Rotator cuff injuries

Overview

The rotator cuff is a group of four muscles that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. A rotator cuff injury can cause a dull ache in the shoulder, which often worsens with use of the arm away from the body.

Rotator cuff injuries are common and increase with age. These may occur earlier in people who have jobs that require repeatedly performing overhead motions, or people that play repetitive sports with an overhead element - Tennis, Golf, Weight lifting.

Many people with rotator cuff injuries can manage their symptoms and return to activities with physiotherapy exercises that aim to improve flexibility and strength of the muscles surrounding the shoulder joint.

Sometimes, rotator cuff tears may occur as a result of a single injury. In those circumstances, we often look to seek the advice of orthopaedic specialists or sports physicians to discuss your treatment.

Symptoms

The pain associated with a rotator cuff injury may:

• Be described as a dull ache deep in the shoulder

• Disturb your sleep

• Make it difficult to wash your hair or reach behind your back

• Be accompanied by arm weakness

Prevention

If you are at risk of rotator cuff injuries or if you've had a rotator cuff injury in the past, daily shoulder strengthening exercises can help prevent future injury. Click here to find out more

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 optimise shoulder muscle balance. We see rotator cuff injuries almost everyday, so we have the experience to guide you through an individual exercise plan if you require one

Treating a Rotator Cuff Injury

Diagnosis

During the physical exam, your doctor will press on different parts of your shoulder and move your arm into different positions. He or she will also test the strength of the muscles around your shoulder and in your arms

In some cases, he or she may recommend imaging tests, such as:

X-rays

Although a rotator cuff tear won't show up on an X-ray, this test can visualize bone spurs or other potential causes for your pain — such as arthritis.

Ultrasound

This type of test uses sound waves to produce images of structures within your body, particularly soft tissues such as muscles and tendons. It allows dynamic testing, assessing the structures of your shoulder as they move. It also allows a quick comparison between the affected shoulder and the healthy shoulder.

Treatment

Conservative treatments — such as rest, ice and physical therapy — sometimes are all that's needed to recover from a rotator cuff injury. If your injury is severe, you might need surgery.

Physiotherapy

Physiotherapy is usually one of the first treatments your doctor may suggest. Exercises tailored to the specific location of your rotator cuff injury can help restore flexibility and strength to your shoulder. Physiotherapy is also an important part of the recovery process after rotator cuff surgery.

Injections

If conservative treatments haven't reduced your pain, your doctor might recommend a steroid injection into your shoulder joint, especially if the pain is interfering with your sleep, daily activities or physical therapy. While such shots are often temporarily helpful, they should be used judiciously, as they can contribute to weakening of the tendon and may lower the success of surgery if this is eventually needed.

Surgery

Many different types of surgeries are available for rotator cuff injuries, including:

Arthroscopic tendon repair. In this procedure, surgeons insert a tiny camera (arthroscope) and tools through small incisions to reattach the torn tendon to the bone.

Open tendon repair. In some situations, an open tendon repair may be a better option. In these types of surgeries, your surgeon works through a larger incision to reattach the damaged tendon to the bone.

5 Exercises for strengthening a Rotator Cuff

Once you have been diagnosed with a rotator cuff injury, either by your physiotherapist or your doctor, then strengthening your rotator cuff is often the best solution. In many cases strengthening and muscle balance around your shoulder is all that is required to restore your function.

A key goal with physiotherapy strengthening is knowing which part of the cuff we need to strengthen. It is important that this is done in conjunction with your therapist, so the specific muscles are targeted. Below are 5 key strengthening exercises that might be recommended during your strengthening programme

1. Doorway stretch

Warm up your muscles by standing in an open doorway and spreading your arms out to the side.

Grip the sides of the doorway with each hand at or below shoulder height, and lean forward through the doorway until you feel a light stretch.

Keep a straight back as you lean and shift your weight onto your toes. You should feel a stretch in the front of your shoulder. Do not overstretch.

2. Side-lying external rotation

Lie down on the side opposite your injured arm.

Bend the elbow of your injured arm to 90 degrees and rest the elbow on your side. Your forearm should rest across your abdomen.

Hold a light dumbbell in the injured side’s hand and, keeping your elbow against your side, slowly raise the dumbbell toward the ceiling. Stop rotating your arm if you feel strain.

Hold the dumbbell up for a few seconds before returning to the start position with your arm down.

Repeat 3 sets of 10 up to 3 times per day. Increase reps to 20 when a set of 10 becomes easy.

3. High-to-low rows

Attach a resistance band to something sturdy at or above shoulder height. Be sure it is secure so it doesn’t come loose when you pull on it.

Get down on one knee so the knee opposite your injured arm is raised. Your body and lowered knee should be aligned. Rest your other hand on your raised knee.

Holding the band securely with your arm outstretched, pull your elbow toward your body. Keep your back straight and squeeze your shoulder blades together and down as you pull. Your body should not move or twist with your arm.

Return to start and repeat 3 sets of 10.

4. Reverse fly

Stand with your feet shoulder-width apart and your knees slightly bent. Keep your back straight and bend forward slightly at the waist.

With a light weight in each hand, extend your arms and raise them away from your body. Do not lock your elbow. Squeeze your shoulder blades together as you do so. Do not raise your arms above shoulder height.

Return to start and repeat 3 sets of 10.

5. Lawn mower pull

Stand with your feet shoulder-width apart. Place one end of a resistance band under the foot opposite your injured arm. Hold the other end with the injured arm, so the band goes diagonally across your body.

Keeping your other hand on your hip and without locking your knees, bend slightly at the waist so the hand holding the band is parallel to the opposite knee.

As if starting a lawn mower in slow motion, straighten upright while pulling your elbow across the body to your outside ribs. Keep your shoulders relaxed and squeeze your shoulder blades together as you stand.

Repeat 3 sets of 10.