Issue 15: "You must have a rotator cuff problem"...or do you?

It’s one of those terms which is tossed around, a lot. But what actually is it?

So, you mention to your friends that you’re having problems with your shoulder. They start talking about their experiences with shoulders issues, some say ‘it must be frozen shoulder’, some say ‘it must be your age’, some say ‘you probably have a rotator cuff problem’. You’re left feeling puzzled, Googling some more but nothing is making sense.

Well we’re here to help. Confused on whether you have a rotator cuff problem?

Keep reading.

What is the rotator cuff?

S – Supraspinatus

I – Infraspinatus

T – Teres Minor

S – Subscapularis

The rotator cuff is a group of smaller muscles in the shoulder responsible for the active dynamic stabilisation of the glenohumeral joint. They help provide a compressive and downward shear force to prevent the humerus from moving out of place alongside the passive structures such as the ligaments and labrum (cartilage) in the joint capsule.

Due to their size, they aren’t designed for huge force production – which is why rehabilitation for them usually involves simpler movements and lesser weight.

How are problems caused?

→ Degenerative Changes: More common in >50 years old, history of tendinosis or partial-thickness tears. These do not equate to pain or the inability to function.

→ Repetitive Microtrauma: Fatiguing from excessive use, a weakness or lack of endurance.

→ Acute Trauma: Overhead activities

→ A Secondary Dysfunction (e.g. Extrinsic Factors): Shoulder impingement, rotator cuff tendonitis…

There are various types of rotator cuff tears and anatomically, because the cuff is a blanket of muscle, without an MRI they can be very hard to structurally diagnose!

What’s the most common type of tear? The supraspinatus - located on the inside surface of the scapula (shoulder blade), this type of tear most often occurs alongside another cuff muscle.

What symptoms might show up?

→ Pain with overhead activities – in particular, abduction, external rotation

→ Pain at night, difficulty sleeping on injured side

→ Potential weakness when lifting the arm at shoulder height

→ Fatigue from excessive use

→ Lack of endurance

→ Sometimes less joint stability

A few of the differential diagnosis:

→ Shoulder Impingement:

Can be caused if instability takes place and the subacromial space decreases which can cause inflammation, pain and more weakness to the cuff.

→ Rotator Cuff Tendonitis:

Traditionally more degenerative in nature. Can lead to partial-thickness tears, again, difficult to diagnose without an MRI scan.

→ Subacromial Bursitis:

Pain will occur over the subacromial place (top/outer surface of the shoulder) which will result in inflammation of the bursa. Normally caused by repetitive overhead activities or trauma.

→ Bicep Tendinopathy:

Most commonly over the long head tendon. The tendon sheath becomes swollen and uncomfortable. Pain limiting on abduction, internal rotation and resisted elbow flexion.

If anything of this is ringing alarm bells for you, then do book in with us so we can help you!