The rotator cuff is a group of four muscles that help move the shoulder joint. The rotator cuff is also commonly referred to as a stabilizer of the shoulder but there is minimal evidence of this.
The four muscles are grouped together because they all originate off the scapular (shoulder blade) and attach to the humerus (upper arm bone) at close but different points.
These muscles can be injured through direct trauma such as a fall or the arm being jerked away from the body unexpectedly. Repetitive motion is also a common reason for tearing or tendonitis (inflammation of a tendon).
The Mayo Clinic lists the most common symptoms from rotator cuff pain:
The muscles of the rotator cuff include supraspinatus, infraspinatus, teres minor and subscapularis.
Tears in the rotator cuff muscles can be confirmed using diagnostic imaging procedures such as MRIs and ultrasounds. MRIs of the shoulder region produce images which show the muscles, bones and tendons in the area. These images can determine if there is any tearing or impingement present in the muscles and tendons of the rotator cuff! They can also help to determine the severity of a tear. Ultrasound may also be used to confirm the presence of rotator cuff injury. If our osteopaths think you might have a tear, they can refer you to have these procedures done!
A strain in the rotator cuff occurs when a tendon is stretched beyond its comfortable range but does not experience separation from the bone. This can occur as a result of landing awkwardly on your arm or overusing the tendon in sporting or occupational activities. Depending on the extent of the damage, these strain injuries can vary from mild to severe.
However, a rotator cuff tear occurs when the tendon becomes partially or completely separated from the bone or is ripped somewhere along its length. These injuries are generally more painful than strains, and typically occur as a result of sudden and major trauma, rather than overuse. Tears are also often characterised by more severe pain and muscle weakness compared to strains.
Overuse or RSI injuries become a factor if there is poor biomechanics through the shoulder AND body in the first place. For example, if someone has broken an arm or sprained a wrist in the past, it’s not just the injury that is affected, there is a domino-effect into the joints through the whole arm, even after the initial injury has healed. All joint influence how well each other move.
When any of these joints in the arm (fingers, wrist, elbow, shoulder, ) have been injured, it has a big impact on the other joints as a protective factor from the pain. This may result in the shoulder working extra hard because the let’s say the wrist is not doing its total job after a wrist injury.
If the shoulder continues to be relied upon to take up the slack for a long period of time, then muscles around the shoulder like the rotator cuff muscles, are overused and this results in more long-term injury. This happens so often and these joint relationships are hugely overlooked.
The other big influencer for the arm is the rib cage. We sometimes forget this relationship, but of course they have a connection via the shoulder blade’s movement over the ribcage! With a direct link like this, if the rib cage has limitations in movement, then either the shoulder blade doesn’t move well OR has to take up the slack, and we could end up with the same overuse problem I mentioned before.
But what might affect the ribcage?
By assessing using orthopedic testing, mobility testing and taking a comprehensive case history, many rotator cuff injuries are recognised. Mild rotator cuff injury is treated with ice, rest, and anti-inflammatory medications (such as ibuprofen and others). Generally, physical therapy such as osteopathy and using gradual exercise rehabilitation is required. Exercises are used that are specifically designed for rotator-cuff strengthening. We use hands on therapy to help with pain symptoms and increase some range of motion.
The bigger aim is always to take away the causative factor in the first place, so this might involve working with the elbow, wrist, or rib cage as well as directly on the shoulder.
Pain in the rotator cuff or surrounding area may occur as a result of the following conditions:
Patients experiencing partial tears in the rotator cuff often do not require surgery, and can instead focus on resting the affected shoulder, aiming to improve the range of motion of the joint and applying ice and pain medications when necessary. However, if a complete tear is present, the pain and weakness can be debilitating for the patient. If these symptoms persist for several months and are not improved through non-surgical methods, then surgery is often recommended. The procedure commonly involves the tendon being re-attached to the bone.
The first step with a shoulder injury is to see an appropriate manual therapist such as our Osteopaths.
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