Rotator cuff (RC) injuries are incredibly common, particularly as we age. Due to the structure of the shoulder joint being a ball and socket, over time it can begin to lose stability. A good analogy of the joint is to imagine a golf ball sitting on a tee.
The rotator cuffs are a group of four muscles which surround the shoulder joint, working in unison and with tendons they provide stability for the joint. The four individual muscles are as follows:
- Subscapularis — Supports internal rotation of the shoulder (imagine bringing your hand towards the midline of your body)
- Suprapinatus — Supports abduction of the shoulder (movement of your arm away from the midline of your body)
- Infraspinatus — External rotation of the shoulder (imagine moving your hand away from the midline of your body)
- Teres Minor — Helps to hold the humeral head (ball) into the shallow cavity of the scapula (socket), also supports external rotation of the arm at the shoulder joint.
Like every muscle it’s possible to strain, rupture or inflame the rotator cuffs and tendons. Age plays a significant role in the chance of injury, with under 10% of people under 20 years of age experiencing RC injuries, whilst this increases to more than 60% over the age of 80.
Rotator Cuff Injury Assessment
With the four rotator cuffs working together, it’s possible to injure one or multiple muscles in the joint. Some of the most common types of injuries we see are as follows.
Overuse Injuries
Overuse injuries are by far the most common source of RC complaints. Typically seen in people who perform repetitive overhead movements, for example working with their arms overhead or playing sports which involve throwing. Due to the continual use of the muscles and often weakened muscles over time, there’s a gradual build up of wear and tear on the tissues. Overuse injuries become more of a serious issue with incorrect form, which can lead to additional load and stress on the muscle(s), and a significant risk of further injury.
Traumatic Injuries
A direct impact to the shoulder joint or a sudden forceful movement in the shoulder can cause rotator cuff strains and tears. For example falling onto an outstretched arm, which is also a very common cause of forearm fractures. If the impact stretches the muscles to a point where they cannot sustain the load, it will result in a tear or strain to varying degrees.
Degenerative Changes
Muscles and tendons naturally weaken with age (this is known as muscle atrophy). This means that the force that the rotator cuffs can withstand decreases over time, leading us to become more susceptible to strains. In turn this can lead to an increased risk of both overuse injuries and traumatic injuries detailed above. A good way to help prevent this increased risk is to work on strengthening all the rotator cuff muscles in unison, for example overhead presses are a great movement for this.
Poor Posture
This is less common than the other examples discussed, but poor posture can lead to some muscles being under-utilised leading to others becoming over-utilised. In doing so you’re constantly overstretching the over-utilised muscles and making them more susceptible to straining.
Treatment & Rehabilitation
The treatment of a rotator cuff injury is very similar to the rehabilitation of any muscle strain. Often the tests we use in assessing the injury will given as starter exercises. We will then progress to isometric work (allowing you to work the muscle without movement), followed by isotonic movement (to begin recruiting the muscle). Resistance bands can be a great tool for this type of rehabilitation, allowing us to slowly add load and rebuild strength.
If you’re experiencing any shoulder pain or reduced range of motion, we would be happy to see you in our injury clinic for a full assessment.
