Function: The rotator cuff muscles originate from the various surfaces on the shoulder blade (scapula) and attach to the top of the arm bone, wrapping around what is called the head of humerus. Co-ordinated contraction of the rotator cuff muscles keeps the head of the humerus centred in the socket during arm movement. Without this action the shoulder becomes weak, the forces of arm movement are not well controlled, and injury and degeneration are likely. A secondary role of the rotator cuff is to assist movement of the arm into internal and external rotation (Wilk and Arrigo, 1993).
Injury: An injury to the rotator cuff might be indicated by symptoms such as an ache around the shoulder and down into the arm; a pinching feeling with movements over head; an arc of pain as you lift your arm up to the side (abduction): or a sharp catching pain with rapid or unusual movements of the arm. The time taken for these symptoms to develop depends on the mechanism of injury.
Injury to the rotator cuff can occur in a number of ways but usually involves one of two general mechanisms:
(A) Acute onset: High forces / trauma: eg. falls onto the shoulder crush the rotator cuff muscles between the humerus and tip of shoulder blade. Heavy unexpected loads / rapid loading of the rotator cuff muscles can strain the muscle fibres eg. catching a heavy object or having your arm pulled forcefully.
(B) Slow onset: A poor balance of strength between the different muscles of the rotator cuff allows the head of humerus (HOH) to move out of position and the rotator cuff muscles can be pinched between the HOH and tip of shoulder blade (Acromion). Additionally poor scapula control muscles, tightness of large muscles such as the pec and lat, and even poor posture, causes poor positioning of the scapula at rest and with movement.This again leads to pinching/increased stress on the rotator cuff fibres between the HOH and the Acromion.
Repair: Fixing this injury involves identifying and addressing the factors that caused the damage. At Red Hill physiotherapy we will use assessment of general posture, muscle length, strength of the rotator cuff, scapular stability and a number of other testing methods to determine the likely cause of your rotator cuff injury. We will also identify any contribution from the neck, thoracic cage, and pelvis.
In cases where the damage to the rotator cuff is minimal to moderate we will use hands-on methods of treatment for pain relief and to correct these issues. We also encourage, where possible, a program of self management involving rotator cuff/scapular exercises, stretches and postural changes specific to your problem. The management of your injury will progress as you begin to heal and will always incorporate functional / sport specific components.
In cases where severe damage is suspected you may be referred for an Ultrasound or MRI scan to help clarify the nature of the problem. If it is thought that you may require surgery an appointment with an Orthopaedic Specialist will be arranged. Information, explanation, and ‘prehabiliation’ exercises from your physiotherapist will be an important part of your preparation for surgery if it is to go ahead. Post operatively you will be managed in a number of different ways depending on the surgical methods used. Commonly there are strict limitations to your movement for the first 6 weeks as set by your surgeon. Also a number of rehabilitation drills will need to be done as set by your physiotherapist. Progression of these therapeutic exercises will help you return to full function in 6-12months.