The Rotator Cuff

What Is the Rotator Cuff?

The rotator cuff is made up of a group of four muscles that connect your upper arm bone (humerus) to your shoulder blade (scapula):

• Supraspinatus – runs across the top of the shoulder; helps lift the arm out to the side.

• Infraspinatus – sits just below the supraspinatus; assists with external rotation of the arm.

• Teres Minor – a small muscle that also helps with rotating the arm outward.

• Subscapularis – located at the front of the shoulder blade; helps turn the arm inward.

  
  

The muscles form a cuff around the head of the humerus, stabilising the ball-and-socket joint of the shoulder. It is important to remember the biceps muscle when discussing the rotator cuff; the fibres of the long head of the biceps blend with the tendon fibres of the supraspinatus, so dysfunction, strain and inflammation in one is often linked with the other too.

The rotator cuff plays two main roles:

1. Stabilisation: The coordination of the 4 muscles keeps the head of the humerus securely in the shallow socket of the scapula (the glenoid), preventing dislocations or excessive movement.

2. Movement: The muscles contribute to important arm motions, such as raising your arm, rotating it inward or outward, and controlling the arm during lifting or reaching.

These muscles are the fine tuners of the shoulder, and function best when the base (your scapula) is in the correct position and stable. If the scapula is in an abnormal position or your shoulders are rounded in poor posture, the muscles remodel to respond to the over stretch placed on them, chronically lengthening the rotator cuff muscles. Over time, they lose optimal tension and strength, making them less effective at stabilizing the shoulder and vulnerable to painful trigger points (also known as knots).

Overuse can also cause stress on the rotator cuff muscles and tendons, as well as short term use to hold heavy loads. Things like holding long beams up or painting at an awkward angle are common contributing factors we hear about in the clinic!

Injuries

Rotator cuff injuries can vary from mild to severe. Some of the most common issues include:

• Tendonitis – inflammation of one or more tendons in the rotator cuff due to sustained strain and stress either from compensation for altered shoulder mechanics (see our blog from June for more details about this), repetitive use in overhead positions, or a heavy lifting motion with the shoulder in a twisted position. These can occur acutely or slowly build over time, as the tendons become less and less able to adapt to the increased loading.

• Rotator Cuff Tears – These are divided into several categories: partial or full-thickness tears of the tendon, and acute- traumatic or degenerative/ overuse tears. Full thickness tears often result in severe loss of shoulder strength and motion, whereas partial tears tend to have more motion when examined. Acute or traumatic tears from falls, overload or poor needle positioning tend to heal quicker than tears in a more fibrous and degenerated tendon.

• Impingement Syndrome – occurs when the rotator cuff tendons gets pinched between end of the collarbone and the humerus causing pain and irritation during arm movements.

  
  

Symptoms that your rotator cuff might be injured include pain in the shoulder, especially when lifting your arm, weakness or difficulty with certain movements and pain that worsens at night or when lying on the affected side

Complications - Frozen Shoulder

Frozen shoulder, or adhesive capsulitis, is a condition where the shoulder joint becomes stiff and painful due to inflammation and thickening of the joint capsule, leading to a significant loss of movement. Rotator cuff tendon problems often precede the development of a frozen shoulder. The shoulder joint can become stiff from improper and painful movements, causing a tightening of the joint structures. This, combined with ongoing inflammation, irritates the joint capsule and causes the capsule to become thickened and stiff, known as fibrosis. The fibres of the capsule then stick to themselves leading to a severe reduction in range of motion. This 'freezing' process can often be very painful too.

Chiropractic Care of Rotator Cuff Injuries

We see a lot of shoulder conditions here at Marlborough Chiropractic Clinic and help in the management of cases through a variety of techniques including:

• Adjustments to the spine and rib joints that are closely linked with the shoulder, to ensure the shoulder is working from a stable but flexible base, for optimal movement patterns.

• Adjustments to restore movement to the shoulder and collarbone joints.

• Muscle release techniques to help correct faulty movement patterns

• Advice regarding activity modification and strengthening exercises for at home.

It is very common for us to work alongside sports therapists and physiotherapists in the management of shoulder conditions to provide a holistic approach; the chiropractors focus on on joint function, spinal mobility, and nerve function, whilst the physios and sports therapists focus on movement rehabilitation and exercise therapy.

Prevention!

Rotator cuff injuries are often caused by overuse, poor mechanics, or muscle imbalances, all of which are controllable risk factors! Here are some key ways to protect your shoulders:

• Reaching or lifting overhead repeatedly — especially with poor form: These movements are necessary, so if you find yourself like painting, lifting weights or doing vigorous DIY take breaks, use proper technique, and avoid overloading the joint.

  
  

• Keeping your shoulder muscles strong and balanced is one of the best ways to prevent injury. Focus on exercises that target the rotator cuff muscles as well as the scapular stabilisers, like the mid and lower trapezius and serratus anterior. Resistance bands, light weights, and bodyweight movements can help build endurance - ask your chiropractor at your next appointment!

  
  

• Poor posture (especially rounded shoulders and a forward head position) alters the alignment and movement patterns of the shoulder. Aim to sit and stand tall with your ears over your shoulders, shoulder blades slightly back and down, and your chest open.