1. What is it?
The rotator cuff is made up of the four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) and their tendons that attach the upper arm to the shoulder blade.
These muscles allow for movement of the shoulder, which is the most mobile joint in the body, and provide stability by helping to hold the ball shaped portion of the upper arm securely in the shoulder socket.
Damage or irritation to any of these muscles or their respective tendons (tendons are the structures that attach a muscle to a bone) is considered a rotator cuff injury.
Injury can be of the following types:
a) Tears (of the muscle, either partial or full thickness)
b) Tendonitis (inflammation of the tendon)
c) Tendinosis (degenerative changes in the tendon usually due to chronic tendonitis)
2. What are the causes/predisposing factors of injury?
The main causes of injury are: trauma, repetitive activities, poor posture, anatomical variation and wear and tear
a) Trauma: This can be from a fall on an outstretched arm, or trying to lift something that is too heavy or using poor lifting technique.
b) Repetitive Activities: Using the arm in an overhead position repeatedly is the most common culprit.
c) Poor Posture: Having the shoulders slumped forwards in a slouched position can pinch or irritate rotator cuff muscles.
d) Anatomical Variation: The shape of the bones in the shoulder can limit the space for the rotator cuff tendons causing irritation.
e) Wear and Tear: As we age the substance of the tendon and muscles can begin to deteriorate. This makes them more susceptible to injury.
3. What are the symptoms?
Shoulder pain that occurs when reaching overhead or behind the back, performing lifting or pulling movements or lying on the affected shoulder is the common presentation. There may be associated weakness and loss of mobility too. Pain that is more intense at night is also seen in many cases. Most commonly, I see patients that experience severe pain as they try to raise their arms in front of them up to and above shoulder level.
4. What can be done to prevent and treat this injury?
My recommendations for prevention are to avoid repetitive activities with the arms overhead and to do exercises to strengthen the rotator cuff and associated muscles.
Treatment of rotator cuff injuries can be frustrating and lengthy in duration. This is due to the inability to properly rest the area and the sometimes poor blood supply to the damaged tissue.
Common treatment modes are: rest, ice, anti inflammatories, ultrasound, electrical stimulation, soft tissue therapy (I like using cross-friction massage), rehabilitation exercises and in some cases corticosteroid injections and surgery.
I would advise anyone who suspects they have a rotator cuff injury to see their healthcare provider for an evaluation. If warranted, more advanced diagnostic testing can be performed to determine the nature, extent and prognosis of the injury.