The rotator cuff is a group of four muscles the supraspinatus, infraspinatus, subscapularis and the Teres minor muscle. These muscles work synergistically to stabilise the humerus in the glenoid or your shoulder joint making sure that the humerus glides perfectly within the joint and preventing the humerus from compressing the structures around the joint. The muscles of the rotator cuff also act as synergists to the bigger surrounding muscles. Unfortunately these muscles are neglected and are rarely exercised well enough or at all by most active individuals. Therefore they become weak and unable to check the force generated by the much larger chest and back muscles leading to dysfunction and later to injury.
Rotator cuff tears (RCT) are a fairly common orthopaedic complaint. Typically people who suffer a RCT are usually from two different camps. First is the degenerative RCT typically affecting people of 60+ years old and the second camp are usually athletes or sports enthusiasts who play racquet sports and especially throwing sports such javelin, water polo and rugby. The causes of a RCT vary from person to person however, for those who are playing sports the cause is usually traumatic or overuse with inadequate conditioning of the shoulder complex. However for the degenerative RCT there are several intrinsic and extrinsic causes.
Intrinsic and Extrinsic Factors
The most widely excepted factor for RCT's is chronic overuse of the rotator cuff that leads to micro-tears within the tendons that overtime build up to cause a rupture of the tendon (usually the supraspinatus). Some researchers believe that degeneration of the rotator cuff is a normal and natural part of ageing. A study back in 1991 found that 97% of 891 tendons examined had signs of degeneration. This would certainly support the ageing theory. However, just because something is normal does not make it optimal. As their is no research that has investigated our modern lifestyles effect on degenerative RCT. In other words how does our lack of exercise, high stress jobs, poor food quailty etc have on our bodies ability to heal itself and prevent things like RCT's. Whilst there are no studies that factor in all the various variables as it would be impossible to quite frankly. There are studies available that single out certain lifestyle choice, such as smoking as well as looking at diabetes and high cholesterol (Essentially the effect of a poor diet/lifestyle) and the increased incidence of RCT. I will link to those papers at the end of this blog.
Regardless of the cause of your RCT there are basically two options when it comes to treatment. Conservative treatment that includes exercise and manual therapy or surgery. Before we go into the pros and cons of both of these lets quickly outline the symptoms people usually experience with RCT's.
- Pain at around the 90 degrees of abduction (bringing your arm out to the side)
- Grumbly niggling pain in the shoulder
- Pain at night when lying on the affected shoulder
- Pain with certain movements ( depends on which muscle is affected)
- Weakness in the shoulder / Arm
Conservative approaches such as physiotherapy, massage and osteopathy to rotator cuff tears have a mixed success rate. Ultimately it depends on several factors, the severity of the tear, the quality of the tissue (your diet is a large factor in this) and the compliance to the exercises / manual therapy. Whether you opt for surgery or not a Tailor made exercise and rehab programme can go a long way in helping either rehab the existing injury or prevent any further damage as osteopathy and corrective exercise can seek to resolve any bio-mechanical discrepancies that lead to the injury in the first place.
Surgical interventions have also shown mixed success largely down to the severity of tear. A complete rupture will obviously require surgery to reattach the tendon. However, even large to massive tears have mixed success rates. The choice to have surgery or not is largely down to the individual and the surgeon. However, depending on the severity and the integrity of the joint itself a conservative approach may be favoured first before surgery is considered.
Hopefully this article will give you some insight into rotator cuff tears and what your options in terms of treatment. Should you wish to discuss any issues please feel free to contact me via email firstname.lastname@example.org or via our facebook page.
Your in Health
Andrew Graves M.Ost
Osteopathy in Cwmbran, Pontypool, Abergavenny & Usk.
Andy has been involved in the health & fitness industry for over 10 years, specialising in corrective exercise, injury prevention and rehabilitation of low back, neck and shoulder pain. He also has an interest in the use of Osteopathy for the management of headaches.