What is the Rotator Cuff?
The rotator cuff is a group of muscles located at the shoulder joint, running between the shoulder blade) and upper arm. Like most muscles, the rotator cuff has a tendon at each end which serves to attached the muscle to the bone. Unlike other joints, our shoulders are very mobile and able to move in multiple of directions. Such movement is had at the sacrifice of localized joint stability. The rotator cuff helps to position and secure the ball in the socket as it moves through range into different positions. The muscles of the rotator cuff are quite small, hence cannot generate large amounts of power. These muscles are constantly working to a low level however, hence are required to have greater endurance capacity.
How Does The Rotator Cuff Get Injured?
As the rotator cuff is made up of muscles, any injury that can happen to a muscle can affect the rotator cuff. Any injury to the rotator cuff which affects function will have an impact on the shoulder, which can result in any one of pain, instability, weakness, reduced movement or power etc.
The muscles of the rotator cuff can become weak, normally through disuse or a reduction in activity levels, just like another muscle group – “use it or lose it”. If the muscles are weak, their ability to perform their role is impaired, hence its ability to stabilise the shoulder joint in its optimal position is compromised. As such, the muscle needs to be strengthened to the appropriate level and demands of the individual’s lifestyle and hobbies, whether that’s to a level of general every day activities or playing more challenging sports such as tennis, golf, rugby etc., which obviously demand a greater amount of stability due to their overhead positioning etc.
The muscle can be inhibited by pain, which may give the appearance of weakness. Pain inhibition decreases the body’s ability to activate and use the muscle. The muscle may be healthy and not actually injured but just not working efficiently or effectively. In this case the muscle “weakness” is a symptom and not the cause. Identification and treatment of the cause are key but equally the rotator cuff muscles need to be re-activated through appropriate use to reduce symptoms.
And finally, the muscle can be damaged or strained (muscle tear). The muscle fibers themselves are damaged – either from repetitive over load or a specific injury such as a sudden forceful movement. Again, this will present as weakness of the rotator cuff and affect shoulder movements and stability. We would expect to see pain on or near the site of the injury, as you would expect with muscle injuries anywhere else in the body.
Muscle strains are graded by clinicians from 1 to 3 depending on severity.
Grade 1 strains are mild and only affects a few muscle fibers and has minimal power or function loss.
Grade 2 strains covers a bigger range, but more fibers are affected with more weakness and pain
Grade 3 strains are complete rupture of the muscle – sometimes there will be no pain but would have a significant weakness
Muscle injuries are generally considered to take approximately 6 weeks to heal but this depends on the severity of the injury amongst many factors both intrinsic and extrinsic to the patient. Naturally the body will attempt to heal the damage but often needs assistance or input to aid and speed up recovery. This section only covers muscle injuries to the rotator cuff, the tendons
associated with each muscle can be damaged or injured – please see Tendon Injuries in the condition section for more detail.
Signs and Symptoms
- Pain on movement of your shoulder – particularly with overhead activities or repetitive movements. It may present as a deep ache at rest or give sharp pain on movement
- Weakness or reduced power with certain movements, often with rotation movements. This is often accompanied by pain. Common complaints include changing gear, brushing hair or reduced sporting ability.
- Reduced range of movement – hand behind your head or behind your back – it may feel tight or be limited by pain.
Risk Factors for Rotator Cuff Injuries
- Age – as we age our muscles slowly deteriorate, become less robust and more susceptible to injury
- Occupation – physical or demanding jobs will place increased stress onto muscles
- Sport or hobbies – repetitive, overhead, throwing or contact sports can all cause injury to the rotator cuff
- Decreased muscle strength – the stronger the muscle the better it can protect its self from damage
How Can Physiotherapy Help?
Physiotherapy can be effective in treating rotator cuff injuries. A detailed assessment of the shoulder and surrounding structures will help to correctly identify the source of the symptoms.
- Restore normal movement and function of the shoulder joint / complex
- Manage pain levels
- Educate patients to the cause of the initial problem
- Prevent re-occurrence of injury
- Achieve specific patient goals
Treatment may include
- Advice regarding activity and exercise modification, positional or posture changes
- Individual exercise programme to strengthen, activate or promote healing
- Acupuncture to address pain levels or specific areas of muscle spasm
- Soft tissue treatment of muscles – often addressing neighbouring muscles which are compensating for the injury
- Taping – where appropriate to help offload or provide postural feedback
What Can I Do To Help This Condition Myself?
If you are yet to attend physiotherapy, patients can somewhat help speed up the healing process or manage the symptoms.
- Appropriate analgesia (pain medication) can help manage the pain levels and often facilitates normal movement of the joint – and normal movement promotes normal healing. For further advice, it is recommended to see your G.P. or pharmacist, especially if you are already taking other medication.
- Relative rest and avoidance of the aggravating factors can help normal healing of the affected tissues. Relative rest does not mean complete rest and it is important to still move and use the shoulder as able in a pain free range; otherwise it could become weaker through inactivity.
Still concerned about a possible rotator cuff injury, & self treatment is not helping? One of our highly qualified physiotherapists can help, with immediate appointments often available across one of our many clinic locations – Royal Crescent, Newton Mearns, Clarkston, Mosspark, & Kirkintilloch.
Please call 0141 353 0906 to appoint.