 |
The rotator cuff is the group of four tendons and their related muscles (Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis) that surround the shoulder joint. These are relatively small muscles that help with motion and rotation of the shoulder and play an important role in stabilising the joint. The tendons of the rotator cuff, not the muscles, are most commonly damaged. When the tendons are irritated or torn, they cannot function properly. Of the four rotator cuff tendons, the supraspinatus is most frequently torn as it passes under the bony acromion and so is more prone to rubbing and wear.
Pain and weakness due to a rotator cuff tear is one of the most common causes of shoulder pain. Damage and tears to the rotator cuff tendons may be as a result of a traumatic injury, such as a fall onto the shoulder, or more commonly may present as a result of poor shoulder mechanics and gradual rubbing and wearing of the tendon. This latter cause is seen more frequently in patients over 40 years of age.
Tears of the rotator cuff tendon are described as partial thickness tears, full thickness tears and full thickness tears with complete detachment of the tendons from bone.
Partial thickness tears often appear as fraying of an intact tendon. Full thickness tears are through-and-through tears. These can be small pin-point tears or larger button hole tears or tears involving the majority
of the tendon, where the tendon still remains substantially attached to the humeral head and thus maintains function.
Full thickness tears that involve complete detachment of the tendon(s) from the humeral head and may result in impaired shoulder motion and function may be significantly affected. Shoulder pain is variable and does not always correspond to the size of the tear.
Treatment of rotator cuff tears is largely dependant on the size of the tear and the amount of pain and restriction of shoulder movement that is present as a result. As a general rule, conservative management of the injury with physiotherapy is always attempted first. This may involve soft tissue release, range of motion exercises taping, bracing or the use of a sling.
 |
 |
The main focus of treatment however, is provision of exercises aimed at maximizing the remaining muscular control systems of the shoulder. This usually begins with scapular (shoulder blade) control exercises in order to provide the remaining rotator cuff muscles with a stable foundation from which to work. The remaining intact rotator cuff muscles can to some degree be trained to take over the role of the damaged tendon through rotator cuff control exercises designed by your physiotherapist.