Describe rotator cuff injury

The rotator cuff is a group of 4 muscles that surround the shoulder (glenohumeral joint). There is one muscle on top called the supraspinatus. Two muscles behind the joint or posterior named infraspinatus and teres minor. There is also one muscle in front of the joint (anterior) called the subscapularis.

The most commonly injured muscle is the supraspinatus. The supraspinatus is situated in the most precarious and vulnerable location of all the rotator cuff muscles, it lies between two bones. It lies underneath the acromion process of the scapula and above the head of the humerus. There isn't a whole lot of room between these two bony structures and as such the supraspinatus often gets impinged upon (pinched) due to biomechanical dysfunction in the shoulder.

If this only happen for a short while you may only get some pain/discomfort and we call it tendinitis. If the process continues to occur (months) the tendon will slowly begin to degenerate, which can cause pain/discomfort, weakness - particularly with shoulder abduction and reduced range of movement (again mainly with abduction); we term this tendinosis.

If you have chronic supraspinatus tendinosis for long enough (years) eventually the tendon will begin to fray (tear), if it tears enough you will experience significant pain and reduced range of motion. If it is a complete or what is called a full thickness tear then the only way to repair it is surgery, although some people choose not to have the surgery, however, they will have lost the use of the supraspinatus muscles which is the only muscles capable of raising the arm above 90 degrees of abduction.

You can however, avoid all these problem is you consult a practitioner who specialises in some form of myofascial release: Active Release Techniques (ART), Graston, ASATM, ASTYM, Gua Sha. There may be other techniques that I either do not know of or have forgotten to mention.

As a certified ART practitioner, I would identify the cause of the shoulder impingement (the cause of the tendinopathy) and correct the biomechanics of the shoulder so that it no longer impinges on the supraspinatus. I would also work on breaking up the scar tissue within the degenerated tendon to slowly restore it back to a strong and healthy state. I would also look at possible causes of the rotator cuff injury such as poor technique in a sport (i.e. swimming, pitching, throwing etc…). Other causes include work related or sleeping postures, as well as repetitive activities which may be overloading certain structures and causing problems. 

I think I've made this long enough.

Hope this helps.

Dr Adam Gavine

As mentioned above, any kind of rotator cuff injury is most likely to be preceded by varying degrees of prolonged abnormal loading of that area. 

We know that happy and healthy tissue should not injure easily, and that day-to-day shoulder postures seem to be by far and away the most common reason for abnormal loading or “overloading”. 

When determining why the rotator cuff becomes vulnerable to injury, it is best to look towards the things we do most often. Believe it or not, the simplest most uninteresting things tend to be the most likely to negatively impact the rotator cuff - because we do them consistently.

The simple phrase “it's not WHAT you do, but HOW you do it” should be applied to our everyday activities in order to uncover simple underlying factors for rotator cuff injury.

If looking to recover from these types of injuries, it is important to figure out why these things happen in order to minimise rehabilitation time and reduce the risk of it re-occuring.

Grant.

Rotator cuff injuries are a very common cause of shoulder pain. The rotator cuff is comprised of a group of 4 muscle-tendon units that surround the shoulder joint and allow for overhead motion of the arm. A rotator cuff injury can occur when any of these muscle-tendon units become damaged. This is typically characterised by a separation or “tearing” of the tendon attachment off of the humerus.

Certain other conditions, such as impingement and tendonitis, can also contribute to tearing of the rotator cuff. These tears result in a significant amount of shoulder pain, weakness, and limited range of motion. The severity of the injury may range from a mild strain with associated inflammation to a partial or complete tear that might require surgery.