The shoulder is made up of 3 bones: the upper arm bone called the humerus, the shoulder blade called the scapula, and collarbone called the clavicle. The shoulder joint is a ball and socket joint. The rotator cuff is made up of 4 muscles and tendons which help keep the humerus in the shoulder joint. The muscles attach to the humerus and scapula and help lift and rotate the arm to perform functional reaching and overhead activities. A common acronym for these muscles is “SITS," since the rotator cuff muscles sit on the shoulder joint.
To learn more about the anatomy of the shoulder, go this this Shoulder Anatomy Video.
Image of rotator cuff muscles.
Their main function is to help stabilize and mobilize the shoulder. Here are the muscles that make up your shoulder.
S - Supraspinatus: Holds the humerus in place, provides stability for the upper arm, and helps lift the arm.
I - Infraspinatus: The main muscle that externally rotates and extends the arm.
T - Teres Minor: The smallest muscle of rotator cuff, it helps with the rotation of the arm away from the body.
S - Subscapularis: Provides stability of the humerus to the scapula (shoulder blade), internally rotates your arm, holds the arm straight out, and lowers the arm.
A torn rotator cuff can cause shoulder weakness and make activities of daily living painful and difficult to perform. Rotator Cuff injuries are caused by:
Torn rotator cuff symptoms consist of a gradual or sudden onset of pain with certain movements. Pain is typically located on the front and side of the shoulder. Pain is increased when moving the shoulder away from the body. You may experience weakness and a decrease in range of motion. It may be impossible to hold up arm up in front of your body or to your side. This can make performing activities of daily living (ADL’s), such as grooming hair and reaching behind the back, difficult and painful.
Some individuals will experience crepitus (a clicking sensation) when moving in certain positions due to changes in the shoulder joint. The pain is generally worse at night which makes it difficult to sleep. Over time, the shoulder will become stiffer. The lack of movement and inflammation from a torn rotator cuff can lead to Frozen Shoulder. The most common tendon to tear is the supraspinatus tendon. It is very common for the rotator cuff tendon to begin to fray from degenerative changes and activities of daily living which can lead to a torn rotator cuff.
There are two types of tears - partial and full thickness tear.
Some risk factors of rotator cuff tears are: being over age of 40 years of age, repetitive lifting, overhead reaching, and athletics. Most rotator cuff tears in young adults are caused by traumatic injury or falls.
Posterior Shoulder & Rotator Cuff Muscles
Majority of the time, a rotator cuff is unable to heal without any intervention. If you have symptoms of a torn rotator cuff, you need to be evaluated by an Orthopedic MD which will include medical history, symptoms, a shoulder examination, X-ray and possibly MRI. The MD will then decide whether conservative or surgical treatment is the best option for you based upon your evaluation.
A torn rotator cuff can be treated conservatively with Occupational or Physical Therapy, anti-inflammatory medication or steroid injection and activity modification/rest. Physical therapy would involve strengthening of the rotator cuff muscles with exercises. If shoulder symptoms do not respond to conservative treatment, or an MRI reveals a significant tear of the rotator cuff with weakness and loss of function in your shoulder, surgery may be necessary to restore shoulder function.
Signs that surgery may be the best option are symptoms lasting 6-12 months, a large tear more than 3 cm, significant weakness and loss of function or tear caused by a recent acute injury. Surgery to repair a torn rotator cuff involves reattaching the tendon to the bone. There are surgical options in repairing a torn rotator cuff which include an open repair, an arthroscopic repair and mini open repair.
After surgery, you will require occupational or physical therapy to relieve pain, restore shoulder range of motion and strength, and improve the functional use of your arm.
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By: Nikki Clayton, PT, DPT, ATC
