The rotator cuff (RC) is comprised of four muscles: the supraspinatis, infraspinatis, teres minor and subscapularis. They are commonly referred to as the “SITS” muscles.
The function of the rotator cuff is to dynamically reinforce and stabilize the shoulder joint, while also allowing for forceful rotation when required.
Injuries can be either acute (sudden onset such as a sports injury or a fall) or chronic (wear and tear over time). The supraspinatis is the most commonly injured muscle of the cuff.
Tears in the cuff are commonly classified as Grade I (1/3 thickness tear), Grade II ( b/w 1/3-2/3 thickness tear) and Grade III (full thickness tear). Most Grade I and II tears are generally treated conservatively, while Grade III tears usually require surgery.
The rotator cuff can also become inflamed, and this is referred to as RC tendonitis.
Symptoms of a rotator cuff injury may vary greatly depending upon whether it is an acute, traumatic injury or a chronic injury over time.
Acute symptoms usually involve a very sharp tearing pain with localized swelling, and difficulty or inability to raise the arm overhead.
Chronic symptoms may initiate more gradually, but still can become sharp over time, with the same difficulty raising or attempting to raise the arm overhead.
Contributing factors to both include poor posture, poor mechanics, age, repetitive overhead tasks, weak shoulder muscles as well as certain sporting events (ie: pitching, throwing, etc.).
RC tendonitis symptoms usually are not as severe as a tear, initiate from gradual onset, and may be specific to certain tasks or positions of the arm/shoulder.
What to expect from therapy
A thorough physical examination and evaluation, including special tests, help determine the severity of the injury, as well as the specific structures that are involved.
The initial focus of rehabilitation is to reduce pain, while restoring lost range of motion and strength. That may include specific exercises designed to improve mobility of the shoulder while also improving mechanics of the joint. That not only is important to facilitate a recovery, but even more important to prevent future re-injury.
Initially ice, heat, the use of anti-inflammatory medication as well as certain modalities like E-stim may be used to reduce pain, swelling or muscle spasm and to promote a healing response.
Eventually, emphasis changes to restoring lost motion, improving strength of the rotator cuff, as well as improving the mechanics of the joint to restore lost function. Strengthening exercises typically progress from the use of weight or resistance bands to functional strengthening, specific to the sport or work task the patient is returning to.
It is of paramount importance for any person who has a rotator cuff Injury to be treated by a physical or occupational therapist, who has the unique skills and knowledge to properly rehab these injuries, as well as to address your individual health concerns. Proper technique and follow through in skilled therapy is the key to reducing pain, increasing mobility and stability of the joint as well as building strength to restore normal shoulder mechanics and a return to full function, including sport and work tasks.
Most patients respond well to skilled therapeutic care, whether or not surgical intervention is required.