Rotator Cuff Injuries
What is a rotator cuff?
The rotator cuff is a collection of four muscles around the shoulder that help permit the shoulder to do a wide range of motion while contributing to its stability. The four muscles that make up the rotator cuff are subscapularis, infraspinatus, teres minor, and supraspinatus, all of these muscles originate from the shoulder blade and attach to the humerus in the upper arm.
What does a rotator cuff do?
The rotator cuff must perform a job that is slightly contradictory in that it must allow the shoulder to be very mobile so we can perform tasks like reaching up over our heads and bringing objects towards our face (vital for being able to eat). The glenohumeral joint is a very shallow ball and socket joint, making it vulnerable to instability problems such as dislocation, it relies on stability being provided for it by negative intraarticular pressure between ball and socket (a bit like the effect of a plunger), the ligaments around the joint, the strong fibrous capsule that surrounds it, and the rotator cuff.
The muscles of the rotator cuff provide dynamic stability to the glenohumeral joint, meaning that it is most involved when the arm is performing movement. Its structure of inserting and enveloping the top, front, and back of the humerus with each muscle synchronously performing its specific action allows it to do this. The underside of the glenohumeral joint lacks protection from excessive movement which is why the vast majority of dislocations resulting the shoulder moving down the body. The fine movement control that the rotator cuff provides also prevents the humerus from coming into contact with other bones of the shoulder during movement (see our article on this here). It does this by three of its muscles providing a downward pull on the humerus as you lift your arm therefore making space between it and the bones above. (1,2)
How does a rotator cuff get injured?
How does a rotator cuff get injured?The rotator cuff is the most common reason for shoulder pain and dysfunction and can occur in many ways such as a fall on the shoulder, repeated overhead activities such as a tennis serve, or an overload of the tissues by pulling or pushing a heavy object. The cuff can also become injured or inflamed by changes to the acromioclavicular joint that lies above the humeral head or as a result of deterioration of the tendons of the cuff, these non-traumatic reasons would be more likely to occur in older people (3).
Other factors can make a rotator cuff injury more likely, such as being a smoker, having high cholesterol, thyroid problems, or having postural problems in the neck and back).
Several types of conditions can affect the rotator cuff such as tears to the muscle/tendon, inflammation of the tendons (tendonitis/tendinopathy), or having a frozen shoulder (3,4).
What are the symptoms of a rotator cuff injury?
The most common presentation of a rotator cuff injury is pain in the shoulder which comes on suddenly or gradually over time, the pain can be felt in various locations around the shoulder or down into the upper arm. Range of motion is not normally limited, although people with a rotator cuff injury often reduce movement to also control the pain. Often people will have had the pain for a while and have managed to adapt their movement and habits to lessen the pain, however when this becomes ineffective then this is when they seek care. Very commonly people will have problems with overhead activities due to the rhythm of the shoulder movement being disrupted. More passive symptoms are also common such as pain at night, especially when lying on the affected shoulder (3, 4).
It is also possible to have a rotator cuff tear and not have any symptoms, in fact non-symptomatic rotator cuff tears are found in 62% of elderly people, common enough to be described as an aspect of a normal aging process by some researchers (5).
How do you get a rotator cuff injury better?
Treatment options for rotator cuff injuries depend on the type of injury, and often the age of the person suffering it.
For most rotator cuff problems, the first line of treatment will be manual therapy and exercise. Often this will involve massage and joint mobilization techniques to help remove tension in the unaffected muscles and optimize joint position of the various shoulder joints. This will be coupled with effective strength and stretch exercises to improve the function of the torso and should muscles, while not aggravating the affected part of the rotator cuff (6).
This approach can be effective even when there has been a complete tear of a part of the rotator cuff, and if it is to be effective it will be evident within 6-12 weeks (4). Often a corticosteroid injection can be used as part of this method of treatment but there is not much evidence to say that the use of steroids is effective on their own (7).
For people who do not respond to this type of management then a surgical repair of the cuff may be necessary (8).
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References
1 – Maruvada S, Madrazo-Ibarra A, Varacallo M. Anatomy, Rotator Cuff. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441844/
2 – Yamamoto N. A review of biomechanics of the shoulder and biomechanical concepts of rotator cuff repair. Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology. 2015; 2(1):27–30.
3 – Huo HC, Luo ZP, Cofield RC, An KN. Influence of rotator cuff tearing on glenohumeral stability. Journal of Shoulder and Elbow Surgery. 1997; 6(5):413 – 422, (2B).
4 – May T, Garmel GM. Rotator Cuff Injury. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547664/
5 – Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014 Dec;23(12):1913-1921. doi: 10.1016/j.jse.2014.08.001. PMID: 25441568.
6 – Collin PG, Gain S, Nguyen Huu F, Lädermann A. Is rehabilitation effective in massive rotator cuff tears? Orthopaedics & Traumatology: Surgery & Research.2015; 101(4): S203-S205.
7 – Dang A, Davies M. Rotator Cuff Disease: Treatment Options and Considerations. Sports Med Arthrosc Rev. 2018 Sep;26(3):129-133.
8 – Schmidt CC, Jarrett CD, Brown BT. Management of rotator cuff tears. J Hand Surg Am. 2015 Feb;40(2):399-408