What is a Rotator Cuff?
A group of four distinct muscles and their tendons, which provide strength and stability during motion to the shoulder complex is commonly called as the Rotator Cuff.
The four muscles are Supraspinatus, Infraspinatus, Teres minor, and Subscapularis.
They are also referred to as the SITS muscle, with reference to the first letter of their names in the same order as mentioned above.
The muscles arise from the scapula and connect to the head of the humerus, forming a cuff around the glenohumeral (GH) joint or the shoulder joint.(1)
Why is the Rotator Cuff so important?
The Rotator cuff muscles are essential players in almost every type of shoulder movements including flexion, abduction, internal rotation and external rotation.
Functioning of the entire shoulder girdle depends on the strength and flexibility of the "SITS" muscles.
They help in stabilizing the shoulder joint, by providing the "fine tuning" movements of the head of the humerus within the glenoid fossa.
They keep the head of the humerus within the small glenoid fossa of the scapula in order to enlarge the range of motion in the GH or the Gleno-Humeral joint and avoid mechanical obstruction.(1)
How does the Cuff help the Shoulder joint?
The glenohumeral joint is a ball and socket joint and comprises a large spherical humeral head and a small glenoid cavity.
This anatomy makes the joint highly mobile, however, really unstable.
Stabilization in the shoulder is provided collectively by the non-contractile tissue of the glenohumeral joint (static stabilizers) such as the capsule, the labrum, the negative intraarticular pressure, and the glenohumeral ligaments; and the contractile tissues (dynamic stabilizers) such as the rotator cuff muscles and the long head of the biceps brachii.(2)
The SITS muscles are deeper muscles and are very active in the neuromuscular control of the shoulder complex during upper extremity movements.(1)
The tendons of the rotator cuff muscles blend with the joint capsule and form a musculotendinous collar that surrounds the posterior, superior, and anterior aspects of the joint, leaving the inferior aspect unprotected.
This arrangement is an important factor since most shoulder luxations occur because the humerus slides inferiorly through the unprotected part of the joint.
During arm movements, the rotator muscles contract and prevent the sliding of the head of the humerus, allowing full range of motion and providing stability.(2)
Thus, RC dysfunctions can lead to shoulder pain, impaired functional capacities and a reduced quality of life(1).
Causes of injury
Trauma
Overhead activities
Advancing age
Postural imbalance and poor biomechanics may cause repetitive strains to RC(1)
Common injuries
Rotator Cuff Tears (micro or macro tearing of the muscles or tendons);
Rotator Cuff Tendinitis (acute inflammation of the RC soft tissue);
Rotator Cuff Tendinopathy (chronic irritation or degeneration of the RC soft tissue);
Impingement syndrome (biomechanical dysfunction of the shoulder complex with causes abnormal wear and tear on the RC soft tissue).
(Watch out for this space in the coming months to know more about these injuries)
Symptoms
Pain
Painful range
Muscle weakness
Functional impairments
Treatment
Corticosteroid injection into the subacromial space
Physical therapy.
Surgical repair of RC tears.
Physical therapy management
Diagnosis of RC complaints will be done at ease by your physical therapist through various tests. These cluster tests will help in isolated assessment of muscles involved.(1)
Physical therapy management aims at reducing shoulder stiffness, increasing the strength of muscles and improving the range of motion and muscle strength.
Meeting patient’s goals and achieving the required functional levels of activity and home-based exercise programme are all a part of physical therapy services that we provide.
Physical therapists follow specific protocols in case of a Rotator Cuff repair.
At Valley Healing Hands, we provide the best Physical Therapy treatment for Rotator cuff injuries. We provide a warm atmosphere for all our patients with a one on one ratio; for the best quality of care needed for maximum outcomes and return to play or regular routine. Our physical therapists are highly qualified and will plan an individualized treatment routine, customized to meet your specific needs. Our patients are highly satisfied with our services. You can learn about what they have to say about us here and get connected to us here. Our patients love us and you too will! We can get you back to your daily routine!!!
Researches
Proper physical therapy effectively treats most patients with RC Syndromes without subacromial decompression. No difference in outcome has been reported for surgery over physical therapy in several trials(2).
Conservative treatment with NSAIDs, and most importantly, physical therapy, should be the first attempt at therapy. Surgical treatment with arthroscopy is done in cases of both acute or chronic full-thickness tears since delay can result in significant muscle atrophy, tendon retraction, and poorer surgical results.(2)
Sources
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