The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. The rotator cuff muscles begin on your shoulder blade and end on the upper end of the humerus.
The four muscles of the rotator cuff are; subscapularis (at the front of the shoulder), supraspinatus (at the top of the shoulder), infraspinatus (at the back of the shoulder), and teres minor (at the back of the shoulder below infraspinatus).
Rotator cuff injuries are common and increase with age. Many people with rotator cuff injuries can manage their symptoms and return to activities with exercises that focus on improving muscle flexibility and strength. Occasionally surgery is required when the tear is full thickness, especially in the young sportsperson.
Rotator cuff tendinopathies are caused by excessive overhead activity, or secondary to shoulder impingement. As the base of your whole upper limb’s stability, your shoulder blade (scapula) has a vital role as the central dynamic stable base (think crane base) that attaches your arm to your chest wall. Your arm then acts as a crane boom to perform a vast range of functional activities. Poor scapular muscle control can tip the acromion into your shoulder bursa and rotator cuff, which may cause your dynamic shoulder impingement and injury to the rotator cuff.
There are 2 main causes of rotator cuff tears: traumatic injury and degeneration. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand. It may also develop over time due to repetitive activities. Rotator cuff tears may also happen due to aging, and are common in the older sportspeople, due to degeneration of the tissues.
The sports person with a rotator cuff injury will complain of pain with overhead activity such as throwing, swimming, and overhead shots in racquet sports. Activities undertaken under shoulder height are usually pain-free. Older athletes with a rotator cuff tear often complain of an inability to sleep on the affected shoulder.
Other symptoms of a rotator cuff injury include grating or cracking sounds when moving the arm, limited ability to move the arm and muscle weakness.
How can Physiotherapy help?
Physiotherapy treatment of a rotator cuff tendinopathy is considered in two parts. The first part is to treat the tendon itself, and the second is to correct associated abnormalities that have contributed to the injury in the first place.
Physiotherapy of a rotator cuff tear is conservative (non-surgical) if the rotator cuff tear is small and of partial thickness. Full thickness rotator cuff tears in young sportspeople require surgical repair. In older people treatment of a tear is guided by the person’s symptoms and level of function.
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