Rotator Cuff Pathology and How Physical Therapy Can Help
By: Richard Gardner, PT, DPT: Board Certified in Orthopaedic Physical Therapy
You have probably heard the term rotator cuff in regards to the shoulder. In physical therapy we often hear our patients refer to it as a “rotary cup” or “rotary cuff,” but understand it is rotator cuff😊 We all have one and it is part of our shoulder complex. It is also the source of potential shoulder problems that can limit our ability to enjoy life’s activities. Injuries to this region can start at a tendonitis and progress all the way to a tear of the muscle/tendon complex. The purpose of this blog post is to break down what the rotator cuff does for our shoulders and how physical therapy can help one overcome potential issues to this tissue.
The rotator cuff is comprised of 4 muscles. These muscles are call the supraspinatus, infraspinatus, subscapularis, and teres minor. As pictured above these muscles wrap around the shoulder joint and connect to the humerus (long bone in upper arm) from the front, side, and back. This attachment is underneath the larger deltoid muscle. The head of the humerus (the ball on the ball and socket joint) is very large and the glenoid (the socket) is very small.
These are not large muscles and don’t produce a lot of power with activity. Since the design of the shoulder joint with a large ball and a shallow socket, the shoulder is very unstable without muscular support. The rotator cuff provides some function with lifting objects, but their main function is to provide the stability in the shoulder joint with movement. Since these muscle wrap around the humeral head they function to keep the shoulder in it’s joint and in the correct position with overhead lifting.
Rotator cuff pathology is usually a progressive process. Without getting too much into biomechanics we can start having issues with our rotator cuff due to poor posture, weakness of the shoulder complex, overuse, thinning of the tendons with age, or genetic variation. These initial issues of the rotator cuff are usually diagnosed as a shoulder impingement.
Shoulder impingement is caused when the attachment sites of your rotator cuff will literally impinge or “rub” over the end of the clavicle (collar bone) and create inflammation and tendon irritation. Left untreated over time, often years, this can begin to breakdown the tendon and create a rotator cuff tear. Rotator cuff tears can also be traumatic and caused from falling on an outstretched arm. A vast majority of the time a rotator cuff tear does not heal and can vary in regards to size and thickness of the effected tissue. However, there is good news, a rotator cuff tear is not always a surgical fix.
Physical therapy can be a valuable method in treatment of shoulder impingement and even some tears. For shoulder impingement, physical therapy is the treatment of choice to work on strengthening the rotator cuff and scapular muscles. In addition, there can sometimes be a flexibility issue that needs addressed to improve overall posture. Shoulder impingement is a common thing we see in clinic, and we have great results in helping resolve this.
Physical therapy can also be effective for patients with rotator cuff tears. Having a tear does not always mean surgery. In patients who have an atraumatic full thickness rotator cuff tear physical therapy is effective for treatment 75% of the time (Kuhn et. al. 2013.) This is fantastic news for people who are working towards avoiding surgery. We have seen on numerous occasions patients come see us who are considering surgery and leave feeling great and avoiding surgery. If you fail conservative treatment for a rotator cuff tear surgery is then an option. Surgery is also the best option if one has a traumatic tear such as falling on their arm with a sudden loss of ability to elevate the arm.
This post will not have exercises to help address impingement or tears. Reason for that is so many impingement and rotator cuff tear patients are so unique. This leads to my last point that treating this is not a one size fits all program. We must find where you are at on the function scale and progress smart. We don’t want to have you doing exercises that are going to increase your pain and ultimately lead to no improvement. If you are feeling like you have a shoulder impingement, or a possible rotator cuff tear reach out to us. We can evaluate your shoulder and determine the best course of action for you. If you have already elected surgery and are looking for a spot to come do your post op rehab, look no further. We will ensure you get your full function back.
Do you have questions? Want me or one of our outstanding therapists to examine your shoulder? Send me an email at firstname.lastname@example.org. We can always screen your shoulder and get a specific program for you.
Kuhn JE, Dunn WR, Sanders R, An Q, Baumgarten KM, Bishop JY, Brophy RH, Carey JL, Holloway BG, Jones GL, Ma CB, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW; MOON Shoulder Group. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013 Oct;22(10):1371-9. doi: 10.1016/j.jse.2013.01.026. Epub 2013 Mar 27. PMID: 23540577; PMCID: PMC3748251.