The Rotator Cuff
The marvel and complexity of the shoulder joint is something most of us will take for granted throughout our lives. Whether it’s reaching up to the top shelf in the supermarket, brushing our hair or waving goodbye to loved ones, we perform simple tasks without thinking about the complicated mechanisms behind them. Even when participating in some of our favourite sports – such as swimming, tennis, or football – we forget about the demand we put on our shoulders. That is, until something goes wrong.
One of the most common causes of shoulder injury is irritation or damage to the rotator cuff muscles. The rotator cuff is a group of four muscles that, firstly, help to stabilise the shoulder joint and secondly, assist in raising and rotating the arm. These four muscles are Supraspinatus, Infraspinatus, Teres Minor and Subscapularis (bit of a mouthful to say!). To maintain the functionality of the shoulder girdle these muscles must remain balanced in both strength and flexibility, however this can be disrupted when carrying out both day to day activities and certain sporting movements.
There are several injuries that can affect the rotator cuff, these include:
Acute Tear. This type of tear can occur when you fall on an outstretched arm or lift something too heavy. Pain will often happen immediately and can be related to a specific event.
Degenerative Tear. Overuse of the shoulder joint and muscles over many years can result in wear and tear (or degeneration) in the rotator cuff tendons. Repeating the same movements over a long period of time is often the cause of this. It usually affects people older than fifty, although this can affect those with certain jobs at an earlier age, such as plasterers and decorators, where the arm moves excessively in the same motion. The same applies to those who swim or play tennis competitively.
Rotator Cuff Tendinopathy. This occurs when the tendon of one of the muscles becomes inflamed or irritated and can cause an impingement underneath the bony groves at the front of the shoulder. This generally occurs gradually over a period of time and, unless the cause is corrected, it can get worse. It usually affects younger people but can occur at any age.
Bursitis. The bursa, a tiny sac of fluid that helps reduce friction between the shoulder joint surfaces, may get irritated with repetitive motion. Like rotator cuff tendinopathy, the source of the irritation needs to be corrected as the discomfort can linger for a long time.
Typical symptoms of rotator cuff issues include:
Pain, usually a deep dull ache which could be localised to the front or side of the shoulder with some referred pain down the upper arm.
Muscle weakness around the shoulder.
Functional impairments such as being unable to brush your hair, fasten a bra behind your back, lift or push anything.
Disturbed sleep as you are unable to lie on the shoulder or find a comfortable position for it to rest in.
Fortunately, most rotator cuff injuries can be treated with a combination of pain management and conservative treatments, such as exercise and massage. To manage the pain and inflammation both ibuprofen and paracetamol can be taken (provided your GP agrees), alongside hot and cold therapy. There should be a reduction in the amount of activity performed by the shoulder; repetitive motions and overhead sports should be stopped to avoid aggravating the injury further. Total rest, however, is not encouraged as this does not help in the long term. Stretches and certain exercises are performed to help increase mobility and restore strength. For those who have suffered with pain for a long time, it may be advised to have a steroid injection. This can help break the cycle of inflammation, provided exercises are completed afterwards. For those that have torn or severely impinged tendons, a surgical repair may be necessary.
If you have any questions or think you may be suffering from a rotator cuff injury and require advice or treatment, please feel free to contact Guildford Chiropractic Centre and speak to one of our team.