The rotator cuff is the name used to describe the group of muscles and tendons that surround and support the shoulder joint and allow movement in different directions.
There are four muscles that make up the rotator cuff. These are the supraspinatus, subscapularis, infraspinatus and teres minor.
It is an area very commonly injured in people who perform physical jobs that involve overhead duties (such as painters and carpenters) and people who lift heavy weights or use the shoulders in a forceful or repetitive manner. It is also commonly injured by people who play racquet sports such as tennis or baseball.
Rotator cuff problems are very common and may occur as a result of a single injury or as a degenerative process over time. The risk of injury increases with age.
There are different types of rotator cuff injuries and they can vary greatly in significance and impact on quality of life. Some of these include:
- Rotator cuff impingement: Impingement occurs when the tendons of the rotator cuff muscles and the bursa of the shoulder become ‘pinched’, causing swelling and inflammation.
- Rotator cuff tendonitis or tendonopathy: This refers to swelling or inflammation of the rotator cuff tendons due to injury or degeneration due to repetitive movements over time.
- Shoulder bursitis: A bursa is a small fluid filled sac that sits between the muscles and the clavicle bone. It is designed to allow fluid movements and reduce friction during movement. Sometimes the bursa can become inflamed, causing pain. There is often associated tendon inflammation when bursitis occurs.
- Rotator cuff tears: Tears are most commonly found in the supraspinatus tendon, where it attaches to the head of the humerus, although other muscles and tendons may be affected. Tears may be partial or full thickness.
- Calcific tendonitis: This is an inflammatory condition of the tendons causes by build-up of small calcium deposits within the rotator cuff. It is more common in people aged between 30-40 years and those with diabetes.
Symptoms of a rotator cuff injury include:
- Dull ache deep inside the shoulder
- Pain or ‘clicking’ when attempting to elevate the arms above shoulder height
- Pain extending from the shoulder to the elbow or across the upper back
- Pain when reaching across the body e.g. when reaching for a seatbelt
- Reduced range of movement in the shoulder joint
- Pain or disturbed sleep when lying on the affected side
- Muscle weakness or fatigue when attempting to lift or reach
It is not always straightforward to diagnose a rotator cuff injury as shoulder pain can be caused by many different things. Usually diagnosis requires a physical examination and imaging tests such as ultrasounds, CT scans and MRI scans.
Treatment options will depend on the type of injury sustained and the severity of that injury. There is usually a combination of medication and physical therapies used, such as physiotherapy, osteopathy and hydrotherapy. Sometimes corticosteroid injections are also used to provide relief.
Extensive rotator cuff may require surgery to repair. Surgical repair may involve repair of muscle tears or even joint replacement in severe cases where conservative measures or other arthroscopic procedures have not been helpful.
Rotator cuff problems can rapidly decline if not treated early, causing permanent damage to the shoulder and permanent loss of range of motion.