The rotator cuff consists of 4 main small muscle groups that provide stability and improve the overall function of the shoulder. The muscles include the infraspinatus, teres minor, supraspinatus, and subscapularis. Each muscle or muscle groups have a different function with the shoulder. The function of the infraspinatus and teres minor muscle group is to externally rotate the shoulder and stabilize the head humerus of the shoulder from extreme anterior displacement or translation. The function of the supraspinatus is to assist the deltoid with shoulder abduction at 90 degrees of elevation as well as depress the head of the humerus to keep the humerus from subluxing superiorly. The subscapularis internally rotates the head of the humerus and protracts the scapula.
Function of the Shoulder Blade
The function of the shoulder blade and musculature is to stabilize the glenohumeral joint and provide optimal movement of the shoulder joint. The muscles that attach on the shoulder blade influence the shoulder in allowing controlled movements and range of motion. The function of the shoulder is optimized by the force coupling of the shoulder blade musculature and the glenohumeral joint musculature. When lifting the shoulder overhead force coupling combines the activation of the upper trapezius to help upwardly rotate the scapula, while in turn the serratus anterior posteriorly tilts the scapula. The over activation of the upper trapezius can lead to abnormal mechanical movement of the shoulder blade, thus decreasing range of motion, or causing irritation to the shoulder joint itself. These force couples also occur with shoulder abduction, horizontal shoulder movement, internal and external rotation, and shoulder adduction and extension.
How is the Rotator Cuff Injured?
Rotator cuff tears usually occur due to a traumatic event. People who play contact sports and sports with overhead activity can cause traumatic tears or injury to the rotator cuff. Acute rotator cuff tears typically occur with a forceful movement overhead with activities that can include: contact sports, weightlifting, swimming, baseball, softball, and shot put.
As we age, the tendons of the rotator cuff can degenerate, becoming thinner and more prone to tearing. Chronic rotator cuff tears can also include a number of sport athletes like baseball, swimming, softball, and shot put athletes that have caused damage to the rotator cuff over time due to poor biomechanics and irritation to the tissue.
Symptoms of a Rotator Cuff Injury
Symptoms of a rotator cuff injury can include:
Inability to lift the arm overhead or shoulder weakness
Pain with arm elevation
Pain in the shoulder at rest or night time
Lack of range of motion
Painful arc with shoulder motion
Popping or clicking in the shoulder
Can Physical Therapy Help?
Physical Therapy can help alleviate the symptoms of an injury to the rotator cuff. Many minor tears and irritation to the rotator cuff can be treated with physical therapy to alleviate pain, increase range of motion, decrease inflammation, improve strength, and improve overall shoulder function. Physical therapy focuses on the improvement of the stability and strength of the shoulder joint after a rotator cuff injury. Physical therapy can help improve range of motion with overhead lifting, internal and external range of motion, and motions that require across body movement. Physical therapy concentrates on correct functional movement of the shoulder that corresponds to everyday activities as well as sports or work specific duties.
Diagnostic imaging does not always correlate with severity of symptoms, so a rotator cuff tear diagnosed by MRI does not necessarily indicate surgery is required. Not all rotator cuff tears need surgical management. There are a number of people living their daily lives with rotator cuff repairs that are completely unaware of the fact that they have a tear.
Patients with major rotator cuffs tears or those who's symptoms have not responded favorably to conservative management may require surgery to correct, but physical therapy can help improve the outcomes after surgery. Following a rotator cuff repair patients will begin physical therapy a few weeks after surgery starting with passive range of motion. Shoulder range of motion and scapular mobility will be progressed followed by strengthening and stabilization of the shoulder to return patients to their previous level of function. Proper biomechanics of the shoulder girdle are emphasized for optimal movement patterns. Patients can expect approximately 2-4 months of physical therapy following surgical intervention for a rotator cuff tear. Patients who receive physical therapy before surgery have shown to have improved strength, range of motion, and decreased pain after surgery.
New Patients are Always Welcome!
The doctors at F.I.T. Muscle & Joint Clinic in Overland Park & Shawnee, Kansas and Lees Summit, Missouri are here to help lessen and relieve your shoulder pain. Do not hesitate; contact us today for leading evidence-based assessments and treatments for your musculoskeletal pain and dysfunction.