According to the Journal of Orthopedics, a little over 22% of the population has a partial or full-thickness rotator cuff tear, with rates increasing steadily with age. At age 60, one has a 54% percent of having had such an injury. While only 34% are symptomatic in and of themselves, even the asymptomatic ones can destabilize the shoulder and increase the risk of additional injury. With an injury this common, it makes sense we should know more about it. Let’s talk a little about what the rotator cuff is and what it does.
The rotator cuff is a group of four muscles in the shoulder. It consists of the supraspinatus, infraspinatus, teres minor and subscapularis; the so-called SITS muscles. They DO rotate the shoulder, but more importantly, the provide stability to the head of the humerus (upper arm bone) within the socket during all movements of the upper extremity. If the rotator cuff is compromised, your upper limb is compromised.
The most commonly injured muscle of the rotator cuff is the supraspinatus muscle; a muscle located at the top of the shoulder. Any number of compensation patterns can create a tightening of the muscles (guarding) of the shoulder, reducing the space for this muscle to move, often pressing on the supraspinatus during movement causing fraying or even tearing. This is called shoulder impingement and it is one of the leading causes of rotator cuff injuries. With shoulder impingement, there is often pain around the mid range as one lifts the affected arm, most commonly at the top of the shoulder or around the deltoid muscle. Other common causes include instability of the shoulder blade and problems of the wrist or elbow. Another common rotator cuff injury is tearing or thickening of the subscapularis tendon. This is a muscle that rotates your shoulder inward.
So how do these injuries come to be? Most commonly, tears to the rotator cuff come from degeneration to the tissues over time, versus a single acute incident. This is strain caused by faulty body mechanics, poor posture, repetitive stresses, etc. Treatment of these injuries ranges from conservative therapies like manual therapy all the way up to surgery. In many cases, surgery for a torn rotator cuff isn’t necessary. Depending on severity and location, they can often heal given the opportunity. The key is to eliminate the stresses that created the problem in the first place. If you don’t, healing is less likely. In my clinic, conservative therapies are the name of the game. I use a combination of Active Release Techniques to create motion and address adhesion, multiple neurologic modalities to address the various compensation patterns, tape to provide additional support, cold laser to help with healing and inflammation and corrective exercises to shore up weak links in the kinetic chain. This works in most cases. If not, that’s when I recommend people consult with an orthopedist for imaging and treatment options.