Do you have shoulder pain? A likely structure causing your shoulder pain or loss of shoulder function is the rotator cuff.
What is the rotator cuff?
The rotator cuff is the name for the group of muscles and tendons on the back part of your shoulder. The rotator cuff starts on the shoulder blade, extending over your shoulder, with the tendons anchoring on the upper arm bone and surrounding the ball of the shoulder like a cuff—hence the term rotator cuff. The rotator cuff muscles are known as stabilising
muscles, because they hold the ball of the shoulder in the socket by balancing the forces of the bigger shoulder muscles. They also help the bigger muscles move the shoulder correctly.
The rotator cuff consists of the supraspinatus, infraspinatus, subscapularis and teres minor muscles.
How does the rotator cuff get injured?
You can injure your rotator cuff in two ways;
a traumatic injury like a fall or in a tackle at footy
a chronic injury can occur slowly due to repetitive overuse of the muscles
What type of injuries occur?
Tear - this can be a partial or complete tear and can have an impact on treatment decisions
Tendinosis - a degeneration of the tendon's collagen in response to chronic overuse
Bursitis - inflammation of the bursa (fluid filled sac) at the top of the shoulder joint
Diagnosis
If you have torn your rotator cuff acutely, you will experience sharp pain in the shoulder and upper arm. You may have difficulty lifting your arm or you may have a painful arc of pain between 60 and 120 degrees when you lift your arm out by your side.
Chronic tears don’t have that intense pain. However, in both acute and chronic tears, there is a deep, dull ache in the shoulder and you may have difficulty sleeping, particularly if you are lying on that shoulder. Your arm will feel weak and you’ll have pain reaching forward and overhead.
Your physiotherapist will listen to your history and do a range of functional tests to determine if you have injured your rotator cuff.
Your physiotherapist or doctor may send you for an ultrasound scan, particularly if the rehabilitation isn't progressing as well as hoped, to confirm the presence of a rotator cuff injury.
Rehabilitation of your injury
After working out that the rotator cuff is not functioning properly a program of rest from aggravating activities and overuse, manual therapy and a graduated exercise program to progressively increase the loading of the rotator cuff.
Your physiotherapist will be able to educate about how to manage your injury and guide you through your exercise program.
If your shoulder does not start to improve within 4 weeks of commencing a quality rehabilitation program then other options can be considered to help the process. You may be referred for a cortisone injection to help reduce inflammation. Often this allows some of the pain to settle so that you can then perform your exercises more effectively.
If the shoulder disability is so great and not improving then you may be referred to an orthopaedic surgeon for an opinion. This may result in surgery to repair the rotator cuff or referral back to physio to continue (it will just take longer than expected).
If you do end up having surgery, it is a 6 month plus recovery, involving initial rest in a sling and then physiotherapy rehabilitation to get the shoulder strong again so you can get back to the activities you would like to!