What is the Rotator Cuff?
The rotator cuff (NOT rotator cup or rotary cuff!!) is made up of four muscles that work to stabilize the shoulder joint. These muscles include supraspinatus, subscapularis, infraspinatus and teres minor. The tendons of these muscles insert and blend into the shoulder’s joint capsule – the connective tissue that surrounds the shoulder joint.
The shoulder is classified as a ball and socket joint. The head of the humerus (arm) bone is the ball and the glenoid fossa on the scapula (shoulder blade) is the socket. As you move your arm, the rotator cuff muscles work to keep the head of the humerus centred in the glenoid fossa. For things to go well, the muscles in the rotator cuff need to be able to produce enough force as well as work with adequate timing and coordination.
Rotator Cuff Syndrome
Shoulder pain can arise from many different sources including, but not limited to:
- Subacromial bursitis (inflammation of a fluid filled sack in the shoulder joint)
- Rotator cuff tendinopathy (changes that occur in one or multiple rotator cuff tendons)
- Rotator cuff tears (partial or full thickness)
Pain arising from these structures can be collectively called Rotator Cuff Syndrome. This terminology is used by doctors and physiotherapists because it can be difficult to differentiate between problems in individual structures when assessing someone in clinic. Diagnostic imaging is often used to get a better idea which of these structures is implicated. However, diagnostic imaging is not perfect. There is a growing number of research studies that show findings of rotator cuff tendinopathy or partial tears in people that have no shoulder pain at all!
What does all this mean to you?
Because we know that asymptomatic people can have imaging findings that suggest various types of rotator cuff problems, we can’t definitively say what the exact source of your shoulder pain is. The good news is that this does not matter! In order for things to get better, we need to focus on why this happened in the first place.
There are three main categories of problems that contribute to Rotator Cuff Syndrome:
- Loss of range of motion in the shoulder joint, thoracic spine or scapulothoracic joint (this joint involves the movement of your shoulder blade on your body)
- Lack of adequate strength in your rotator cuff muscles
- Lack of adequate strength in your scapular stabilizers (the muscles that move and stabilize your shoulder blade)
People can have problems with just one or even all three of these categories. Seeing a qualified physiotherapist for a thorough assessment is the best way to determine which of these areas is a problem for you. With that being said, the vast majority of people with Rotator Cuff Syndrome will have issues with categories 2 and 3. Determining if you have problems with category 1 is more difficult to do on your own, however I will provide you with some simple tests you can do to screen your shoulder for range of motion problems.
Now that you have some background information, we can get down to fixing your shoulder. I have divided rotator cuff treatment into individual posts targeting each of the three categories mentioned above:
- insert link for shoulder range of motion self assessment and treatment
- Insert link for scapular stabilization
- insert link for rotator cuff strengthening