Buff Rotator Cuff
Today we will be discussing the most common of shoulder problems – those to do with the ‘rotator cuff’ tendons.
Let’s start with the basics. The shoulder is a ball and socket joint. In order to allow us to have such a huge range of movement at the shoulder, the socket is actually very shallow. It doesn’t hold on to the ball very well at all! Thankfully, we have a group of tendons helping to hold the ball in its socket. These are the rotator cuff tendons. They are so called, because these tendons also assist with rotation movements at the shoulder.
When all is good with the world, and we are young and injury free, the rotator cuff tendons, and the ball and socket shoulder joint all work together to move your arm around. There are a lot of different structures around the shoulder joint, and there is only just enough room for everything to move.
But alas, as we get older (think 30 plus –terrible I know!), these tendons become less elastic, and therefore less able to bounce back from the jolts, twists and pulls that we subject our shoulders to (picture a rubber band that has been sitting in your drawer for a while and just doesn’t stretch like it used to).
One day, you go to reach into the back seat of the car, and twang – something hurts in your shoulder. Sometimes pain may start gradually and build up for seemingly no reason. What causes this? Rotator cuff problems can be categorized into 3 main types (of which some poor buggers get all at once!):
1) Rotator cuff tendinopathy
A worn tendon becomes overloaded and painful. This is often slow to settle, and treatment involves relative rest from aggravating activities, and a strength program for the shoulder.
2) Rotator cuff tear
One of the rotator cuff tendons (usually the Supraspinatus) can develop a tear. This can be the result of an actual injury, or cumulative over time. Tears can be partial, which are normally managed with Physiotherapy, or full thickness, which often need surgical repair (not fun – six weeks in a sling and long rehab). Ultrasound imaging is the only way to properly diagnose a tear.
3) Shoulder impingement
If a tendon becomes injured and inflamed, it swells, takes up more space, and can become pinched between the humerus (arm bone) and the top of the shoulder blade. Pain is usually felt with overhead activity. Treatment can involve anti-inflammatory medication, avoiding overhead activity, taping and a strengthening program.
There are a number of things you can do to keep your tendons healthy, and decrease the likelihood of a rotator cuff injury:
• Keep fit – good general fitness makes the tendons more healthy
• Keep good shoulder range – make sure you take your shoulders through their full range of movement everyday. Lift them right up over your head, behind your back, out to the sides
• Keep good movement in your Thoracic spine/mid back, especially if you sit a lot. Think spinal twists, arching, lying over a rolled up towel.
With so many structures in our shoulders, it is important to get an accurate diagnosis, to assist with the best rehab plan.
If you have any further questions about this article, email me:
karen@physios-online.com
Karen Finnin
Musculoskeletal Physiotherapist
BAppSc(Physio),MMuscPhys