Rotator Cuff Injury Diagnosis, Rehab & Treatment: Be informed of your options!

Anatomy of the Shoulder

Let’s start by understanding the anatomy. A golf ball on a tee without support isn’t too stable due to the small surface area contact, right? That’s where our rotator cuff comes into play. The shoulder joint is a ball and socket joint, made up of the arm (Humerus), the shoulder blade (Scapula) and the collar bone (Clavicle). The structure is similar to that of a golf ball sitting on a golf tee. The muscles that support and give movement to this structure are your rotator cuff muscles. 3 million Aussies a year visit a medical professional relating to a rotator cuff injury. At Motus Health and Performance we treat all injuries to the shoulder and one of the most common concerns we see in the clinic is the rotator cuff. 

 

What muscles make up the rotator cuff?

4 Muscles that make up the rotator cuff work together to keep the ball in the socket, preventing dislocations.

• Subscapularis
• Supraspinatus 
• Teres Minor
• Infraspinatus

They also work in harmony with the upper arm muscles to lift, rotate and move the arm with precision and control. They allow us to reach, push, pull and throw, and when working efficiently they do this smoothly and without pain.

What are the common Rotator Cuff Injuries? 

The main rotator cuff injuries we see in clinic are: 

1. Rotator Cuff Tendinopathy: Where the tendons of the rotator cuff become inflamed due to overuse or repetitive arm motions.
2. Rotator Cuff Bursitis –  Inflammation of the bursa (fluid-filled sac) and tendon in the shoulder. Often caused by an overload, trauma, an inflamed joint or elder age.
3. Rotator Cuff Tears: These can be either partial or full thickness tears of the muscle due to either: 
   1. Acute trauma ie lifting an object that is too heavy, having the shoulder pulled quickly, or landing onto the shoulder with a large force or 
   2. Degenerative wear from repetitive stress for example from an occupation or sport that requires lifting the arm overhead repetitively.

 

What are the signs and symptoms of a rotator cuff tear?

• Avoidance of reaching or lifting type activities because they cause pain 
• Tenderness to touch, or sleep on the affected shoulder 
• Loss of shoulder range of motion 
• Weakness of the muscles 
• Difficult lifting the arm

 

How common are rotator cuff tears?

Tears of the rotator cuff are common. The prevalence of a rotator cuff tear is 25% in those over 50 and 20% in those over 20 years of age. However only 1/3 of rotator cuff tears are connected to feeling pain.

We can’t stress enough how important it is to truly understand the ability of our body to adapt well. Our pain is not always what is identified as pathology on our imaging. As we’ve mentioned, not one rotator cuff muscle works in isolation, but as a team of four, with additional assistance from the arm muscles. So, we can continue to function, without pain even with rotator cuff injuries if we regain strength in the injured portion, and regain function by optimising the use of the remaining parts of the team. That’s where physiotherapy comes into the picture. 

 

What can you do for your Rotator Cuff Tear? 

1. Pain management:
   Physiotherapy including manual therapy, and the right dosage of exercise is the best place to start. Non-steroidal anti-inflammatory medication can be used to assist when indicated. 
2. Range of Motion Exercises:
   As we know the rotator cuff positions the shoulder joint specifically for the task we’re completing with arm movements. Lack of movement is probably the thing that frustrates you first, and therefore is the target of a good physiotherapy lead recovery program. We do this gradually to decrease pain and promote full function. 
3. Strengthening Exercises:
   Often the rotator cuff injury results in a deficit in muscle strength. An assessment will determine which muscle has weakened, and which movements are affected as a result. Re-strengthening is crucial to stabilise and move the shoulder joint well. We will use tailored exercises specific to your injury and to return you to your desired tasks. 
4. Think of the big picture:
   The position of the upper back and shoulder blade plays a significant role in rotator cuff function. Therefore, we always address and improve the ability for you to control upper back and shoulder blade movement and posture throughout all of your usual daily tasks or sport. 
5. Do all the things!:
   Ultimately, we both want to restore your shoulder’s function, to all of your pre-injury activities. Therefore, we practise reaching, lifting, carrying, pushing, pulling and or throwing without pain or limitation. We’re here to rebuild your confidence and educate you on strategies for long term management and prevention of future rotator cuff injuries. Physiotherapy management alone has shown to be effective in 73-80% of patients with full-thickness rotator cuff tears, without need for later surgical intervention.  

 

When is Surgical Management indicated for rotator cuff tears?

Surgery could be performed on those with the following:

• Symptoms for longer than 6 months that don’t resolve with physiotherapy treatment 
• Rotator cuff tears greater than 3cms
• Significant weakness and loss of function

*Definition referenced from the American Academy of Orthopaedic Surgeons (AAOS)

When should you seek help for your Rotator Cuff Injury? 

It’s worth noting that addressing the issue early on can prevent them from worsening. Delayed treatment can lead to ongoing pain, more extensive muscle imbalance and a longer recovery time. If you suspect a shoulder issue, don’t hesitate to see a physiotherapist. You can do this without a referral or shoulder imaging at Motus.

Can we prevent Rotator Cuff Injuries? 

There are steps that can reduce the risk of incurring a rotator cuff injury: 

• Thorough warm up prior to activities or sports that require repetitive arm motions or lifting 
• Using optimal technique with good positioning of the upper back and shoulder blade to reduce stress placed through the rotator cuff when lifting or strength training 
• Strength training with shoulder specific exercises to increase the threshold of load the muscles can tolerate well 
• Load management and addressing periods of overuse with repetitive reaching, lifting or throwing 
• Frequent activity to maintain upper body strength, mobility and shoulder health 

Let’s wrap it up!

Your rotator cuff is a complex and vital part of the shoulder joint allowing for a wide range of movements and functionality. Understanding it’s anatomy and role helps us to diagnose and treat injuries. If you’re experiencing shoulder pain, or decreased function don’t hesitate to seek the advice of a physiotherapist. Remember you don’t need a referral or a scan for an initial assessment. Early intervention and a tailored rehabilitation program is the best line of treatment to regain pain free movement, strength and return you to the activities you love, or need for work and sport. There is no need to push through shoulder pain, we’re here to help. Contact us today if you need a rotator cuff or shoulder assessment, we’ll get you back to doing the things you love and living with less pain.