A rotator cuff injury is an injury that occurs to either the muscles or tendons in the shoulder joint. The rotator cuff is a group of muscles located around the shoulder which provide movement and stability in everyday life and consist of muscles such as supraspinatus, subscapularis, teres minor and infraspinatus. Usually the rotator cuff is injured towards the supraspinatus muscle which performs abduction of the arm at the shoulder joint, and solely produces the movement for the first 10-15 degrees. It also helps stabilise the shoulder by keeping the humerus touching the glenoid fossa.
Pain, weakness and a crackling sensation. It is hard to distinguish between the levels of severity as the subjective symptoms are extremely similar such as intense pain related to a specific point such as a tackle or trauma, interrupted sleep through constant aching pain, pain when the shoulder is flexed or abducted as well as when externally rotating the arm
Numerous things can cause a rotator cuff injury; an initial trauma or a condition which has been left untreated such as impingement syndrome, tendinitis or shoulder instability. If injured it becomes increasingly more difficult to abduct the arm at the shoulder over the first 15 degrees as the deltoid produces more of the movement.
The locations for injury are either on the body of the muscle which is the top of the shoulder and is shown more prominent when the shoulder is abducted; the second point for injury is underneath the acromion process which is the bony point at the side of the shoulder where the tendon inserts at the greater tubercle of the humerus. Injuries can range in severity between clients; instability is caused when there is a postural problem towards the rotator cuff muscles whereby there is usually a weakness compared to the pectorals and/or upper back muscles such as upper trapezius. Secondly there can be more serious injuries known as partial tears, these are separated by the number of fibres actually damaged in the muscle and range between grade 1 – under 10% of muscle fibres damaged and grade 3 which is a complete rupture and the muscle is torn all the way across.
Each of the tears are classified under three separate categories; primary comprehensive cuff disease, secondary comprehensive cuff disease and tensile lesions. The type of pain responses can provide positive analysis for a rotator cuff injury although an MRI, X-ray or arthroscopy can determine the level of injury as well as pinpointing the exact location or injury.
Six months. A rotator cuff injury can take up to six months to fully heal and regain its full mobility.
Acute treatment for an injury should be to apply RICE (Rest, Ice, Compression, Elevation) at the time of the injury until swelling subsides. If it is an instability injury, postural awareness as well as sports therapy may be applied to loosen off the tight muscle shorter muscles, along with a specific rehabilitation programme to strengthen the weak extended muscles around the shoulder; including a variety of shoulder movements such as shoulder flexion, shoulder extension, abduction, adduction and external rotation may be completed with a resistance band. A light strength band is used to begin such as yellow or green, It will allow for speedy progress. If the injury is only a partial grade 1 or 2 injury then a cortisone steroid may be injected into the body of the muscle which can speed up the protein synthesis process and repair the muscle much faster. It would also be beneficial for the client to strengthen the shoulder as soon as resistance movements become pain free, this is after immobilisation and passive range of movement exercises are completed. Lastly if a grade 3 injury or full rupture is diagnosed the client will have to be referred to surgery; if your pain has continued between 6/12 months, you have a larger rupture than 3cm, if you have a significant loss of shoulder movement, or if your injury was caused by a recent acute injury you may also be recommended for surgery. Surgery can be performed in three different ways. An open surgical method is used if a rupture is long or complex. An incision is made over the shoulder and the deltoid muscle is detached to enable easy access. This was the first and most basic method that has been used. Secondly an arthroscopic repair can be performed by inserting an arthroscope which guides the surgeons via a monitor to repairing the rupture. Lastly a mini open repair is a mixture of the two above, where a small incision is made and arthroscope also used but the surgeon looks at the structures directly allowing After surgery is completed you have to wait for the swelling and the body’s natural healing processes to subside before any sort of strengthening can be completed. It would be beneficial to try and complete range of movement without any resistance to retain a good level of functionality of the glenoid humeral joint, if this is not completed then frozen shoulder can set in whereby post surgery the structures at the coracoids process fuse together preventing normal range of movement. Once a good level of immobilisation of the joint has been completed the passive strengthening can be completed via movements completed with your therapist. After range of movement is slowly returning active strengthening can then be completed via resistance band rehabilitation as mentioned above. It can also progress further from unilateral to bilateral movements as well as adding more substantial weight once a good level of strength is achieved. Sports Therapy can also be completed to prevent frozen shoulder and to loosen off the structures around the shoulder as well as removing scar tissue and waste products which are caused through the surgery. Whichever treatment is completed, the rehabilitation process for a rotator cuff injury takes time and range of movements can be measured through a goniometer, especially if progress is slow so that the client keeps faith and continues with their exercises, although rehabilitation should be monitored fully throughout