Rotator Cuff Syndrome
A rotator cuff tear is a very common injury. These injuries are usually caused by either repetitive motion or trauma. These injuries, in the older population, are often due to a decrease in elasticity of muscles and tendons that occurs with the aging process.
No matter what the cause, the location of pain from a rotator cuff tear is often quite difficult to pinpoint. Patients often describe the pain as being a broad area of involvement over the shoulder. Often the pain of a rotator cuff tear radiates down their arms and elbows.
If the rotator cuff is only partially torn, the pain experienced by the patient will likely be the predominant complaint. If there has been a complete tear of the rotator cuff the patient will not be able to perform certain motions with their shoulder.
When it comes to diagnosis, rotator cuff tears will not be seen on X-rays. Usually an ultrasound or MRI (magnetic resonance imaging) is needed to confirm the tear. In most cases a physical examination is all that is needed to diagnose this condition; that is unless there are indications of a complete tear, such as a complete inability to perform certain motions.
Fortunately, most rotator cuff tears do not need surgery. On the other hand, significant disability can result from untreated rotator cuff tears. Conservative treatments and exercise rehabilitation should always be tried before surgery is performed.
In most cases a rotator cuff injury can be treated within a short period of time with soft tissue procedures (Active Release, Graston Technique, Myofascial Release, Massage Therapy) and exercise alone. However, in other cases, what appears to be a simple rotator cuff injury often involves several other areas of the body. To resolve these cases a more complex understanding of shoulder biomechanics is needed. Without this understanding acute injuries often become chronic shoulder problems.
To get a better understanding of shoulder problems let’s consider some common examination findings. Because the mechanisms of these injuries are very similar, it is common to see similar examination findings. For example, the follow examination findings are often seen in injures caused by overhead throwing or overhead reaching:
- Shoulder joint instability (Glenohumeral instability).
- Abnormal shoulder blade motion (Scapular Dyskinesis).
- Restriction in internal shoulder rotation.
Shoulder joint instability (Glenohumeral instability)
Research has shown that shoulder instability can lead to a cycle of micro trauma and secondary impingement syndromes which often result in chronic shoulder pain. Practitioners will often see this type of instability when performing examinations of the shoulder (translation tests).
Shoulder instability, especially anterior shoulder instability (laxity of the anterior capsule), is often related to problems in the posterior shoulder capsule. It is important to understand these kinetic chain relationships.
Abnormal shoulder blade motion (Scapular Dyskinesis)
Numerous studies have shown that an alteration in normal shoulder blade motion can cause shoulder impingement. Abnormal shoulder blade motion frequently causes an alteration in muscle activity of three specific areas; the upper trapezius (UT), lower trapezius, and the serratus anterior muscle (SA). This alteration in muscle activity is often overlooked in patients who have been diagnosed with a rotator cuff injury.
These abnormal motion patterns affect the patient’s ability to perform certain actions such as the ability to bring their shoulder forward or backward (protraction and retraction).
A lack of backward motion (retraction) is often related to what is called hyperangulation; another risk factor for shoulder impingement (internal shoulder impingement).
Restrictions in internal shoulder rotation
Restrictions in internal rotation are commonly related to an increased risk of shoulder injury. This is especially true when actions are performed when the shoulder is flexed and internally rotated. In this position pressure is created between the insertion of the supraspinatus muscle and the acromion or coracoacromial ligament. This can become a focal point of impingement.
Sometimes rotator cuff injuries are just that, tears in the attachment points of specific tendons and muscles of the rotator cuff. Other times, what is diagnosed as a simple rotator cuff injury is actually a complex shoulder problem. These problems could include joint instability, abnormal scapular motion, restriction in joint motion, soft-tissue restrictions and multiple areas of impingement.
That is why a complete assessment of any shoulder problem is essential. The practitioner must take the time, and have the expertise, to look beyond what appears to be a simple tear.
The success rate in resolving shoulder injures is very high in the hands of an experienced soft tissue practitioner (Active Release, Graston, Massage Therapist). As the practitioner work through the shoulder restrictions they will be looking for changes in tissue consistency, movement and function. Some of these changes are often noted even during the first treatment.
Exercise is Essential
Again as with all injuries any type of treatment must be followed by the right exercises. Without exercise the chance of re-injury will be significant. For more information see our Blog about “Exercise and Tissue Remodeling”.
For information and exercises that we recommend to our patients for the treatment of rotator cuff injuries, see our “Exercises for the Shoulder to Hand” kinetic chain exercise book.