Rotator Cuff

A rotator cuff injury is when there is a strain, tear or damage to the one or more of the rotator cuff muscles. It is one of the most common injured areas of the shoulder. The injury usually involves damage to the rotator cuff tendons (The part of the muscle that connect the muscles to bones). By the age of 50 approximately 10% of people will have a rotator cuff tear. A study by Yamamoto showed 20.7% of 1366 shoulders had full-thickness rotator cuff tears in the general population of a mountain village in japan.

WHAT IS THE ROTATOR CUFF?
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The rotator cuff is a group of muscles that stabilise the shoulder joint, it does this by attaching the scapular (shoulder blade) to the humerus (upper arm bone). The rotator cuff also provides and helps guide movements of the shoulder.

​The rotator cuff is made up of 4 muscles (look at diagram for where they are):

• Supraspinatus. The supraspinatus tendon is the most common site of injury.
• ​Infraspinatus
• Subscapularis
• ​Teres minor

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Movements that the rotator cuff perform:

• Internal rotation (rotate upper arm towards the body).
• External rotation (rotate the upper arm away from the body).
• Abduction (move the arm away from the body).

SYMPTOMS

• Pain and tenderness in the shoulder and on certain types of movements
• Weakness of the shoulder
• Discomfort when sleeping on the affected side
• Decreased range of motion especially in abduction
• ​Pain and difficulty performing daily activities
• Swelling
• ​In some cases, there can be no symptoms with a rotator cuff tear. A study by Hiroshi Minagawa found that 65.3% of rotator cuff tears were asymptomatic and 34.7% symptomatic

CAUSES

• Most common cause is a degenerative process due to the tendons wearing down as the body ages
• Repetitive trauma to the area from movements in sport, work or daily activities that involve overhead movements or lifting
• Single trauma such as falling on outstretched arm or lifting something heavy
• Poor posture
• Bone spurs that decrease the space for tendons and impinge cause inflammation

RISK FACTORS

• >40 years of age
• Participating in sport that requires forceful overhead actions or heavy lifting (e.g tennis or baseball pitchers)
• ​Working in an occupation such or painter, carpenter or other trades-person that is required to perform repetitive overhead activities for long periods

TREATMENT

• Period of rest
• Ice
• ​Discontinue activities that aggravate the shoulder during the healing process
• Over the counter anti-inflammatory medicines (e.g Ibuprofen)
• ​Pain free range of motion
• Rehab exercises to place the tendons underload and strengthen the rotator cuff and surrounding shoulder muscles
• ​Corticosteroids (if other forms of treatment have not helped)
• Surgery (large full thickness tear or significant weakness and poor function)

​​Treatment through chiropractic:

• Massage
• Trigger point therapy
• Dry needling
• Manipulation
• Mobilisation

PREVENTION

• Shoulder warm up and stretches before performing activity
• Strengthening exercises
• Balance between the muscles at the front and back of the shoulder complex

If you have had a rotator cuff injury or shoulder discomfort, we recommend visiting your local health practitioner for an accurate diagnosis of your complaint with proper treatment and rehab plan. As mentioned above there are four muscles in the rotator cuff and making sure treatment is directed to the right area is vital. If you are local to the Loftus area, we are happy to help or answer any questions you may have.
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Written by Joshua Hallinan,
Chiropractor
Health Associates
Working Tuesday (AM & PM), Wednesday & Friday (PM)


References 

Minagawa, Hiroshi, et al. "Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: from mass-screening in one village." Journal of orthopaedics 10.1 (2013): 8-12.

Yamamoto, Atsushi, et al. "Prevalence and risk factors of a rotator cuff tear in the general population." Journal of Shoulder and Elbow Surgery 19.1 (2010): 116-120.

Jerosch, J., T. Muller, and W. H. Castro. "The incidence of rotator cuff rupture. An anatomic study." Acta Orthop Belg 57.2 (1991): 124-129.

Ellenbecker, Todd S., and Ann Cools. "Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review." British journal of sports medicine44.5 (2010): 319-327.

Lin, James C., Nancy Weintraub, and Dixie R. Aragaki. "Nonsurgical treatment for rotator cuff injury in the elderly." Journal of the American Medical Directors Association 9.9 (2008): 626-632.

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