In the rotator cuff region there are four muscles, tendons and ligaments, surrounding the shoulder which provide added stability to the shoulder joint. This structure helps to keep the bone securely placed into the socket. Injury to the rotator cuffs can cause an ache like pain in the shoulder. This may lead to a feeling of muscle weakness and inability to lift the shoulder above the head.
Rotator cuff injuries are most commonly presented in people regularly exposed to overhead movements, such as painters, carpenters and builders. Individuals who suffer from this injury can usually manage their symptoms, through sports massage and specific exercises focusing on the rotator cuff muscle region. However, if not treated correctly, further injury to the area may occur such as a complete tear, which may result in surgery.
Anatomy
The rotator cuffs are made up by four muscles, these are the supraspinatus, infraspinatus, teres minor and subscapularis. These muscles aid in keeping the upper arm and shoulder into the socket with stability. They also each allow specific movements at the shoulder joint. The group of four muscles all originate within the shoulder blade, but all insert into different portions of the upper arm bone.
Supraspinatus: This muscle originates at the supraspinous fossa; the muscle belly passes laterally over the acromion process and inserts into the greater tubercle of the humerus bone. This muscle allows the first 15 degree’s movement of abduction, after this the deltoid and trapezius muscles will then allow further motion.
Infraspinatus: The origin of the infraspinatus is the infraspinatus fossa, and the insertion is also the greater tubercle of the humerus. The motion created by this muscle is lateral rotation of the shoulder, moving the arm away from the centreline of the body.
Teres Minor: A small narrow muscle on the back of the shoulder blade which sits underneath the infraspinatus. The origin is the lateral boarder of the scapula. This muscle contributes to external rotation of the arm of the body.
Subscapularis: This rotator cuff is the strongest and largest out of the three listed above. This muscle originates at the subscapularis fossa and inserts into the lesser tubercle of the humerus. The subscapularis allows greater motion at the shoulder and mainly aids in allowing medial rotation of the arm.
Symptoms
Common symptoms of possible rotator cuff injury:
- Dull ache
- Difficulty lifting arm over head
- Weakness around the shoulder
- Disturbed sleep
- The constant need to use self-myofascial techniques
Causes
There are a few common risk factors of why rotator injury may occur:
- Family History: There may be family history of rotator cuff injuries which may make certain family members more prone to having the injury than others.
- The type of job you do: Individuals who work in construction or manual labour who have repetitive overhead movement of the shoulder could damage the rotator cuff overtime.
- Age: As you get older joints and muscles become weaker, meaning you may be more prone to injury overtime.
Diagnosis
To diagnose a rotator cuff injury a physical examination will be carried out by a doctor or a physiotherapist. Firstly, they may ask about your day-to-day activities which may determine the seriousness of the injury. The doctor will test the range of movement at the shoulder by getting you to perform movements such as flexion, extension, abduction, adduction and medial and lateral rotation. This will allow the doctor to determine if it is actually rotator cuff injury or whether it may be other conditions such as impingement or tendinitis.
Imaging scans such as X-Ray’s may also be used to see if there is any abnormal bone growth within the joint, which may be causing the pain.
Treatment
Treatments for rotator cuff injuries can be non-surgical or surgical. Tendinitis may occur over time from the repetitive strain placed around the joint, so it is important to treat the affected area.
- Apply a cold compress/ ice to the effected area to reduce swelling
- Heat packs can be used to reduce swelling
- Resting the affected area
- Inflammatory medication such as ibuprofen and naproxen
- Reduce the amount of repetitive movement to the joint
- Don’t lift the arm overhead
Exercises
- Doorway Stretch: Stand facing an open doorway with your hands placed on the door frame at shoulder height. Step one foot forward and gently lean forward, feeling a stretch in your chest and shoulders. Hold the stretch for 20-30 seconds before releasing. Repeat the stretch with the other foot forward.
- External rotation with weight: Hold a dumbbell or weight plate in one hand and stand with your elbow bent at 90 degrees and your upper arm against your side. Rotate your arm outwards, away from your body, while keeping your elbow tucked in. Slowly return to the starting position and repeat for 8-12 repetitions before switching arms.
- High to low rows with resistance band: Attach a resistance band to a sturdy anchor point at chest height. Stand facing the anchor point with the band in both hands. Pull the band towards your chest, keeping your elbows tucked in and your shoulders down. Slowly release the band back to the starting position and repeat for 8-12 repetitions.
- Reverse fly’s: Hold a dumbbell or weight plate in each hand and bend forward at the waist, keeping your back straight. Extend your arms out to the sides, keeping them parallel to the floor. Squeeze your shoulder blades together as you bring the weights up towards your body, then slowly release back to the starting position. Repeat for 8-12 repetitions.
- Lawn mower pull with resistance band: Attach a resistance band to a low anchor point and stand with your side to the anchor point. Hold the band in one hand with your arm extended towards the anchor point. Pull the band towards your chest, keeping your elbow bent and your shoulder blade squeezed down and back. Slowly release back to the starting position and repeat for 8-12 repetitions before switching sides.
- Isometric internal rotation: Stand with your elbow bent at 90 degrees and your upper arm against your side. Place a rolled up towel or small ball between your elbow and your side. Squeeze your elbow into your side, holding the contraction for 10-15 seconds before releasing. Repeat for 2-3 sets of 10-15 repetitions.
- Isometric external rotation: Stand with your elbow bent at 90 degrees and your upper arm against your side. Hold a resistance band in both hands, with one end of the band anchored to a sturdy object. Rotate your arm outwards, away from your body, while keeping your elbow tucked in. Hold the contraction for 10-15 seconds before releasing. Repeat for 2-3 sets of 10-15 repetitions before switching arms.
Prevention
- Strengthen the rotator cuff muscles: Exercises that target the rotator cuff muscles can help to build strength and stability in the shoulder joint. Examples of such exercises include external rotation with a resistance band, internal rotation with a light weight, and scapular stabilization exercises.
- Warm up properly: Before engaging in any activities that involve overhead arm movements, it is important to warm up the shoulder joint with dynamic stretches and exercises. This can help to increase blood flow to the muscles and reduce the risk of injury.
- Practice good technique: When engaging in activities that involve overhead arm movements, it is important to use proper technique and form. This can help to reduce stress on the rotator cuff muscles and tendons and minimize the risk of injury.
- Use proper equipment: Using equipment that is properly fitted and designed for the activity can help to reduce the risk of rotator cuff injuries. For example, using a tennis racket with a larger grip or wearing properly fitting swim goggles can reduce the stress on the shoulder joint.
- Rest and recover: Resting and allowing the shoulder joint to recover after activity is important for preventing overuse injuries. Avoiding overuse and engaging in activities that strengthen and stretch the shoulder muscles can help to prevent rotator cuff injuries.
How We Can Help
We understand that dealing with a rotator cuff injury can be a challenging and painful experience. As healthcare professionals, we are dedicated to helping you manage your symptoms and regain full function of your shoulder joint.
We are pleased to offer you our services in massage therapy and sports therapy, both of which can be highly effective in treating rotator cuff injuries. Our trained and experienced therapists can work with you to reduce pain and inflammation, improve range of motion, correct muscle imbalances, and provide advice on injury prevention.
Our services are tailored to meet your individual needs and goals, and we will work with you to develop a treatment plan that is effective and manageable for you. We believe in a collaborative approach to healthcare, and we may work in conjunction with other healthcare professionals, such as physiotherapists or orthopedic specialists, to ensure that you receive the best possible care.
We take pride in providing our patients with high-quality, compassionate care, and we are committed to helping you achieve optimal health and well-being. If you are interested in learning more about our massage therapy and sports therapy services, or if you would like to schedule an appointment, please do not hesitate to contact us.
