Tears can also be present due to degenerative changes occurring in the muscles and tendon. Interestingly enough, when imaging shoulders i.e. through ultrasound or MRI, tears may be present in the rotator cuff that are asymptomatic with no pain associated with the tear. These may be picked up when imaging the shoulder for other pathologies, or imaging the other side for comparison.
The other common pathology of the rotator cuff is rotator cuff tendinopathy. Rotator cuff tendinopathy occurs when the tendon is exposed to higher loads that they are not used to, leading to a change in the tendon properties. Pain usually has a gradual onset not long after the increase in load, i.e. taking up tennis after time off or a big day gardening.
Diagnosis of Rotator cuff pathology:
If you are having shoulder pain it is a great idea to see one of our Physiotherapists or Osteopaths here at 13th Beach Health Services. They will go through a detailed assessment of shoulder function, movement, and orthopaedic testing to see what may be contributing to your pain. If the rotator cuff is involved, often there will be pain in the direction of movement that these muscles produce and pain on strength testing.
Management of rotator cuff:
There are a number of ways to manage rotator cuff pathologies, whether they are tears or tendinopathies. For large tears it may be necessary to refer to specialists to make decisions about the best direction of care, but for most cases, they can be well managed through treatment and exercise rehabilitation. Releasing the rotator cuff muscles by a physiotherapist or osteopath through soft tissue work can be a great way to relieve pain. In conjunction with this, it is important to implement a strengthening program, specifically targeting your rotator cuff muscles. Your practitioner should start at a basic level, and continue to progress the exercises as able to build up strength. Often these exercises can easily be done at home with minimal equipment or with the use of Thera bands or light weights. For return to high-level activities or at the end stage of rehabilitation exercises can be performed in the gym to further load these muscles.
The rotator cuff is a vital part of our shoulder and is involved with all shoulder movement, both through stabilizing the shoulder joint and through the muscles contracting to produce movement. It is important that we work to make sure these muscles are strong to ensure correct shoulder movement patterns and to help prevent injury.
Image from https://commons.wikimedia.org/wiki/File:Rotator_cuff_syndrome.jpg