As a rehabilitation provider in an orthopedic setting, rotator cuff injuries are extremely common among our patient population. Patients will commonly refer to the ‘rotator,’ ‘rotary cup,’ or simply ‘the cuff,’ and we find the rotator cuff often bears the blame for a myriad of shoulder ailments. Understanding the signs and symptoms of a true rotator cuff injury are important, as successful outcomes often hinge on proper diagnosis and early treatment.
Anatomically, the rotator cuff is aptly named; it literally encircles the humeral head and functions to maintain the congruency of the ‘ball and socket’ style of the shoulder joint. In plain terms, it maintains proper joint positioning and stability during shoulder movement. The cuff is comprised of four separate muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. Each of the four muscles attach vi a tendon to the humerus. Because each tendon attaches at a different point and from a different angle, the muscles function differently during movement and combine to provide a stabilizing ‘cuff’ around the joint.
These muscles are quite small, but mighty; they can exert a large amount of force and can maintain this force over long periods of time, allowing the body to complete daily activities with ease. However, breakdown can occur when the system is overloaded, often suddenly, causing the muscle or the tendon to tear. These types of traumatic injuries can happen during a fall or a sudden traction force (dogs on leashes are common culprits). More commonly, however, rotator cuff injuries brew slowly over time, and without obvious symptoms. Repetitive movements of the shoulder combined with postural changes can exert mechanical pressure on the rotator cuff, causing inflammation and tendon fraying. Ultimately this weakens the system to the point that even a mundane movement can cause failure. Many times, patients with rotator cuff tears cannot even pinpoint the moment at which the injury happened.
There are a few red flags that can indicate the cuff is at risk. If you find that you are having trouble reaching fully overhead, or if performing this movement causes pain along the outside and upper portion of the shoulder, you may have some compression of the cuff (called ‘impingement’). Other symptoms include pain and/or weakness with pushing movements or reaching out and away from the body (retrieving a seatbelt, throwing the covers back in bed, or even combing your hair). Left unchecked, impingement can lead to a tear, but if diagnosed early enough it is very treatable with a course of physical therapy.
If impingement or injury ultimately cause a rotator cuff tear, all hope is not lost! In many cases, a tear is manageable with conservative treatment such as physical therapy and/or injections. Reducing the inflammation, optimizing posture, and retraining the surrounding muscles to provide the most stability possible can often restore lost function and avoid surgery. If these treatments are not enough, a physician may recommend surgical repair of the rotator cuff. This procedure is quite involved, and requires a lengthy recovery and rehabilitation process, but ultimately leads to favorable outcomes for most patients.
If you are experiencing pain or loss of function in your shoulder, do not wait for it to get worse! Research has shown that early diagnosis and intervention drastically improve outcomes. At the MMI division of the Centers for Advanced Orthopedics, we have a qualified team of orthopedic specialists with convenient office hours in Frederick, Urbana, and Hagerstown. We would be happy to meet with you, take time to understand your symptoms and your lifestyle, and build our treatment plan around your goals. If you have questions or would like to make an appointment, please visit our website (mmidocs.com), check us out on social media (@mmidocs), or call our office at 301-694-8311!