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 strain include:
- 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 strain 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 strain 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 strain 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
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1. Doorway Stretch
- Purpose: Stretches the chest and shoulder muscles, helping to alleviate tension and improve flexibility in the shoulder joint.
- How to Perform:
- Stand in a doorway and place your arms on the door frame with elbows at 90 degrees and your hands slightly above head level.
- Step forward with one foot, gently leaning into the doorway until you feel a stretch in the front of your shoulders and chest.
- Hold for 20-30 seconds and relax.
2. External Rotation with Weight
- Purpose: Strengthen the rotator cuff muscles, particularly the infraspinatus and teres minor, which are responsible for external rotation of the shoulder.
- How to Perform:
- Lie on your side with your elbow bent at 90 degrees, holding a light weight in the top hand.
- Keep your elbow close to your body and rotate your forearm upward, lifting the weight.
- Slowly lower the weight back down and repeat before switching sides.
3. High to Low Rows with Resistance Band
- Purpose: Strengthen the muscles of the upper back and shoulder, improving stability and support for the rotator cuff.
- How to Perform:
- Anchor a resistance band above shoulder height.
- Hold the band with both hands and step back to create tension.
- Pull the band down and back toward your hips, squeezing your shoulder blades together.
- Slowly return to the starting position and repeat.
4. Reverse Fly’s
- Purpose: Target the posterior deltoids and the upper back muscles, which help support and stabilise the shoulder joint.
- How to Perform:
- Stand with feet hip-width apart and a slight bend in your knees, holding a light weight in each hand.
- Bend forward at the hips with your back flat and arms hanging down.
- Raise your arms out to the sides until they’re level with your shoulders, squeezing your shoulder blades together.
- Lower your arms back down and repeat.
5. Lawn Mower Pull with Resistance Band
- Purpose: Strengthen the shoulder and back muscles, mimicking the movement of starting a lawn mower, which engages the rotator cuff.
- How to Perform:
- Anchor a resistance band at ground level.
- Stand with one foot forward and grab the band with the opposite hand.
- Pull the band up and back diagonally, rotating your torso and mimicking the motion of starting a lawn mower.
- Slowly return to the starting position and repeat before switching sides.
6. Isometric Internal Rotation
- Purpose: Strengthen the subscapularis muscle of the rotator cuff without moving the shoulder, which is helpful when active movement is painful.
- How to Perform:
- Stand next to a wall with your elbow bent at 90 degrees, holding a small towel or cushion between your forearm and the wall.
- Press your forearm into the wall, engaging the internal rotators of the shoulder.
- Hold the tension for 10-15 seconds, then relax and repeat.
7. Isometric External Rotation
- Purpose: Strengthen the external rotators (infraspinatus and teres minor) of the rotator cuff without movement, useful for stabilising the shoulder.
- How to Perform:
- Stand next to a wall with your elbow bent at 90 degrees, this time with the back of your hand pressing against the wall.
- Push your hand outward into the wall, engaging the external rotators.
- Hold the tension for 10-15 seconds, then relax and repeat.