HELP! I Think I Hurt My Rotator Cuff!

We’ve all heard it – “I hurt my rotatory cup!” – but what’s actually going on when someone says that? Medically, what they’re referring to is the rotator cuff, an essential group of muscles that stabilizes and powers our shoulder. In this blog post, we’re going to take a deep dive into the rotator cuff anatomy, how it works, and the common injuries that can cause shoulder pain.

What Exactly Is the Rotator Cuff and What Does It Do?

The rotator cuff is a group of four muscles and their tendons that play a key role in stabilizing the shoulder and enabling movement.

• Infraspinatus

• Supraspinatus

• Teres Minor

• Subscapularis

These muscles keep the ball of the humerus (upper arm bone) within the shallow glenoid fossa (socket) of the scapula (shoulder blade). This allows your shoulder to be both highly mobile and relatively stable — a delicate balance.

Why Is This Important?

Unlike the hip, which has a deep ball-and-socket joint, the shoulder’s socket is much shallower, allowing for a wider range of motion but also making the joint prone to instability. Without the rotator cuff muscles, the head of the humerus could slide out of place, leading to pain, weakness, and dysfunction.

The rotator cuff muscles are located on the scapula and attach to the humerus, allowing for key movements, including:

• Supraspinatus: This muscle is positioned on the top of the scapula and helps lift your arm, particularly in abduction (raising your arm sideways, like in a snow angel).

• Subscapularis: Found on the front of the scapula, it helps rotate your arm inward, like when reaching behind your back.

• Infraspinatus: Located on the back of the scapula, it helps rotate the arm outward.

• Teres Minor: This muscle works in tandem with the infraspinatus to rotate the arm outward.

Common Rotator Cuff Injuries

Many rotator cuff injuries involve the tendons that connect these muscles to the humerus. The most common types of injuries include:

• Tendinopathy: A broad term encompassing pain, swelling, and dysfunction of the tendons, including tendinitis and tendinosis.

• Tendinitis: This is acute inflammation of the tendon, typically caused by overuse, poor posture, or trauma. It's a short-term, inflammatory condition.

• Tendinosis: Chronic degeneration of tendon fibers, often caused by long-term overuse, aging, or poorly healed injuries. This condition typically requires longer recovery.

• Tears: Tendon tears occur when the tendon detaches from the bone — either partially or fully. These can be acute (from a fall or trauma) or degenerative (from repeated wear and tear over time).

• Calcific Tendinopathy: A condition where calcium deposits form in the tendon. The exact cause isn't well understood, but it can lead to significant pain and mobility issues.

• Muscle Strains: A tear or overstretching of the muscle fibers, often resulting from sudden, forceful movement or overstretching.

• Bursitis: Inflammation of the bursa (a small fluid-filled sac) near the rotator cuff. Though not a direct injury to the cuff, bursitis often occurs due to friction caused by rotator cuff dysfunction. This can lead to pain, swelling, and limited movement in the shoulder.

How Can a Physiotherapist Help Diagnose Rotator Cuff Injuries?

If you think you’ve injured your rotator cuff, a physiotherapist will work with you to assess the situation and design an effective treatment plan. The process typically includes:

1. Detailed History: Understanding when the pain started, how it affects your daily activities, what movements trigger or relieve the pain, and any previous shoulder injuries.

2. Physical Assessment: Your physiotherapist will assess the range of motion (ROM) in your shoulder, test muscle strength, observe your posture, and perform specific special tests to isolate the cause of the pain.

3. Imaging: While most rotator cuff injuries don’t require imaging, your physiotherapist can assess whether it's necessary. In many cases, physiotherapy can address the issue without the need for scans.