Conditions of the Rotator Cuff
The Rotator Cuff
The rotator cuff is comprised of four muscles:
3) Teres Minor
These muscles surround the ball and socket of the shoulder joint forming a 'cuff' around it. As the shoulder joint itself is inherently unstable, due to the shallow socket, the main function of the rotator cuff is to contain the ball within the socket during movement of the arm.
Rotator Cuff Tendinopathy
During elevation of the arm, if the rotator cuff is not functioning properly, the ball can pulled upwards towards the acromion, by the bigger deltiod muscle. This can result in painful compression of the structures within the subacromial space; the subacromial bursa and rotator cuff tendon itself. This is termed subacromial impingement. This is not a diagnosis of your problem but a symptom or a clinical sign.
There are a number of conditions that can lead to dysfunction of the rotator cuff:
- rotator cuff tendinopathy
- an acute injury or strain of the rotator cuff
- calcific tendonitis
- partial or full thickness tear of the rotator cuff
These condtions can occur together and often come hand in hand with subacromial bursitis. Subacromial pain syndrome is an umbrella term used to describe these co-existing pathologies.
Tendons are bands of fibrous tissue that connect muscle to bone. Pathology can occur in tendons where they become thickened, inflamed and weak. This is called a tendinopathy and can occur in various areas in the body. Common tendonopathies are tennis elbow, achillies tendinopathy and rotator cuff teninopathy.
When this occurs in the rotator cuff it can affect the muscles ability to do their job; to stabilise the ball in the socket on movement of the arm. This means when the arm is lifted the ball moves closer to the acromion, decreasing the subacromial space and pinching the bursa and rotator tendons. This causes further rotator cuff tendon irritation; it is a vicious cycle!
Cause of Rotator Cuff Tendinopathy:
During everyday arm movements, strain, or load, is placed on the rotator cuff tendons. This is normal and keeps the tendons healthy and strong. If too much load (tendon overload) is placed on the tendons it can lead to the development of a tendinopathy; a thickened, inflamed and weakened tendon.
Tendon overload be can produced in an injury, such as a fall onto the shoulder or outstretched arm. In this case, pain may begin quite suddenly at the time of the injury or in the following days. Tendon overload can also occur from unaccustomed overhead activity, for example painting or trimming a hedge. Or it may be the result of a repetitive strain from a repeated activity at work or during a hobby. Pain may begin more gradually in these cases.
There are, however, many other factors to consider. Weakness or stiffness in other areas of your body can result in increased stress at the shoulder and rotator cuff tendons. For example, when reaching up to trim a hedge, or when serving in tennis, if the muscles in the legs and trunk are weak the shoulder muscles work harder and, therefore, tendon overload is more likely. At Yorkshire Shoulder Physiotherapy we will assess this and ensure treatment addresses these issues.
Furthermore, certain risk factors have been identified that mean you are more likely to develop tendon problems. These include smoking, alcohol consumption and obesity.
Treatment for this is aimed at reducing inflammation and restoring strength in tendon so it can stabilise the shoulder. There has been lots of research into the treatment of tendon pain and specifically in the treatment of rotator cuff tendinopathy. Certain exercises can target the rotator cuff tendon but it is also vital to assess other areas of the body that may be weak, resulting in increased stain on the shoulder during activates of the arm. At Yorkshire Shoulder Physiotherapy we will apply the latest clinical research and available evidence to treat this condition.
For further treatment details click here.
The YSP team recently attended the Tendon Masterclass hosted by the prestigious Liverpool Upper Limb Unit. To read our blog entry regarding this click here.