What are the rotator cuff muscles?
The rotator cuff is a group of muscles which work together to provide the Glenohumeral (shoulder) joint with dynamic stability, helping to control the joint during rotation (hence the name). The rotator cuff muscles include:
Supraspinatus and Infraspinatus are the most commonly injured rotator cuff muscles. Due to the function of these muscles, sports which involve a lot of shoulder rotation – for example, bowling in cricket, pitching in baseball, swimming, kayaking – often put the rotator cuff muscles under a lot of stress.
Problems with the rotator cuff muscles can be classed into two categories – Tears of the tendons/muscles, and inflammation of structures in the joint.
Acute Tear
This tends to happen as a result of a sudden, powerful movement. This might include falling over onto an outstretched hand at speed, making a sudden thrust with the paddle in kayaking, or following a powerful pitch/throw.
The symptoms will usually include:
- Sudden, tearing feeling in the shoulder, followed by severe pain through the arm
- Limited movement of the shoulder due to pain or muscle spasm
- Severe pain for a few days (due to bleeding and muscle spasm) which usually resolves quickly
- Specific tenderness (“x marks the spot”) over the point of rupture/tear
- If there is a severe tear, you will not be able to abduct your arm (raise it out to the side) without assistance
Chronic Tear
A chronic tear develops over a period of time. They usually occur at or near the tendon, as a result of the tendon rubbing against the overlying bone. This is usually associated with an impingement syndrome.
- Usually found on the dominant side
- More often an affliction of the 40+ age group
- Pain is worse at night, and can affect sleeping
- Gradual worsening of pain, eventually some weakness
- Eventually unable to abduct arm (lift out to the side) without assistance or do any activities with the arm above the head
- Some limitations of other movements depending on the tendon affected
When should I seek medical attention for my Rotator Cuff Injury?
Seek medical attention if:
- The pain persists for more than 2-3 days
- You are unable to work due to the pain/limitations
- You are unable to reach up or to the side with the affected arm after 2-3 days
- You are unable to move the shoulder and arm at all
- For any acute injury where you are unable to move the injured shoulder as well as the uninjured shoulder
What should I expect when I visit a healthcare professional with a possible Rotator Cuff problem?
- A detailed history of your general health, past problems and injuries, and what happened to cause this injury will be taken
- Both shoulders will be looked at and compared (you will need to partially undress for this) both visually and using palpation (feeling)
- Your neck, elbows and wrists will be checked to make sure they are not contributing to the problem
- Range of movement will be assessed, you’ll be asked to do certain movements and the clinician will observe and ask you to report any pain (but will not be done if a fracture is suspected)
- Passive range of movement will be assessed – you will be asked to lie on a couch while the clinician moves your shoulder (but will not be done if a fracture is suspected)
- Sensation and strength in the arm will be assessed
- Some specific tests will be done which can help to identify which tendon is causing the problem and confirm if it is a rotator cuff tear, or due to inflammation or some other cause.
What can I do to help my rotator cuff muscles recover?
Treatment for an Acute Rotator Cuff Tear
- Apply ice to reduce swelling
- Control the pain with appropriate medications
- Rest the arm – a sling can sometimes be quite useful if you still need to go to work/school, which can be removed at night
- You may require imaging studies (x-ray, MRI, CT Scan) to identify what the problem is and rule out any fractures
- Consider consulting a physiotherapist who can assist you with rehabilitating the injury
If the injury is quite severe and you are young and active, you might require an operation to fix the tear. Indications include:
- Under 60 years old
- Complete tears of the tendon/muscle
- Failure of other treatments after 6 weeks
- Professional/keen sports people
- If your job requires constant shoulder use
Treatment for a Chronic Rotator Cuff Tear
- Control pain
- Apply ice as above
- Alternating heat and ice may also be benficial.
- Sometimes you might be referred for an injection of steroid medication directly into the site of the problem to help reduce any inflammation and allow you to proceed with rehabilitation
- Shoulder exercises which can be provided by a physiotherapist
- You may require surgery, with the indications as above
How long will it take to get better?
- Depending on several factors, conservative treatment has a 40-90% success rate at fixing the problem.
- Surgery often has good results, with some studies citing a 94% satisfaction rate with the surgery, resulting in lasting pain relief and improved function. Very extensive tears often have a poor surgical outcome, however this injury is thankfully quite rare.
- If you are older, it will take you longer to heal due to changes in your physiology.
Assessment >>
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