WHAT IS THE ROTATOR CUFF? - Peak Performance Physical Therapy
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Jul14th 2014


The arm is kept centered in your shoulder socket when you move your arm by your rotator cuff. A rotator cuff is a group of four muscles that come together as tendons to form a covering around the ball (humeral head) and socket (glenoid). The rotator cuff attaches the humerus to the shoulder blade and assists to lift and rotate the arm. A bursa is in between the rotator cuff and the acromion (bone on top of the shoulder). It is a lubricating sac that allows the rotator cuff tendons to glide freely when the arm is moving.

When one or more of the rotator cuff tendons is torn, the tendon is no longer attached to the humeral head. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff can also be involved. In many cases, torn tendons begin by fraying and as the damage progresses, the tendon can completely tear. According to American Academy of Orthopaedic Surgeons, there are different types of tears. A partial tear is a type of tear that damages the soft tissue, but does not completely sever it. However, a complete tear, also known as the full-thickness tear, splits the soft tissue into two pieces. With the complete tear, there is a “hole” in the tendon. When the rotator cuff tendons are injured or damaged, the bursa can also be affected and be inflamed as well. There are two main causes of the rotator cuff tears: injury and degeneration. Factors that could cause an acute tear include: falling and using your arm to break the fall, lifting something too heavy with a jerking motion, and repetitive overhead movement of your arms. Most tears are the results of a wearing down of the tendon that occurs slowly over time. Several factors contribute to degenerative rotator cuff tear: repetitive stress, lack of blood supply, and bone spurs.

Professional personnel conclude that the most common symptoms of a rotator cuff tear are:

  • Pain at rest and at night, particularly if lying on the affected shoulder
  • Pain when lifting and lowering your arm or with specific movements
  • Weakness when lifting or rotating your arm
  • Crepitus or crackling sensation when moving your shoulder in certain positions

At first, the pain may be mild and only present when lifting your arm over your head. Over-the-counter medication, such as aspirin or ibuprofen, may relieve the pain at first. Over time, the pain may become more noticeable at rest, and no longer goes away with medications. The pain and weakness in the shoulder may make routine activities more difficult.

People recover from a rotator cuff injury with physical therapy exercises that improve flexibility and strength of the surrounding muscles of the shoulder joint. Most people exercise the front muscles of the chest, shoulder, and upper arm. But, it is equally important to strengthen the muscles in the back of the shoulder and around the shoulder blade to optimize shoulder muscle balance (American Academy of Orthopaedic Surgeons). Daily shoulder stretches and exercises can help prevent future injury. However, severe rotator cuff injuries may require surgical repair.

Doctor may recommend surgery if the pain does not improve with nonsurgical methods. According to the Mayo Clinic, other signs that surgery may be a good option include:

  • The symptoms have lasted 6 to 12 months
  • Tear is more than 3 cm
  • Person has significant weakness and loss of function in the shoulder
  • The tear was caused by a recent, acute injury

Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone).