Rotator Cuff Injuries

What is the rotator cuff?

The rotator cuff is comprised of a group of muscles and tendons which surround the shoulder joint. They work together to keep the shoulder stable meaning the ball (humerus head) stays in its proper position in the socket (glenoid cavity). The supraspinatus is responsible for abducting the arm, the infraspinatus and teres minor muscles initiate external rotation and the subscapularis is responsible for internal rotation.

What injuries can occur?

Tear:

A tear can be anywhere from 1% of muscle fibres torn to 99% of fibres being torn, it only becomes a rupture when all muscle fibres have been torn. There are 3 grades of tears reflecting the mechanism of injury and depicting the severity.

Grade I is classified when 1-10% of the fibres have been torn and the expected rehabilitation time is around 4-6 weeks.

Grade II (minus) is classified when 10-35% of fibres have been torn and Grade II (plus) is classified as 35-80% fibres torn.

A Grade III tear is the most severe, classified when 80%+ of fibres have been torn and the rehabilitation journey is likely to require surgery.

Tendinopathy:

This occurs when the tendons in the shoulders become degraded and thickened as a result of overuse, overload or lack of treatment when pain begins. The normal width of the tendon is 3-4mm but can double in size to 7-8mm when injured. This can be from sports such as tennis or swimming or from an occupation which involves a fair amount of overhead use such as electricians or decorators.

The symptoms of tendinopathy are often classified as ‘Impingement’ – which describes the ‘catch’ or ‘rubbing’ sensation of the tendon on surrounding soft tissue or bone – creating a sharp pain in the shoulder. The tendon begins to catch or rub on the surrounding tissue and bone creating a sharp
pain in the shoulder.

Symptoms:

 Dull ache in shoulder & arm
 Pain is worsened when elevating the arm
 Pain when washing/brushing hair/putting jacket on/seatbelt on
 Sleeping on the side may be uncomfortable

The pain presents itself in different ways in different areas of the shoulder. The pain is a dull ache in
the deltoids and biceps, a pinching pain at the front of the shoulder and tightness at the back of the
shoulder. One of the factors a lot of people do not consider is how much a rotator cuff injury can
affect their day-to-day life. Simple tasks such as brushing hair, putting on a coat or even turning
the steering wheel can be extremely difficult and painful. In addition, sleeping may be
uncomfortable.

Treatment:

 Shockwave therapy – between 4-6 treatments have been proven effective for reducing pain
and increasing range of movement.
 Corticosteroid injections – great for pain relief.
 Surgery – for the more severe injuries to excel rehabilitation.
 Rehab – strengthening exercises with a specialist.