What is a Rotator Cuff (R.C.)? The Anatomy!

Rotator Cuff  is the group of muscles which give stability and strength to the shoulder joint during its movements. It is made up of four muscles named as: SITS (Supraspinatus, Infraspinatus, Teres Minor, Subscapularis). This group of muscles originates from the shoulder blade(scapula) and attach to the arm bone (head of the humerus) and make a cuff-like structure around the shoulder joint. In the shoulder joint, there are some anatomical spaces made up of bones, which are Subacromial space and Sub coracoid space. Certain muscles like the Rotator Cuff and their tendons pass through these spaces.

How do we get Degenerative Rotator Cuff?

Degenerative RC tear is atraumatic(meaning no trauma, but a slow onset( condition. This process of degeneration is thought to occur with aging. There are types of factors that can contribute to this degeneration, which includes Extrinsic or external, Intrinsic or internal factors:

Extrinsic Factors:

External impingement: This term is utilized when a certain structure gets compressed or pinched within Subacromial and sub coracoid spaces.

Internal Impingement: This term is applied when any structure within the shoulder joint is getting compressed.

Intrinsic Factors:

Impaired Tendon Health: Muscle tendons get impaired due to lack of vascularity (blood supply), unhealthy muscle fibers and many more. These impairments are results of repetitive compressive and mechanical load, Genetics, Metabolic diseases, Smoking and alcohol consumption, Prolonged Anti-inflammatory usage.

 

Asymptomatic & Symptomatic Rotator Cuff Tear:

A Rotator Cuff can be both partial or full tear, and this degeneration is majorly depending on natural progression and aging. This progression and symptoms significantly vary person to person. On one side, some patients have severe pain and functional activity limitations, while on the other side, numerous patients do not show any pain or limitations even though tears are present. This variability could be based on functional activity level, intrinsic or extrinsic factors, stage of tendinopathy and comorbidities. One study says that more than half of the people with asymptomatic R.C. tears are 50 years old.

Clinical History

The most persistent finding in all cases is Age. Populations older than 50 years of age are more prone to get degenerative R.C. tears and people under 40 years of age are rarely seen with this condition.

  • Age: >40 years
  • Pain with Pushing, Pulling, Lifting, Carrying, Overhead activities, Reaching for something
  • Pain Pattern: Night pain, Localized, Front, and outer part of the shoulder
  • Weakness and stiffness in shoulder joint

Clinical Examination

Our Registered Physiotherapist will complete a full comprehensive Assessment on your shoulder to determine your limitations and an appropriate treatment plan.

    How Physiotherapy Can Help with Management of your Degenerative Rotator Cuff Pain

    R.C. Tear patients respond slowly to the treatment, rehabilitation can be as long as 12-18 months to recover fully. The main goal of the treatment is to improve the posture along with strengthening the program, which eventually suppresses symptoms and pain level.

    Phases of  rehab program can involve:

    •   Scapular Repositioning
    •   Centralization of humeral head
    •   Improving ROM
    •   Strengthening of shoulder musculature from lower to higher ranges.
    •   Activity specific exercise and maintenance

    Exercises are tailored to each patient and a specific program is given to you with your work and home life taken into consideration.

    If you are struggling with shoulder pain and want to get assessed, contact us to book an appointment or to ask any related question in your mind… We are more than happy to help.

      Written by: Anjali Patel. Registered Physiotherapist Resident. Orthopaedic Physiotherapist. Concussion Management.

      REFERENCES:

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584736/

      https://www.physio-pedia.com/Rotator_Cuff_Tears 

      Orthopaedic Division Canadian Physiotherapy Association. Theory Manual

      Integrative Physiotherapy is a Barrie-based clinic that believes in a one-on-one patient-centred, manual therapy (hands-on) approach to physiotherapy. We aim to empower our patients by providing quality care that is personalized to each patient in an interactive and friendly manner. Through the use of the best available treatment techniques, we aim to provide exceptional care so that each patient feels engaged and motivated.

      Our therapists are continually upgrading their skills and taking time to provide comprehensive assessment and treatment techniques that are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  

      Our therapists would be happy to help you to achieve your goals, get in touch to schedule your appointment.  Don’t let pain ruin your day!

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