By: Dr. Brian P. Kinmartin, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN
The rotator cuff is a term given to a group of muscles and their tendons that act to help stabilize the shoulder joint when you move it. The four muscles of the rotator cuff are the; supraspinatus, infraspinatus, teres minor and subscapularis. The shoulder joint is a ball and socket joint with the shoulder blade, or scapula forming the cuplike socket and the head of the humerus, or arm bone forming the ball.The four rotator cuff muscle tendons combine to form a broad, conjoined tendon, called the rotator cuff tendon, and insert onto the bone of the humeral head in the shoulder. These muscles arise from the shoulder blade and connect to the head of the humerus forming a cuff at the shoulder joint. They help to hold the head of the arm bone in the small and shallow cup or glenoid fossa of the scapula. A good analogy of the shoulder or glenohumeral joint is that of a golf ball (head of the humerus) sitting on a golf tee (glenoid fossa). When you lift the arm the rotator cuffs job is to compress the glenohumeral joint providing stability to the joint allowing the other large muscles of the shoulder to further raise the arm. Without the rotator cuff, when attempting to lift the arm the humeral head would ride up partially out of the glenoid fossa, lessening the efficiency of the other shoulder muscles not allowing full elevation of the arm.
Rotator cuff tears are tears of one, or more, of the four rotator cuff muscles or tendons. Clinically rotator cuff tears are one of the most common conditions affecting the shoulder. Most commonly, it is the tendons of the rotator cuff that are torn. Of the four tendons, the supraspinatus is most frequently torn; with the tear usually occuring at its attachment on the top of the arm bone (the greater tuberosity). Many rotator cuff tears cause no pain or produce any symptoms, tears are known to have an increasing incidence with increasing age.The most frequent cause of rotator cuff damage is age related degeneration.Other causes are sports injuries or trauma. Rotator cuff tendon tears are described as either partial or full thickness tears. Partial thickness tears appear as fraying of an intact tendon. Full thickness tears are through-and-through tears, which can be small pin-point tears or larger button hole tears. Full thickness tears may also involve complete detachment of the tendon(s) from the humeral head resulting in impaired function. Pain from a rotator cuff tear may be variable and does not always correspond to the size of the tear.
Symptoms of rotator cuff pain may include pain or ache over the front and outer aspect of the shoulder. Discomfort may be aggravated by activities causing pushing upwards on the shoulder, such as leaning on the armrest of a chair, difficulty or pain may occur with overhead reaching activities, pain at night may be present when lying on the shoulder, and complaints of weakness may be present with lifting and using the upper extremity.With an extended history of rotator cuff disease and pain, a loss of shoulder mobility and weakness may be present due to pain and guarding. When there is a complete rupture and detachment of the rotator cuff, there is a complete loss of function, which results in the loss of the ability to actively raise the arm. Complete rotator cuff tears with detachment are relatively rare, with most tears presenting with pain and limitation of function, a complaint that can be common to many shoulder pathogies such as tendinitis, bursitis or arthritis. That is why people suffering from complaints of shoulder pain should consult wit a healthcare professional.
Many times patients with partial tears and even some with complete tears can respond to non-operative management. Patients who suffer from pain, but still have maintained a good amount of shoulder function are generally good canidates for non-operative treatment. Non-operative treatment may include oral medications prescribed by your medical practitioner to control inflamation and a referral to physical therapy. A Physical Therapist will perfrom a mechanical and musculoskeletal examination of your shoulder to determine the extenet of involvement of the rotator cuff and its potential for rehabilitation. From there they will design an exercise program to improve shoulder mechanics, mobility and rotator cuff strength. As your shoulder pain decreases and mobility, strength and biomechanical deficiencies improve, your therapist will progress you to a home program, potentially avoiding surgery. If your rotator cuff is in need of repair an Orthpaedic Surgeon will surgically repair it, which is followed by a three to six week period of immobilization then a referral to Physical Therapy as well. Similarly, the therapist will perform an evaluation and progress your therapy gradually regaining mobility and strength returning you to your previous functional activities discharging you with a follow up home exercise program.
Professional Rehabilitation Services is a Physical Therapist owned Private Outpatient Physical Therapy Practice specializing in pain, orthopedics, balance and sports injuries with offices in Myrtle Beach and Pawleys Island, SC. For more information on this topic or to schedule a consultation please contact Brian P. Kinmartin PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN, (Pawleys Island) (843) 235-0200, Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN (Surfside) (843) 831-0163 at Professional Rehabilitation Services, Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN (Myrtle Beach) (843) 839-1300, or visit us at: www.prs.rehabservices.com.