The rotator cuff is something many people have heard of, but often have no idea what it actually does. From being referred to as the rotator “cup,” to statements of decade-old tears continuing to limit function, let’s debunk this muscle group.
The rotator cuff is a group of four muscles surrounding the shoulder joint: Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis. These deep muscles are essential for arm movement and provide stability to the shoulder complex. The bony anatomy of the shoulder is naturally very unstable, a ball and socket joint with about as much stability as a golf ball on a tee. So these four muscles must work in unison to keep the joint held together and centered. The problem for most people though is that these muscles aren’t symmetrical, in terms of strength or flexibility. Factors such as posture and overuse play a major role in the health of the rotator cuff, where most often the front of the shoulder is tight and strong from hours of rounding over tables or computers, leaving the backside very weak. This can result in chronic pain, tearing, decreased range of motion, poor strength, and decreased quality of life.
Rotator cuff tears are classified as either traumatic or degenerative, and partial or full-thickness. Traumatic tears are caused from one event such as a fall or single throw that causes a tear in one or more of the rotator cuff muscles, usually in younger patients. Degenerative tears on the other hand are tears that happen over time, such as with overuse and age. Partial tears only go part-way through the muscle, and can usually be treated conservatively with physical therapy, whereas full-thickness tears go all the way through the muscle. The most common need for surgical intervention is in traumatic, full-thickness tears, as you cannot strengthen a muscle that is not connected.
So you start having shoulder pain, or you’ve been having pain that you’re ignoring. What should you do? Most folks want to start with an MRI, but I encourage you to see a physical therapist first. The reason is that physical therapists are educated in special tests to help determine a full versus partial thickness tear, and can get you started on recovery immediately, including restoring range of motion, posture, and strength. On the other hand if you push for an MRI first, most likely you’ll need a referral to an orthopedic specialist. Meaning you first have to get an appointment with your primary care provider, then get referred to a specialist, wait to get an appointment with that specialist, then get an appointment for an MRI, wait for a follow-up appointment for the reading of the MRI, and then will likely get referred to physical therapy anyways. Now all you’ve done is wasted 8 weeks to get started on rehab and have gotten only weaker during this time. In general, the sooner you can get started on rehab after an injury, the quicker you’ll be out of pain and back to your life. Worst case scenario, if you go to physical therapy first and it is likely you have a full-thickness tear, the PT will send you to an orthopedic doctor for an MRI, and you’ll still be able to start some rehab for range of motion and strength in the meantime.
Maybe you don’t have shoulder pain, but want to know if you can help prevent rotator cuff tears. In general, the best exercises for preventing rotator cuff pathologies include stretching of the front of the shoulders/chest, such as a pec opener on a foam roller or in a doorway, while strengthening the back of the shoulder. Exercises focused on external rotation (especially in overhead positions) such as face pulls, and exercises focused on shoulder blade strength/control such as prone Y’s are extremely important in maintaining health of the shoulder complex. If you are having shoulder pain or want to learn more about preventing rotator cuff tears, schedule an appointment today. Most rotator cuff injuries do not require surgery, and you do not have to spend the rest of your life avoiding activities or living in pain.
Face Pull Exercise
Prone Y Exercise
References
Dickinson RN, Kuhn JE. Nonoperative Treatment of Rotator Cuff Tears. Physical Medicine and Rehabilitation Clinics of North America. 2023;34(2):335-355. doi:https://doi.org/10.1016/j.pmr.2022.12.002
Rotator Cuff. Physiopedia. https://www.physio-pedia.com/Rotator_Cuff?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal
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