What is the Rotator Cuff? I am sure many of you have wondered the same question when it is mentioned by your physio. This article explores what the Rotator Cuff is and what happens when it’s not working as intended.

What is the Rotator Cuff?

The Rotator Cuff is the name used to describe four muscles that attach around the shoulder. They provide stability and strength for one another. 
These four muscles are as follows:
- Supraspinatus
- Infraspinatus
- Teres Minor
- Subscapularis
They each have an attachment from the scapula (shoulder blade) to the humerus and together they form a “cuff” around the joint.

What does the Rotator Cuff do?

The Rotator Cuff is active in all movements of the shoulder. It is active when you’re trying to reach up to hang up the washing, lowering down to pet the dog and even getting dressed. It is involved in almost every active hobby eg swimming, baseball, playing the violin, golf, painting, yoga, tennis, painting just to name a few. The Rotator Cuff balances itself and keeps the shoulder blade stable. This allows the arm to move in space and take part in those activities.

Causes of Rotator Cuff Injury

Rotator Cuff injuries can occur at any age. Within the younger population, it is more often injured by lifting something too heavy. It can also be damaged in overhead throwing sports where the shoulder is exposed to high forces on a regular basis. Baseball pitching is a classic example of this. In the older population injury occurs mostly with degeneration in the muscle. This age related change can progress to a tear or impingement causing changes to the biomechanics of the shoulder.

Symptoms of Rotator Cuff Injuries

The most common symptoms of a Rotator Cuff injury include:
- Pain around the shoulder
- Pain upon movement of the shoulder in different directions
- Inability to move the shoulder due to muscle weakness
- Difficulty completing tasks that are normally done with ease such as putting a shirt on, reaching behind your back or even as simple as lifting a cup

Assessment of Rotator Cuff Injuries

A Physiotherapist will conduct a shoulder assessment starting with a thorough history. This will include how the injury occurred and what aggravates and eases the pain. The next step involves assessing the amount of available movement at the shoulder. Strength testing coupled with specific tests help guide towards the affected structures. Just to throw a curve ball (and not get a rotator cuff injury) studies have shown people over 60 can present differently - even with no symptoms! It is also important to note that other common issues feed into shoulder problems. Neural tension, cervical and thoracic spine dysfunction, muscle imbalance and scapula dyskinesia are just a few of these. Occasionally MRI or Ultrasound imaging is indicated to further guide the treatment plan.

Treatment for Rotator Cuff Injuries

Depending on the extent of the injury, there are conservative and surgical treatments. Conservative treatments focus on:

- Reducing pain with medication and ice/heat therapy

- Activity modification strategies. Physio's have lots of tips to help perform everyday tasks with less pain. Workplace modification is also important. For example if you experience pain with reaching over your head, it may be as simple as using a step so you can work without repetitive overhead movements. Also changing the weight of objects up high on a shelf to a lower weight can help with reducing pain. 

- Avoiding lifting heavy objects and repetitive movements.

- Reducing activities that cause the pain (easier said than done!). A prescription for 'must not hang up the washing' anyone??

- Preserving/Improving movement. A Physiotherapist will prescribe an individualised exercise program. This will focus on exercises that improve range of motion and strengthen weakened muscles.

If the dysfunction does not resolve, corticosteroid injections may be a viable option.

Lastly, some Rotator Cuff injuries may be indicated for surgery if conservative management is ineffective. From there, a surgical protocol is followed for rehabilitation. We work closely with many surgeons on the Gold Coast to facilitate the best programs after surgery. 

A specialist shoulder Physiotherapist can maximise your chances to get back your previous function for work, sport and other hobbies. 

Written by Will Chang