What Exactly is the Rotator Cuff?
As we mentioned last week, the shoulder is a complex joint. Your core, shoulder blade, and upper arm interact to form the movements we refer to as “shoulder movements.” The rotator cuff (RC) is the name for the group of muscles that act directly on the head of your upper arm bone (humerus) to create certain movements. The four muscles of the rotator cuff are infraspinatus, supraspinatus, subscapularis, and teres minor (also known as the SITS muscles). The biceps muscle is occasionally called the fifth muscle of the rotator cuff due to it’s involvement at the shoulder.
Fancy muscle names aside, these muscles hold the humerus in place and direct the movement of the shoulder joint. However, they do not provide the muscle power necessary to lift heavy items with the shoulder. Rather, the lifting power comes from your core and shoulder blade muscles–this is why one of our primary focuses during therapy is strengthening those two areas, so you can learn to lift properly and avoid future injuries.
Rotator Cuff Injuries
There are three basic injuries that can occur with the rotator cuff: tendinitis, partial tear, or a full tear. With tendinitis, one of the tendons of the rotator cuff becomes inflamed and possibly incurs micro-tears. This is very similar to impingement. Your shoulder will be painful with certain movements and it may not get better. With a partial tear of one of the tendons, you may or may not require surgery. Most physicians tend to try therapy first to see if the partial tear can heal on its own. A full tear of one of the tendon generally warrants surgery to repair the torn tendon. After surgery, you will require therapy according to your doctor’s preferred protocol.
Therapy Treatment for Rotator Cuff Injury
Tendinitis & Partial Tear
Therapy will look differently depending on your injury and timing. Typically, we begin by calming down any swelling and inflammation that may be occurring. This requires rest. We usually recommend icing regularly throughout the day to help keep inflammation and swelling at a minimum. This is particularly important in tendinitis. While allowing the shoulder to rest, your therapist will stretch your shoulder or have you stretch it at home. Stretching is important–be careful to avoid a frozen shoulder. So keeping the range of motion, while not over-irritating the shoulder is key. Once the pain has subsided, you can begin strengthening exercises.
Post-Surgery for a Full Tear
If you have rotator cuff surgery, your doctor will refer you to therapy. Different physicians have different preferences of the timeline when you are sent to therapy. Recently, physicians have been holding people back a few extra weeks, to protect the tendon from rupture. Your physician will let you know once they want you to attend therapy. Once you begin therapy, typically the focus in on passive stretching of your shoulder. So you therapist will stretch it for you and show you ways to stretch it without using your muscles. This might be uncomfortable and can be painful. Keeping an open dialogue with your therapist regarding your pain is important. With your physician’s clearance you will eventually progress to active stretching and then strengthening. The physician typically drives your rehabilitation process by providing your therapist with specific instructions.
Were you recently diagnosed with a rotator cuff injury? If so, you may be a candidate for hand therapy services at LB Hand Therapy in Maryland. Visit our Where to Begin page to become a patient.
Planning to have rotator cuff surgery and want to discuss what happens afterwards in terms of recovery? Give us a call to schedule an appointment either before or after surgery to discuss your treatment plan, how to use your sling, what’s going to make it easier to sleep, and any other concerns you may have.