The Rotator Cuff is made up of 4 muscles that work to control the shoulder joint . Despite being relatively small in size they are rather large in significance and most people seem to have heard of the Rotator cuff in come capacity. I think the majority of people may underestimate just how important the Rotator Cuff is when it comes to efficient functioning of the shoulder.
What does the rotator cuff actually do? How do you know when it’s becoming a problem for you?
There are four muscles that make up the rotator cuff (RC):
- Teres minor,
To put it simply the main role of these muscles are to provide stability for the shoulder by keeping the humeral head (ball) into the glenoid fossa (socket).
INJURY OF THE ROTATOR CUFF
Injuries to the RC can vary from full thickness (complete) tears to partial (incomplete) tears & these injuries can affect one or more of the muscles mentioned above. The mechanism of injury can also vary greatly;
- Acute tear occurs when there is an incident such as lifting something too heavy or dislocating your shoulder. Often this will be associated with pain and there may even be an audible pop or snap, a tearing sensation and immediate weakness of the arm.
- Degenerative tears occur from wear & tear over time. This can simply be a normal part of the ageing process or they can also come from repetitive stress being placed on the shoulder, for example in a baseball pitcher or swimmer. Tears that are degenerative in nature may not have a memorable incident but can present as gradual onset shoulder pain.
SIGNS & SYMPTOMS
How these injuries present themselves will be depend alot on the degree of the tear and type of tear. Some of the more common symptoms are:
- Pain at night, especially if lying on the injured side
- Weakness with using the arm, particularly above the head and with rotational movements
- Crepitus (crackling), pain and clicking with movement
WHAT CAN YOU DO?
The million dollar question: if you have a RC tear what can you do to help?
Physiotherapy can play a pivotal role in the rehabilitation of RC injuries. Management should involve strengthening not only the RC but the surrounding muscles, improving shoulder mechanics and mobilizing muscles that will become tight secondary to the underlying injury. The specific exercises will depend on the severity and your individual circumstances. Conservative management is often the first choice of treatment; it can take 3 months + to full recovery and requires you to be exceptionally diligent with your exercise program.
When making the decision to go down the conservative management path there are a few things that are considered. Your age, level of function and/or pain, whether you intend to return to a certain sport or activity. The risks of surgery also need to be considered.
For example a 29 year old rugby player who dislocates his shoulder and in the process suffers a tear to one of the RC tendons would most probably end up having surgical intervention vs a 52 year old man who suffers a partial RC tear in isolation where conservative management will be sufficient to get him back to his desired level of activity.
It’s a case by case conversation. Surgical intervention requires a 6-12 month recovery period which will include a lot of rehabilitation to strengthen the surgical repaired aspect of your shoulder.
In summary RC tears are a very common condition that we see on a regular basis. They can, in most cases, be managed successfully if time and effort is placed on the rehabilitation process. It’s the kind of injury where you don’t want to skip your physio exercises!
If you are suffering from shoulder pain we would always advise seeking an expert opinion – it might not be a rotator cuff tear but there are many important structures in the shoulder that can cause pain. Active RX are always happy to help so if you have any questions feel free to email or call us.