Rotator Cuff Problems
Rotator cuff (RC) problems are a common injury of the very complex shoulder joint. The shoulder joint is a complex formation of bones, muscles, and tendons which provide a great amount of motion in the arm. An extensive range of motion is possible but the downside is an element of instability, which can make the shoulder joint vulnerable to injury.
The RC is the group of four tendons and muscles that surround the shoulder joint. The muscles include supraspinatus, infraspinatus, teres minor and subscapularis. They connect the shoulder blade (scapula) and the upper arm (humerus). The RC is important for lifting movements of the shoulder as well as playing a critical role in the normal stability and mechanics of the shoulder. The scapular stabilisers help your shoulder’s rotator cuff muscles to stabilise the shoulder joint while in motion.
Without a properly functioning RC you can expect some limits in normal shoulder function.
RC Conditions include:
RC tear: A RC tendon that has been weakened by age or wear and tear is vulnerable to tear. Symptoms include pain and weakness (depending on how serious the tear is); difficulty moving the shoulder, especially when trying to lift your arm above your head; snapping or crackling sounds when moving the shoulder; inability to sleep on the shoulder.
Athletes prone to develop a RC tear include: baseball players, swimmers, tennis and football players. You can sustain a RC tear by falling on your shoulder, using your arm to break a fall; lifting heavy weights; or through wear and tear.
RC tendinitis: Tendinitis or tendinosis is an inflammation or irritation of a tendon. It is a repetitive strain type injury caused by repetitive overhead use of the arms (throwing, painting, tennis, golf). Poor posture, lack of stretching or conditioning or doing too much too soon may increase the risk of developing a tendinitis. Tendinitis is more common in those over the age of 40. As we get older our tendons age and tolerate less stress, are less elastic and are easier to tear.
Symptoms include: pain at the site of the tendon and surrounding area; restricted movement. It may develop into an adhesive capsulitis or frozen shoulder. To avoid a tendinitis, build up any sport slowly.
RC Impingement: The tendons or bursae of the RC are pinched between the humerus and the acromion. A risk factor is repetitive overhead activities (painting, lifting, swimming, tennis). Bone and joint abnormalities may predispose to developing a RC impingement. Pain is persistent and affects everyday activities. Impingement syndrome can cause damage to the RC tendons and bursae.
Symptoms include difficulty reaching up behind your back; pain with overhead use of the arm and weakness of the shoulder muscles.
Frozen shoulder: Also known as adhesive capsulitis results in stiffness, pain, and limited movement in the shoulder. Frozen shoulder has an increased prevalence in people with diabetes. It may occur following a stroke or following an injury resulting in disuse. The capsule around the shoulder joint stiffens, scar tissue forms and shoulder movements are painful and restricted.
Frozen shoulder is seen more in women than men, in people between the ages of 40 and 70, and in individuals with chronic disease.
Subacromial bursitis: Bursitis is the inflammation or irritation of the bursae. The bursae is a sac filled with lubricating fluid, located between tissues with the purpose to decreases friction and irritation. Bursitis may be caused by repetitive minor impact on the area or from a sudden more serious injury. Bursitis is more common in those over 40 years of age. The main symptom is pain and may result in a limitation of movement.
Your physiotherapist will complete a thorough examination to determine the source of the symptoms and devise the correct treatment approach for your condition.
The earlier a RC injury is treated, the better. You may use the R.I.C.E.R (rest, ice, compression, elevation, referral) regime for the first 48-72 hours. The shoulder joint does not have a great blood supply so after this period it is important to improve the blood flow to the area to bring oxygen and nutrients to the area. Gentle heat and soft tissue massage are a great way to improve blood flow to the area. Soft tissue mobilisation will assist in laying down the correct orientation of scar tissue and loosen up tight muscles. Don’t stop moving!! Gentle movement is to be encouraged, modify activities according to pain but don’t stop moving all together.
Your treatment and rehabilitation may includes:
- Correct posture – neck and shoulder girdle. A rounded hunched posture is to be avoided at all times.
- Stretching – muscles around your neck and shoulder.
- Strengthening – scapular stabilisers and RC muscles.
Correct Your Scapular Posture
Scapular stabilising exercises target the muscles that support the scapula. Important muscles to strengthen include: serratus anterior, and middle and lower fibres of trapezius. The correct scapular position is key – your physiotherapist will guide and teach you how to obtain the correct setting. Correct scapula setting is challenging to learn and you will need to practice it over and over again.
When you perform any upper body training exercises, get into the habit of starting with good upper body posture. Simply correcting the biomechanical position of your scapula and shoulder joint may relieve an element of your symptoms.
Strengthen the Rotator Cuff
Strengthening the RC muscles is important for stabilising the shoulder joint, which will assist in your recovery or prevent the onset of shoulder injuries. The four muscles making up the RC work in conjunction with the others to provide harmony of motion. These muscles work together with the labrum to keep the shoulder joint in the best position kinematically.
Attach the theraband at waist level to a door knob or window bar. Place a rolled up towel between the upper arm and side. Grasp one end of the theraband and pull the band until it feels taught, move the hand away from the body as far as it feels comfortable. Return to the start position.
In the same starting position as above – now you are going to move the hand towards the belly.
Standing forward flexion (full can)
Set the shoulder blades, keep the elbows straight, and the thumbs facing forward raise the arms forward and upward to shoulder level with a slight outward angle (30’). Slowly lower and repeat. You can do this with a light weight or standing on theraband and holding the ends in your hands.
Holding the theraband at shoulder height, grip both ends in your hands. Pull the band forward and slightly downward in a ‘hugging;’ movement. Pause and slowly return.
With the theraband in front of you, stand with the tubing in both hands, elbows bent to 90’ and fixed at your sides. Pull the band outwards, keeping the elbow at your side. The arms rotate outwards making the shape of a ‘w’.
You can do this in standing, bending forward at the waist so that the arm is hanging freely, or alternatively, lie face down on your bed with your arm hanging off the side. Raise the arm towards your hip with the thumb pointing outward. Do not lift your hand past the level of your hip.
Stretching – Stretching the muscles around your neck and shoulder are important to include in your rehab programme.
An important stretch to incorporate into your programme is the sleeper stretch. It focuses on the posterior and inferior shoulder capsule. Lie on your affected side rotated 45’ upwards, with the shoulder and elbow flexed to 90’. You can start with the shoulder at a lower angle (45’). Place your opposite hand on top of the hand of your affected side. Gently push the arm downwards towards the bed until you feel a gentle stretch. Your physiotherapist will assist you in performing this stretch correctly.
This is general advice, it does not constitute as personal medical advice. As advice from the internet is not always suitable for everyone it should be followed pain free only. For a full assessment and a tailored treatment plan you should consult one of our Chartered Physiotherapists on 045866075 or book online @ www.physiotherapyworks.ie/book-online/