What is the Rotator Cuff?
Rotator cuff injuries are the most common types of shoulder injuries.
The rotator cuff is a group of four muscles that connect your shoulder blade (scapula) to your arm (humerus) and help stabilize the shoulder joint. These muscles work together to help you lift your arm overhead and rotate your arm in and out. The four muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis.
There are different types of injuries to the rotator cuff. The less serious and more common injuries are called shoulder impingement and rotator cuff tendinitis. Shoulder bursitis is a condition that does not directly affect the rotator cuff tendons, but it can occur in conjunction with impingement and tendinitis. The more serious injury is a rotator cuff tear.
Types of Rotator Cuff Injuries
Impingement in the simplest terms means something is being “pinched”. This could be a rotator cuff tendon, shoulder ligament, or your bursa. All of these structures go under a bone called the acromion which is a part of your shoulder blade (scapula). When you move your arm in certain positions, the items underneath the acromion can become pinched or compressed, causing an increase in pain and inflammation.
Rotator Cuff Tendinitis
When the rotator cuff tendons are being compressed, they become inflamed and irritated. Since they are surrounded by bone, when they swell, this increases the pressure inside your shoulder joint. The goal for rotator cuff tendinitis is to decrease the inflammation and allow the tendons to heal.
Bursas are small fluid-filled sacs in multiple areas of the body that help reduce friction. Your shoulder bursa is located in the space between your rotator cuff tendons and the acromion. When you lift your arm in certain positions, this space becomes narrowed, and the bursa can become inflamed and begin to swell.
Rotator Cuff Tear
When shoulder impingement and/or tendinitis goes untreated, it can lead to a more serious condition called a rotator cuff tear. This is due to the tendon(s) being irritated and getting less blood flow over time, potentially causing the tendon(s) to develop small tears or holes. There are different types of rotator cuff tears, depending on how severe the injury is and how many tendons are involved.
1. Partial Rotator Cuff Tear
This type of injury means that only part of the tendon is torn. This typically involves the supraspinatus muscle, which is located on top of the shoulder blade. Repetitive arm motions over time can cause fraying of the tendon, which leads to pain in certain motions. It is possible to heal a partial tendon tear without needing surgery. However, it is important to seek medical help to prevent these types of injuries from progressing to a full thickness tear.
2. Full Thickness Rotator Cuff Tear
Full thickness tears mean that the tendon is completely torn in half. This can involve only one tendon (more common) or multiple tendons (less common, more severe). This type of injury requires medical intervention including cortisone injections, physical therapy, and potentially surgery. They can be diagnosed through an MRI.
What Causes Rotator Cuff Injuries?
There are multiple causes of rotator cuff injuries.
The most common cause is overuse. Jobs that involve more repetitive arm motion such as cleaning, construction work, painting, or lifting heavy objects put increased strain on the rotator cuff. Certain sports such as golf, tennis, baseball, weightlifting, and swimming can also place stress on these shoulder muscles. However, general wear and tear over the years can also cause the tendons to break down and potentially tear. Tendons start to lose their elasticity as they age, so it is easier for older adults to injure their rotator cuff tendons than someone in their twenties.
In addition to overuse conditions, here are other common causes of rotator cuff injuries:
- Repetitive overhead movements
- Weakness in rotator cuff muscles
- Lack of blood supply
- An injury such as a fall
- Poor posture
- Thickening of the bursa or ligaments
- Osteoarthritis and/or bone spurs in shoulder joint
- Anatomy differences in the shape of the acromion, which can decrease the space underneath the acromion (subacromial space)
Signs and Symptoms of Rotator Cuff Injuries
Pain is typically located in the front of the shoulder and extends to the side of your arm. Patients also can report pain in the back of the shoulder.
-Pain in front of shoulder
-Limited shoulder mobility
Typically pain is reproduced with certain arm movements including reaching behind your back, extending your arm overhead, and moving your arm out to the side. You most likely will also experience some weakness in your shoulder muscles if trying to lift an object in these positions. Throwing a baseball and cleaning windows is often challenging and painful. Most patients also report pain and difficulty sleeping on the side of the painful shoulder.
Rotator Cuff Tear
Pain is more severe in a rotator cuff tear, and the pain may be present at rest and not only with certain movements. Typically more significant weakness is noted with a rotator cuff tear, and it may be difficult to raise your arm. The type of pain present in a rotator cuff tear also may depend on if the tear is acute (short-term) or chronic (long-term).
- Acute Rotator Cuff Tear:
- A specific quick arm movement or injury such as a fall caused the rotator cuff tendons to tear
- Can cause extreme sharp or immediate pain
- Pain can be present at rest
- Significant loss of arm strength
- Chronic Rotator Cuff Tear:
- May not have been caused by a specific injury
- Typically occurs over time, starts as shoulder impingement until it progresses to a tear in the tendon
- Starts as mild pain and then may become more widespread and constant
Physical Therapy for Rotator Cuff Injuries
In the majority of cases, shoulder impingement and partial rotator cuff tears can be successfully treated conservatively through Physical Therapy. Complete rotator cuff tears can also be treated through PT to help reduce your pain and improve your range of motion and strength.
During your first session, your PT will ask you multiple questions so he/she can figure out what is the underlying issue of your pain. These questions could include:
- What arm movements cause your pain?
- Is your pain worse in the morning or at night?
- Is your pain always present or is it caused by a single movement?
- When did your shoulder symptoms begin?
- What activities are you unable to perform due to your shoulder pain?
The initial goal of PT is figuring out what is the source of your shoulder pain, whether it be rotator cuff related or another type of shoulder injury. This will help create a treatment plan that was designed specifically for you. Typical PT sessions will include:
- Pain Management: Your PT will help determine which movements cause your pain and help you avoid them in the beginning of treatment to decrease your symptoms.
- Range of Motion and Stretching Exercises: Often your shoulder motion becomes limited due to pain. Your PT will prescribe you stretches for your shoulder to help regain your mobility to help you reach up and out to the side without pain.
- Strengthening Exercises: The rotator cuff muscles are typically weakened which makes it challenging to perform your daily activities. Your PT will give you strengthening exercises for your rotator cuff and postural muscles to reduce the strain in your shoulder.
- Manual Therapy: Hands-on treatment also assists in loosening your tight shoulder muscles and improving the stiffness in your shoulder joint. Dry needling is also an effective approach for relieving low back pain!
You will receive a home exercise program that was designed specifically for you, and your PT will regularly check in with your exercises to make sure they are still beneficial for you. After you graduate from PT, these exercises will be your tool to help prevent future episodes of shoulder pain.
Injuries to the rotator cuff are extremely common, and our physical therapists are specifically trained to help relieve your symptoms. Regardless if you have had shoulder pain for years or just started experiencing shoulder pain recently, we can assist in alleviating your pain! Click here or fill out the form below to schedule an appointment!