Rotator Cuff Injuries
Rotator cuff injuries are a common source of shoulder pain. The rotator cuff is a group of four stabilizing muscles that surround the humeral head, the ball portion, of the shoulder’s ball and socket joint.
Rotator cuff injuries can have many different presentations depending on whether the tendons are being pinched, or if there is an irritation or tear in the tendon. The muscles can be injured in a variety of different ways from repetitive overhead work, poor posture, or weight training with poor form. It is also common that as we age we experience some type of rotator cuff dysfunction due to wear and tear of the tendons from our lifestyle and activities.
Your physiotherapist will be able to conduct a thorough and detailed assessment to determine if your shoulder pain is due to a rotator cuff injury, whether other structures are also involved and if there are contributing factors that exacerbate your symptoms or are limiting your recovery.
What is the Rotator Cuff and Why is it Important?
To understand why the rotator cuff is commonly injured around the shoulder and why the rotator cuff muscles are so important, it is helpful to understand the anatomy of the shoulder a bit better.
The shoulder is made up of three bones: (1) the collar bone (2) the shoulder blade which forms the socket and (3) the arm bone also known as the humerus which forms the ball. The socket of the shoulder joint is quite shallow and the ball is very round and thus, the boney structures are not very stable. Without the joint capsule, ligaments, cartilage, muscles and tendons that surround the bones the ball would pop out of the socket frequently.
The rotator cuff is a group of four muscles that connects and holds the ball of the arm bone to the socket of the shoulder blade. The four muscles of the cuff work together to keep the ball centered in the socket and thus improving the stability of the joint. They include, the Subscapularis, Supraspinatus, Infraspinatus and Teres Minor. The most common type of rotator cuff tear involves the Supraspinatus muscle.
How is the Rotator Cuff Injured?
Injuries to the rotator cuff can occur with direct trauma to the arm/shoulder such as a fall onto an outstretched arm, fall onto your shoulder or any direct blow to the shoulder. Rotator cuff tears can also be associated with collar bone separation injuries and dislocated shoulders.
Most commonly, rotator cuff injuries are degenerative in nature and are caused by the gradual wearing down and fraying of the tendon. This slow process occurs when there is repetitive stress to the tendon. This can be perpetuated by repetitive overhead work, weight training with improper form, arthritic changes in the shoulder joint or postural dysfunctions that cause the rotator cuff tendons to be strained or pinched (impingement).
What are the Symptoms of a Rotator Cuff Injury
Rotator cuff injuries can be associated with pain around the shoulder and upper arm region. Sometimes, pain can even refer past the elbow. The pain intensity can vary based on the severity.
Often you will experience pain with overhead tasks, with movements that require rotation of your arm and/or while lifting your arm out to the side. Also, it is typical to experience pain when you are laying on the affected arm. You may also experience weakness in your arm or clicking in your shoulder.
How can you Prevent a Rotator Cuff Injury?
Rotator cuff injuries can be prevented by the following:
- Performing regular shoulder, neck and upper back exercises to maintain strength and flexibility
- Performing rotator cuff strengthening exercises
- Performing postural muscle strengthening exercises
- Utilizing proper form and posture when lifting or moving heavy weights
- Resting the shoulder when experiencing pain
- Taking adequate rest periods in occupations that require repetitive lifting and reaching
- Visiting a massage therapist regularly to mobilize your upper back and tight shoulder muscles
- Visiting a physiotherapist right away if you are experiencing any pain in your shoulder
What are the Best Exercises to Help with a Rotator Cuff Injury?
Before you start to strengthen the Cuff muscles, it will be important to ensure that the muscles around the shoulder blades are strong and stable. There are a number of important muscles that control the shoulder blade including the lower, middle and upper fibers of trapezius, the rhomboids and the pectorals. One other very important muscle around the shoulder blade that should be targeted is your serratus anterior. Watch the video below for some guidance on how to strengthen the serratus anterior.
Once you have developed strength around the shoulder blade and have reduced pain in your shoulder, you are ready to start some rotator cuff strengthening. The video below, demonstrates a very effective rotator cuff strengthening exercise that you can perform at the gym or at home using a thera-band. To help prevent an injury but also to help you heal.
Warning: Do NOT perform this exercise through pain
Treatment for Rotator Cuff Injuries
Physiotherapy and Chiropractic management of rotator cuff injuries can be very effective.
Treatment may include manual hands on release of tight muscles and structures, laser or ultrasound for cell regeneration and to speed up tissue healing, strengthening and stabilization of supporting musculature, mobilizations to stretch the shoulder joint, taping and acupuncture for pain relief.
Your Physiotherapist and Chiropractor will determine the best course of action based on your specific presentation and the factors that are contributing to your dysfunction. They may refer you for Massage therapy, or if they are not seeing the progress they expect they will refer you to a Sports Medicine Doctor. Sports Medicine doctors can help direct you to other treatment options if required and can help with diagnosis through imaging so you can make sense of your prognosis and why you may not be responding to treatment as expected.
In very few cases, surgery may be required. If this is the case, physiotherapy before and after your surgery will be important to achieve the best outcomes. Also, corticosteroid injections can be used to help alleviate symptoms temporarily if you are unable to participate in physiotherapy due to intense pain.
How Long Does it Take to Recover from Rotator Cuff Injuries?
Normally soft tissue healing time, provided the right amount of rest and activity, should take 6-8 weeks. However, in the case of the rotator cuff, clinically I have found it takes longer, closer to 12 weeks. The rotator cuff is constantly working to hold your ball in the socket. Therefore, it does not get an adequate amount of rest in the early stages of healing and can become easily flared, regressing the healing process. For this reason, it is so important that when you start to feel shoulder discomfort that is not changing or getting worse that you book in with a Physiotherapist, Chiropractor or Sports Medicine doctor for proper diagnosis, treatment and optimal outcomes.
Rebalance Sports Medicine is conveniently located in downtown Toronto. All of our physiotherapists, chiropractors, sports doctors and massage therapists have extensive experience treating rotator cuff injuries and would be happy to help you recover from your injury. Book your appointment today or call us for more information.
Alishah Merchant, FCAMPT Physiotherapist
Alishah Merchant is a FCAMPT physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.