The shoulder is a ball and socket joint, which is comprised of the humerus (arm) and scapula (shoulder blade). The design of the ball and socket joint allows for maximum flexibility in multiple planes. To make sure that the shoulder does not become unstable, the rotator cuff muscles work in unison to maintain the joint securely in its fossa.
The rotator cuff is made up of four muscles, the supraspinatus, infraspinatus, subscapularis and teres minor. These muscles attach the humerus to the scapula whilst also lifting the humerus and maintaining its position within the socket.
Common injuries to the rotator cuff involve a muscle strain and/or tear. This may happen in the muscle belly or in the tendon of the muscle. Most people will notice symptoms to a rotator cuff injury almost immediately. Most notable is tenderness and pain localised to the shoulder, back of the shoulder or even extending down into the arm. Other symptoms such as decrease in strength in the shoulder may also be present. An inability to lift the arm out to the side, reach behind your back, or even lift your arm to brush your hair is also common, especially if the strain or tear is more severe. Most individuals will notice a difficulty in completing simple everyday tasks.
The most common causes of rotator cuff injury can be due to trauma from falling on an outstretched hand as well as repetitive strain. It is also not unusual to tear a rotator cuff muscle from lifting a heavy load.
Diagnosis of a rotator cuff tear includes orthopaedic testing as well as imaging such as MRI. People who have a higher risk includes people who are over the age of 40 and also people who work in trades in the production line where there is repetitive action.
Treatment depends on the severity of the injury. If there is a full thickness tear surgery should be considered. If there is a partial thickness tear or a strain more conservative treatment would be the recommended route. A combination of manual therapy and extensive rehabilitation is the best option for a full return to work or daily activities without pain.
Some simple suggestions to reduce pain in between treatment sessions includes:
ice to alleviate pain – 15 minutes on, 20 minutes off for a few hours
sit up straight and concentrate on pulling your shoulders back. If your shoulders roll forward, this reduces the amount of space in your shoulder joint, causing worsening of the pain.
Roll out – Use a tennis ball and roll out your muscles at the back of your shoulder and into your traps by placing the ball on a wall and leaning gently against it. This may reduce muscle spasm as a result of injury.