ROTATOR CUFF

What is it?

The rotator cuff is the name given to a group of four muscles that act to stabilize the shoulder. Shoulder pain and the so-called frozen shoulder often involve these key shoulder muscles.

They are the Subscapularis (which lies UNDER the shoulder blade), the Supraspinatus (which lies ABOVE the spine of the shoulder blade), the Infraspinatus (which lies UNDER the spine of the shoulder blade) and the Teres Minor. To these four muscles we will add the Biceps muscle for simplicity, since it also a common offender and cause of shoulder pain.

For some pictures of these muscles, and their anatomy, click here. These shoulder muscles allow you to raise your arm, turn it and move the arm into many different positions, each carefully controlled and coordinated, as in throwing a ball accurately, for example.

Unlike the hip joint though, the shoulder socket is very shallow to allow for greater range of motion of the shoulder. This makes the shoulder more vulnerable to injury, leading to shoulder pain, strains, tears and sometimes frozen shoulder.

Rotator cuff syndrome. What is that?

Rotator cuff muscle tears cause pain and weakness in the shoulder. Usually it starts as a small strain with heavy lifting, or not warming up properly before tennis, for example, or a fall on the outstretched arm.

This may be followed some weeks or months later by a partial tear if the initial minor injury was not correctly addressed. The shoulder will be painful, but you can still move the arm in a normal range of motion. Obviously, the larger the tear, the more weakness and the more pain the injury will cause.

Complete rupture is fairly rare, often occurring after cortisone injections, which should be considered only after chiropractic (or other) conservative treatment has been exhaustively tried without success.

Regular stretching before activity is the key to the healthy functioning of the shoulder muscles and joints. Otherwise wear and tear, or degeneration, of the muscles and tendons occur. Tearing of the rotator cuff tendons is an especially painful injury. A torn rotator-cuff creates a very weak shoulder. Most of the time patients with torn rotator cuff are in late middle age. But rotator cuffs tears can happen at any age.

What causes Rotator Cuff Syndrome?

Rotator cuff muscle tears can occur from a single traumatic injury, for example a fall on the outstretched arm, causing immediate severe shoulder pain. If a fracture, or torn ligaments occurs at the same time, then of course the rotator-cuff injury may be missed, and the treatment of the fracture (immobilisation) may unavoidably be the very worst treatment for the muscle injury. It can't be helped. Just rehab of the shoulder, once it comes out of the sling, will be further prolonged and more difficult.

Most tears, however, are the result of overuse of these muscles and tendons over a period of years, starting with a minor injury that is not adequately cared for. People who are especially at risk are those who engage in repetitive overhead sports such as tennis and weight lifting.

This nasty shoulder syndrome frequently starts after a neck injury, long forgotten. Progressive irritation of the nerves from the neck that supply the shoulder weakens the muscles and makes them vulnerable to sprains and strains.

For unknown reasons, smokers are more prone to RIGHT shoulder pain.

A muscle tear usually doesn't occur unless the muscle is already weakened by some other problem, either in the neck and sometimes in the acromio-clavicular (AC) joint and in impingement syndromes.

TREATMENT

Nonsurgical Treatment

The first goal is the correct diagnosis of the condition. This will include an examination of the neck, to see if the underlying cause may be an irritated or pinched nerve.

Classically, in a muscle injury, an ISOMETRIC test (the benchmark test) causes pain. In this examination, the rotator cuff muscle is tested against resistance, WITHOUT movement of the arm.

An echo (Doppler) examination or an MRI may be required in more serious cases of shoulder pain to help with the diagnosis.

Treatment is then addressed at your chiropractor�s findings. Classically this will include a gentle adjustment of your neck, shoulder rest and ice (if acute), gentle stretching perhaps if the tear is not serious, and finally vigorous, active rehabilitation of the shoulder and neck, so that the tear does not reoccur as soon as you return to sport.

Anti-inflammatories should not be used in the first instance because in the initial stage this is not an inflammatory condition, and ice is more effective and safer. 14 000 people DIED in one year in the USA alone from gastric bleeds after using NSAIDs, as they are called.

Cortisone injections are freely acknowledged to be a cause of rotator-cuff tendon rupture and, together with surgery, should only be considered after all conservative treatment has been exhausted.

Depending how serious the strain is, it may take 6-8 weeks to heal. Graduated return to sport is essential.

As a rule of thumb, if your shoulder is not improving to your satisfaction, think of the following:

Has you neck been considered as a possible cause?
Has the AC joint been examined?
In the author's experience, the SUBSCAPULARIS muscle is often the offending rotator-cuff miscreant. Has it been examined?
Are you following a daily exercise program? Daily stretching and strengthening is vital is you wish to regain the function of your shoulder.

SURGERY

A complete tear (most uncommon) will not heal. Complete ruptures usually require surgery if your goal is to return your shoulder to optimal function, and particular if you have competitive sport in mind.

Elderly patients, and those who have other diseases that increase the risks associated with anaesthetics, should avoid surgery, (in my opinion!) and accept the limitations of a weak shoulder. Far more sensible than risking losing your marbles! To go from ROTATOR CUFF to the dangers of a General Anaesthetic.

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