Rotator Cuff Injuries
What is the 'Rotator Cuff'?
The 'rotator cuff' is a term that many people have heard of but probably don't really understand. You will hear talk of it down at the gym, or perhaps know someone who says they injured it, but what does it mean?
The shoulder is a very mobile joint - it has to be in order to give us the free range of movement that we often take for granted. If you compare it to your hip for instance, you will quickly realise that the shoulder allows much more movement and in a multitude of directions. But nothing comes for free as they say, and at the shoulder at least, all that movement comes at the cost of stability. Unlike the hip, the socket of the shoulder is shallow to allow free range, and the ligaments that bind it in place are relatively weak and flimsy. Because of this, the shoulder relies greatly on muscular control for reinforcement; correct function relies on having comprehensive, controlled, and well stabilised movement, and it is exactly this that the rotator cuff provides.
Comprised of four small muscles, the 'rotator cuff' collectively wraps around the humeral head and stabilises it in the socket while at the same time generating and dynamically controlling movement. Each muscle plays an individual part in shoulder movement, but the cuff is considered collectively because they all work together (or 'synergistically'). It is an amazing adaptation, but certainly carries a risk of injury, particularly as we age.
Injuries of the Rotator Cuff
Injuries to the cuff most commonly start to occur through mid-life and as we age. Supraspinatus is by far the most observed tendon tear, subscapularis and infraspinatus tears being less common. In the elderly, degenerative tearing of the rotator cuff is almost a given; it is something that we expect to see almost 100% of the time in those over 80 years of age for instance, yet it may remain asymptomatic and not pose the patient any real issues.
So, to a degree, rotator cuff degeneration seems to be unavoidable and a part of the normal aging process. However, in younger and more active individuals, pain arising from tendon inflammation, strains and tears can impact dramatically on shoulder function and quality of life.
- It stands to reason that the rehabilitation of rotator cuff dysfunction is determined by the severity of the injury. In simplistic terms, we differentiate between those that will benefit from conservative therapy, and those for whom surgical repair may be necessary.
- Rehabilitation of the rotator cuff aims to address a number of biomechanical factors. As Physiotherapists, we look at issues affecting the flexibility and strength of the shoulder, scapula, and thoracic spine. Weakness and imbalance of the muscles that control the movement and control of the upper limb must be rectified. And third, all of these components must be brought together into a cohesive whole that allows the patient to get back to the level of activity that they require.
- Low grade rotator cuff issues will respond favourably to conservative treatment and there is frequently no need for any further medical intervention.
- High grade rotator cuff tears can be very problematic and in those cases where Physio treatment is unsuccessful, surgical repair can be indicated. Your Physio will be able to advise you on this, and we will often work directly with Orthopaedic specialists to optimise your treatment.
- Post surgical rehab is a slow journey that can often take 6-12 months to complete, but at the end the outcome is generally very good. We can help you every step of the way!