ROTATOR CUFF
 
Rotator Cuff
What is it?
Your rotator cuff is made up of muscles and tendons that keep the ball (head) of your upper-arm bone (humerus) in your shoulder socket. It also helps you raise and rotate your arm.

Each one of these muscles is part of the rotator cuff and plays an important role:

Supraspinatus. This holds your humerus in place and keeps your upper arm stable. It also helps lift your arm.

Infraspinatus. This is the main muscle that lets you rotate and extend your shoulder.

Teres Minor. This is the smallest rotator cuff muscle. Its main job is to assist with rotation of the arm away from the body.

Subscapularis. This holds your upper arm bone to your shoulder blade and helps you rotate your arm, hold it straight out and lower it.


Together this group of four deep muscles and their tendons form the rotator cuff that surround the shoulder joint, providing it with strength and stability.

If one or more of these muscles or their tendons ( tendons attach the muscle to the bone) are torn or inflamed (tendonitis), movement is no longer smoothly controlled and the shoulder becomes weak and painful.

Other muscles surround the cuff muscles and give addition movement to the arm but less support.
Rotator Cuff
What causes it?
A rotator cuff tear is often the result of wear and tear from daily use leading to micro tears in the tendon fibres or tendonitis (inflammation of the tendons and shoulder impingement). You’re more likely to have this if you have a job where you need to move your arm a certain way over and over, like a painter or a carpenter, or you play sports like tennis and swimming.

It also can happen suddenly if you fall on your arm or try to lift something heavy. Most cases result from repetitive strain and wear and tear as a result of ageing or arthritis and a deterioration of the cuff over time. 

A small percentage of people develop tendonitis in the cuff following surgery to insert a pace-maker.

Above the rotator cuff there is a bursa, or sac of tissue, that covers and protects the rotator cuff as it comes into close contact with bones around the shoulder. When the rotator cuff is injured or damaged, it can lead to inflammation of the bursa, called shoulder bursitis, which also causes pain and loss of motion. 
Rotator Cuff
Signs and symptoms
Damage to the rotator cuff can vary from microscopic tears to large irreparable tears.

Symptoms can include:
  • Pain
  • Weakness
  • Restricted movement
  • Catching
  • Locking
  • Feeling of looseness in the shoulder
  • Painful to sleep on the shoulder 

The symptoms are usually worse in certain positions, such as reaching backward to fasten a seat belt or reaching behind you for some toilet paper.  Symptoms can also be worse when the arm is elevated overhead, especially if there is weight on the arm, such as when picking up a tool box. Overhead activities like installing overhead light fittings or swinging the arms in an exercise class commonly worsen symptoms. 
Rotator Cuff
How is it diagnosed?
The diagnosis can come from:

History and physical examination: This is the best way to initially evaluate. It is important for the doctor to identify pain that may be coming from places other than the shoulder, such as the neck or even the heart.

X-rays: Although plain x-rays do not show the rotator cuff muscles, they are helpful to look for calcifications, arthritis or bone problems that can cause rotator cuff tears.

MRI: This is the most common imaging method to diagnose rotator cuff tears. It can be used to look for tears or inflammation of tissues and to help determine the size and character of the tear to recommend proper treatment.
 
Injections or arthroscopy may also be used to help diagnose rotator cuff tears. 
Rotator Cuff
Surgery
The operation aims to re-attach the tendon(s) to the bone.

Sometimes the tear is too big and/or the tendon is too fragile for this to be possible and only a partial repair can be achieved. The repair involves sewing the torn tendon into a groove on the bone.

In addition, a ligament is also released, and a prominence on a bone cut away to give the repaired muscle more space in which to move. 
Rotator Cuff
Treatment at Hand Kinetics
Non-surgical treatment options:

  • Rest and activity modification for a period of time determined by the speed of healing which can be anything from 3 to 12 months

  • Specific shoulder exercises to gradually strengthen the injured tendon and muscle until full range of movement is achieved.

  • Therapeutic ultrasound in some cases to accelerate remodelling of tendon and muscle fibres. 

  • TENS - transcutaneous electrical nerve stimulation to heal reduce pain levels

  • Accupunture

Post-surgical treatment includes the above plus scar scar and conditioning exercises for the repaired tendon and muscle

Please talk to our principal therapist at Hand Kinetics to discuss your specific needs and shoulder problem before making an appointment and we will be happy to discuss treatment options with you.

Hand Kinetics Telephone: 0044 28 417 72301
www.handkinetics.com
contactus@handkinetics.com



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