Rotator cuff injuries are very common, very uncomfortable, and most often, pretty annoying! The old saying: “You don’t know what you have until you lose it” can be better applied to your body in that “You don’t know how it can move, until you can’t move it!” It is surprising how these niggly injuries can turn normal daily tasks into painful, restricting challenges. As with all things though, there is light at the end of the tunnel! Knowledge is the first step to recovery, then seeking help in the right places…and finally doing the rehab groundwork to get your rotator cuff buff once more!
My Rotator What?
Your rotator cuff is a group of muscles that run from your shoulder blade to the ball of your humerus (arm bone). You guessed it! These muscles enable you to rotate your shoulder in various different ways; movements that are pretty important for dressing and undressing, doing your hair, scratching you back and various sporting activities. The muscle group is commonly referred to as the SITS group, and also serves to control the position of the ball of your humerus in it’s socket (the glenoid fossa). The muscles that make up the SITS group are:
- Teres Minor
What Busts the Cuff?
There are three main types of rotator cuff injuries:
Minor strains of the rotator cuff muscles occur commonly. Usually they happen suddenly, with a sharp pain or twinge felt in the shoulder area. These strains can cause painful, restricted motion of the shoulder, but normally respond well to rest, stretching and soft tissue therapy.
Complete or partial tears of the rotator cuff tendon are usually seen in the older population, however they can happen in young athletes too. Tears are usually marked by pain when trying to sleep on the affected shoulder and painful, weak shoulder movements. They are mainly caused by significant overload during sporting activity or from trauma.
Tendinopathy basically means pathology of the tendon, or in even simpler terms: tendon not good! There is a wide range of injuries that can be classed under this broad category. Basic knowledge of the anatomy here is necessary to understand the mechanism of tendon damage, so take a deep breath and brace yourself!
Part of your shoulder blade is the glenoid fossa, the socket into which the ball of your humerus fits. This joint is called the glenohumeral joint (GH joint). Another bony part of your shoulder blade is called the acromian process. This articulates with the far side of your collar bone (clavicle) forming the acromioclavicular joint (AC joint). Finally, there is one more bony prominence coming off your shoulder blade called the coracoid process, which helps to stabilise the GH joint from the front. These structures create a tunnel-like area called the subacromial space through which the rotator cuff tendon passes before attaching to the humeral head. This space is important!
If for some reason the rotator cuff tendon is impinged as it passes through this space, it may become swollen and damaged. This is “not good” and the fancy medical term we give it is “Tendinopathy”. The exact reason for the change in the space or in the tendon is not yet fully understood, however the specific diagnoses listed below may be associated with an impingement syndrome:
- Extra bits of bone growing where they shouldn’t
- Calcium deposits
- Enlarged shoulder bursae
- AC joint arthritis
- Injury to the GH joint cartilage
- GH instability
- Biceps tendinopathy
- Nerve root compression in the neck
If you think you may have a rotator cuff injury, it is a good idea to visit a manual therapist who can run through the gambit of orthopaedic tests to determine whether you are, in fact, correct. Sometimes special imaging such as X-Ray, Ultrasound or MRI may be required to assist in the diagnosis.
Treatment depends largely on the type of injury you have. As mentioned before, strains and minor tears usually respond well to rest and soft tissue therapy, while full-thickness tears usually require surgery. In the case of a rotator cuff tendinopathy, the aggravating activity should be avoided and ice should be applied to the painful area locally. Sometimes a once-off corticosteroid injection may be required for pain control and to re-establish movement. In all cases, steps must be taken to correct faulty movement patterns and muscle imbalances which could be causing the tendinopthy in the first place, and a gradual strengthening and stretching rehabilitation program should be implemented. It can take 3-6 months of manual therapy and dedicated rehabilitation to fully recover from a rotator cuff injury, so early diagnosis and dedication are key!
Take your cuff from bust to buff and enjoy all the rotation your shoulders have to offer!
Move Well. Live Well.