Can you name the muscles that comprise the rotator cuff?
The rotator cuff comprises the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles all attach to the head of the humerus at one end, and the shoulder blade at the other. As such, contraction of these muscles both stabilize the humerus in the glenoid fossa of the scapula, and work with the deltoid muscle to elevate the shoulder in many directions.
The shoulder is a highly mobile joint – with optimal function of the glenohumeral joint at 180 degrees rotation in three different planes. While its great to have a lot of movement, this also makes it more vulnerable to injury than other, more stable joints. As a result, diagnosis of injury to the rotator cuff is a common presentation we see at the clinic.
Injury may occur to the muscle itself (strain or tear), or to the tendon (tendonopathy/tendonitis).
Impingement of the rotator cuff tendons can occur with repeated pinching or irritation as they pass under the coracoacromial arch (formed by a ligament that joins two parts of shoulder blade).
Symptoms of rotator cuff pathology
– Pain reproduced with active movements of the shoulder, resisted muscle contraction, passive stretching and palpation over the affected rotator cuff muscle/tendons
– Swelling/inflammation of the shoulder/axilla/upper arm
– Loss of strength especially with rotation or abduction
– Crepitus with movement
Why does it occur?
Impingement and rotator cuff pathology can sometimes be attributed to sustained overhead use or repetitive microtrauma. These actions commonly occur with throwing sports such as netball, cricket, softball and baseball, and also tennis, football, and swimming. They can be acutely painful, or increase in severity over time.
The rotator cuff is prone to fibrosis and degeneration with age. There is a high incidence of rotator cuff tears in the older population that are asymptomatic, 4% of people >40 years of age, and >50% in those >60 years of age. In these cases the muscles can be worn, not torn as such.
What else can it be?
The Osteopath will consider alternate causes of pain to the shoulder before they reach your diagnosis. Other common causes of pain to the shoulder may also include cervical spine dysfunction (referred pain or radicular symptoms), glenoid labrum tears, biceps tendonopathy, thoracic outlet syndrome or adhesive capsulitis (frozen shoulder). If you experience any sharp shooting pain, tingling or weakness/loss of strength of the arms, sudden swelling or feelings of being unwell, please contact a health care provider immediately.
How can Osteopaths help?
Osteopaths evaluate and diagnose your shoulder pain using a series of tests. They may even refer for imaging if the cause is unclear, severe, or not resolving.
Goals of the acute phase is to relieve pain and inflammation, avoid exacerbation of symptoms with active rest, while re-establishing nonpainful range of motion with pendulum exercises. Osteopaths use techniques such as soft tissue massage, mobilisation and articulation, myofascial release, muscle energy technique, manipulation, and dry needling to normalize the arthrokinematics of the shoulder girdle including the scapular-thoracic complex. These are considered conservative techniques in that they are low risk.
Exercise prescription is advised to re-establish strength and stability as the patient returns to normal daily activities. These exercises are progressed depending on the patient’s goals as they work towards returning to their sport.
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This post was written by Dr Jessica Davies.
You can find out more about Jess here or book an appointment with her here.
Alternatively, you can call the clinic on 9908 2844.
References
Carnes, M., Vizniak, N. A. (2012). Quick reference evidence-based conditions manual (3rd). Canada, Professional Health Systems Inc.
DeBerardino, T. M., Chang, W.K., Young, C. (2018). Shoulder Impingement Syndrome Treatment and Management. Retrieved from https://emedicine.medscape.com/article/92974-treatment
Murtagh, J., Rosenblatt, J. (2015). John Murtagh’s General Practice (6th). NSW, Australia, McGraw-Hill Education (Australia) Pty Ltd.
