As mentioned in our last blog, the shoulder is inherently an unstable joint. Apart from the labrum, a group of structures called rotator cuff muscles have a big role to play in its stabilisation, these are; supraspinatus, infraspinatus, teres minor and subscapularis.
A common misconception when learning about these muscles is that each does a particular movement, but actually a key role they play is tensing up just before larger muscles, such as the deltoid muscle, provide the main force for the movement. By tensing up just prior to this movement, the rotator cuff muscles help to control the head of the humerus (the bone in the upper arm) in the socket.
The rotator cuff muscles can get injured both as a result of trauma, such as a heavy rugby tackle, or commonly just gradual degeneration over time, for example if they are underused during sedentary lifestyles. Gradually minor excessive load to the muscles can then lead to degenerative, atraumatic tears over time rather than one particular incident.
It is important to know that there are partial tears and full thickness tears and treatment options vary depending on which one is present.
We’ll start with partial tears. If it’s a traumatic injury there may be quite a bit of acute inflammatory pain associated with the injury. If this is the case, it is worth taking a few days to let the symptoms settle and do some gentle pendular exercises – basically leaning forwards onto a support and gently rotating your arm in small circles. As the symptoms settle, strengthening is the key, starting with an exercise such as the one below.
…before progressing on, when you’re ready, to something like this shoulder press.
With full thickness tears it can get a little more complicated, although emphasis here needs to go on the word ‘can.’
It is possible to have completely asymptomatic full thickness tears of the rotator cuff i.e. the shoulder is fully functioning and pain-free. It is not clear why this is sometimes the case, and both site of the tear and also which rotator cuff tendons are torn may affect this, but if it is very painful and/or affecting function significantly, surgery may be required to repair the rotator cuff, particularly if physiotherapy has been trialled with no significant benefit. However it shouldn’t be entered into lightly, particularly as there is a long rehabilitation afterwards that requires good adherence to the rehabilitation plan, including a time of almost complete rest immediately post-surgery; life demands for that period, therefore, will need to be considered.
Many rotator cuff issues can be successfully treated without the need for surgery through a well structured strengthening programme, alongside any necessary hands on treatment, both of which your physio will be able to provide.