Rotator Cuff Injury
The rotator cuff provides strength and stability to the glenohumeral joint (a ball and socket joint, also referred to as the shoulder joint) and consists of four muscles: the subscapularis, the supraspinus, the infraspinus and the teres minor.
All of these muscles encompass this joint and help to control the joint during rotation. The glenohumeral joint is where the humerus (bone in upper arm) attaches to the scapula (shoulder blade).
The supraspinatus muscle abducts the shoulder and stabilises the glenohumeral joint (movement in the direction away from the body). It originates in the supraspinous fossa of the scapula.
The infraspinatus muscle laterally rotates and adducts the shoulder (movement towards the body) and stabilises the glenohumeral joint. It originates in the infraspinous fossa of the scapula and insets into the Greater tubercle of the humerous.
The Teres Minor laterally rotates and adducts the shoulder and stabilises the glenohumeral joint. It originates from the upper two-thirds of lateral border of the scapula and inserts into the greater tubercle of the humerous.
The Subscapularis medially rotates the shoulder and stabilises the head of humerus in the glenoid cavity.
Injuries to the rotator cuff muscles can be divided into three types: tears to the tendons and muscles, inflammation of the tendons and rotator cuff impingement syndrome. All can differ in severity. Inflammation of the tendons is also referred to as tendinopathy or tendonitis.
In sports injuries the Supraspinatus and infraspinatus are the most frequently occurring injured rotator cuff muscles. Sports and activities that cause a lot of shoulder rotation, such as swimming, tennis, cricket, rowing, painting and decorating often put the rotator cuff muscles under a lot of stress. The activities often result in a repeated action.
Trauma can also cause rotator cuff injury. Any force that causes the arm to rotate internally against resistance or prevents the arm from turning externally can cause damage.
Lifting or throwing heavy objects and falling directly on the shoulder can damage the rotator cuff muscles.
Rotator Cuff Tendonitis
Pain comes on suddenly and acutely, and is the result of recent overuse, for example, repeated throwing of a cricket ball. Pain becomes worse when the arm is lifted above shoulder level; and the pain from this injury can affect sleep. The area might be tender and warm to touch. Range of Movement might be limited due to the pain.
The ‘painful arc test’ is sometimes used to diagnose this condition. A doctor might ask for the arm to be raised, from the side, into an arc. The pain is often felt the most between 70 and 120 degrees.
Rotator Cuff Impingement Syndrome
Pain occurs when the rotator cuff tendon passes in under the space below the shoulder blade (the subacromial space). The tendon becomes trapped in the subacromial space, which results in the tendon becoming worn away, as it is repeatedly scraped by the shoulder blade. In this fragile state it is more likely to tear.
In rotator cuff impingement syndrome the pain is more likely to be chronic (gone on for a long time), rather than sudden and acute. The pain is worse when the arm is raised over the head, and can be worse at night time. As a result of the pain range of movement might be limited.
In addition to the ‘Painful arc Test’, the doctor might perform the ‘Neer Impingement Test’. In this test the doctor will ask for the arm to be straightened, and then raised forwards, with the palm of the hand faced away from the body. If this test is sore to do, then rotator cuff impingement syndrome is likely to be diagnosed.
Rotator Cuff Tears
There are varying degrees of tears: – minor/partial or full/complete. Tears are most common in people over 40 and are a result of a trapped tendon, or as a result of trauma a sudden direct blow to the shoulder, or because of a fall.
The most obvious indication of a rotator cuff tear is pain, and it is often felt over the front and outer part of the shoulder. Specific positions of the arm can make the pain worse, for example brushing your teeth, or waving your arm above the head. Other symptoms can be weakness in the shoulder, or a clicking/catching sensation can be felt when moving the arm. To test for Rotator Cuff Tear the doctor might perform ‘a drop arm test’. In this test the doctor will ask for the person to stand with their arm by their side, and then raise their arm outwards from the side and upwards towards the head. The doctor will then ask for the arm to be returned slowly to the side. If ‘a rotator cuff tear’ is suspected the arm will lower slowly to 90 degrees, and then after 90 degrees the arm will drop quickly to the side.
For both Rotator Cuff Tendonitis and Rotator Cuff tears the doctor or physiotherapist might recommend an MRI scan for confirmation of diagnosis.
Ice can help ease pain and inflammation (particularly in the case of rotator cuff tears). For the first 48-72 hours, ice packs can be administered for 10-15 minutes, every 2-3 hours.
Ice treatment can be continued through the sub- acute stage (3 days-3 weeks), frequency can be reduced according to recovery, and can be continued for as long as deemed necessary.
In the sub-acute stage heat therapy can be applied.
In all rotator cuff conditions NSAIDS (anti-inflammatories} or paracetamol may be necessary. Medical advice should be sought first before administering (in case of possible side effects).
In certain cases doctors might advise Steroid Injections.
Physiotherapy can help by giving flexibility and strengthening exercises in the sub acute and chronic stage of healing. Sports massage can also help aid repair in the sub acute and chronic stage, by improving circulating, breaking down scar tissue, and improving mobility. Massage should not be administered during the acute stage.If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.
In Rotator Cuff Impingement Syndrome it is important that the shoulder is not allowed to stiffen up, and should be kept mobile, however it is important that any exercise that involves repeated movement of the rotator cuff should be avoided. A physiotherapist or Sports massage Therapist can advise on the appropriate joint mobility exercises.
If treatment of the rotator cuff is delayed or ineffective it can result in a condition called “Frozen Shoulder”. This is because, to avoid the pain, the patient becomes more cautious about using the shoulder. The shoulder then gradually stiffens up, and becomes frozen.
Published: November 7, 2011Author: Sophia Cross, BA (Hons) MA