Rotator cuff injuries are among the most common musculoskeletal injuries, able to happen both traumatically and non-traumatically. They are also the leading cause of shoulder surgery and one of the primary reasons people come to see me in clinic. Before we talk more about the injuries, let’s talk more about the rotator cuff itself.
What is the rotator cuff?
The rotator cuff is a group of four shoulder muscles: the supraspinatus, infraspinatus, teres minor and subscapularis. They all have tendon attachments on the humeral head, forming a cuff over the top of the shoulder, hence the name. Each has its own basic function. The infraspinatus is an external rotator of the shoulder, the teres minor is also an external rotator, the subscapularis is an internal rotator, and the
supraspinatus is an abductor. Collectively, they have a more important combined function — they stabilize the head of the humerus for ALL shoulder motions. Thus, it’s not really possible to have a shoulder problem that doesn’t involve the rotator cuff to one degree or another.
How common are rotator cuff tears?
In the United States alone, more than two million people suffer a rotator cuff injury every year. By the age of 50, nearly 75% of people have or have had a rotator cuff injury. They happen to all ages and all genders, though they are more common in adults.
What causes an injury?
Rotator cuff tears come in two main varieties, partial and full. They can happen suddenly with trauma, or gradually over time. Some common causes of gradual, degenerative tears include:
Bone Spurs: Bone spurs can form under the acromion process of the scapula where the supraspinatus passes underneath. This can lead to tearing or fraying of the muscle.
Decreased blood flow: The rotator cuff doesn’t have especially great blood flow to begin with, and it typically gets worse as we age. This makes the tissues vulnerable to injury and slow to heal.
Overuse: Repetitive motions and stresses are among the most common causes of rotator cuff injuries.
Anatomical variations: The acromion process of the scapula can vary in its shape. A type I acromion is flat. Types II and III are curved or hooked respectively. Types II and III make the supraspinatus more vulnerable to compression, fraying, and tearing.
Shoulder impingement: When we don’t have enough space between the humeral head and the acromion, the supraspinatus can be impinged leading to inflammation, fraying, and tears. Click here for some exercises to help with shoulder impingement.
What are some additional risk factors?
- Family history of rotator cuff and other shoulder problems.
- Poor posture. Posture alters the mechanics of the shoulder making us more vulnerable to injury.
- Smoking. Smoking slows healing and decreases circulation.
- Being over 40.
What are the symptoms?
- Shoulder weakness or problems lifting things.
- Shoulder pain that is worse at night or when resting the arm.
- Difficulty or pain raising the arm, especially out to your side.
- Popping or clicking sounds/sensations with movement of the arm.
Typical diagnosis and treatment of injuries
Rotator cuff injuries are are typically diagnosed by medical imaging. Orthopedic tests aren’t especially definitive. Standard treatment includes rest, wearing a sling, medication (including cortisone injections), and physical therapy. In more severe cases and cases involving full-thickness tears, surgery may be indicated.
How do you address rotator cuff injuries at The Body Mechanic?
At The Body Mechanic, I take a multi-pronged approach to deal with rotator cuff injuries. This includes:
- Cold laser to reduce inflammation and speed healing
- ART® to address restrictions around the shoulder girdle and restore normal motion
- Resolving compensation patterns that may have contributed to or resulted from the injury
- Kinesiology taping to support shoulder function as it heals
- Corrective exercises to improve circulation to the shoulder and build strength. Some good ones to get started with include these.
Most rotator cuff injuries don’t result from a single event or moment in time. They typically involve a gradual wearing down of the tissue over time due to preventable factors. Don’t wait until you have a full-blown tear to get these issues resolved. The earlier you address them, the easier they are to treat.