Demystifying the Rotator Cuff: What You Need To Know

Demystifying the Rotator Cuff - What You Need To Know

The rotator cuff is a term that a lot of people have heard of. What the rotator cuff does, most people can figure out, is it rotates the shoulder. However, what the rotator cuff is remains a widespread mystery.

Of all of the shoulder pain patients that I have seen, by far their most common injuries are to the rotator cuff. In this article, I will explain what you need to know about the rotator cuff, including what exactly it is, how it gets injured, and what to do about it.

What is the rotator cuff?

The rotator cuff is a series of four tendons that come together. A tendon is a rope-like band at the end of a muscle that attaches to a bone. The four tendons that form the rotator cuff comes off of muscles located on the front and back of the shoulder blade. The bone that they attach to is called the humerus. At this attachment site, the four tendons come together to form a cuff of sorts (not too different from a dress shirt cuff at the end of a sleeve)!

The four muscles of the rotator cuff each have their own functions, as they each rotate the shoulder in a specific direction. When they work together, your shoulder can rotate 360 degrees.

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How the rotator cuff gets injured

There are several different mechanisms for which the rotator cuff is injured. Short-term injuries range from reaching too far behind your body (such as reaching to put a seatbelt on) to falling on your shoulder. Surprisingly, sleeping on your side is one of the most common causes of long-term shoulder injury. Other causes of more chronic conditions include overhead sports, such as golf and tennis, as well as writing on a chalkboard.

How does sleeping on your side impact your shoulder? The awkward position of the arm can pinch the delicate rotator cuff tendons between your arm bone (humerus) and your collar bone. Over long periods of time, this can inflame and even tear the tendon (known as impingement).

How our current lifestyle contributes to more shoulder injuries

Nowadays, we have a lot of screen time in our lives. From televisions to computers to cell phones, everything we do is in front of us. We often roll our shoulders forward and lean our heads forward. This causes two problems – our shoulders become rounded and our back muscles become weak.

When our shoulders round forward, this leads to tighter muscles and less space for the rotator cuff. Unfortunately, this can cause rotator cuff issues.

The shoulder’s strength generally comes from two places – the ball and socket joint on the side and the shoulder blade in the upper back. 2/3rd of normal shoulder strength is supposed to come from the ball and socket joint. The other 1/3rd comes from the upper back and shoulder blade region. Therefore, if the upper back is weak, the rotator cuff region in the front is doing heavier lifting than it was designed to do. Unfortunately, this makes it more prone to strain.

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Types of rotator cuff issues

There are three main types of rotator cuff problems – tendonitis, a partial tear, and a complete tear.

The first type, tendonitis, refers to swelling in the tendon. This is the mildest type of rotator cuff injury and can usually be treated conservatively.

The second type, a partial tear, varies in both severity and treatment. This refers to the degree that the tendon is torn and can range from a microscopic tear to a 99% tear where the tendon is attached by a thread. A small partial tear usually responds well to conservative treatment. However, the larger the partial tear, the greater the likelihood that it will not respond well to conservative treatment and will require surgery.

A complete, or 100% tear, means that the tendon is torn into two separate pieces with a space in the middle. No amount of conservative treatment will bring the two pieces together. Surgical repair is usually recommended with a complete tear.

4 conservative rotator cuff treatment options

1) Physical therapy

Physical therapy is an effective treatment option for rotator cuff injuries. First of all, modalities such as ice, heat, ultrasound, and electric stimulation help to reduce shoulder inflammation and pain.

Manual treatment by the physical therapist is important as it serves to stretch the tight areas and loosen up muscle tension. Stretching and strengthening exercises are given to improve the shoulder and upper back. This builds up the areas around the rotator cuff allowing it to heal. This also improves posture and can help to prevent recurrence of the problem.

While physical therapy is only prescribed a few times a week, a regular home exercise regimen is important to maintain the benefits of physical therapy.

2) Anti-inflammatory medication

Anti-inflammatory medication, such as Advil or Aleve, can help reduce pain and inflammation. They do not treat the root cause of the issue biomechanically and therefore do not replace physical therapy. However, they do help you feel better faster until therapy takes full hold.

A caution is that use of these products in the elderly and those with heart and stomach issues can make matters worse due to side effects in these areas. A prescription for a topical anti-inflammatory, such as Voltaren Gel, may be a safer option for these patients.

3) Cortisone injections

When it comes to sports, you may have heard of athletes getting a cortisone injection in their shoulders. This can be an effective treatment option for rotator cuff injuries to reduce pain and inflammation. The effect of a cortisone injection lasts only a few weeks but can really break the pain cycle. In addition, if you use this time to get some quality physical therapy, this decreases the chance of the pain coming back.

It probably comes as no surprise that there are limits to how many cortisone injections can be given. Too much cortisone is not good for your rotator cuff or your body.

Generally, this treatment should only be tried once. In more advanced circumstances, it can be done 3 times a year but must be spaced out at least 3 months apart. While a cortisone injection can help reduce pain and inflammation, it will not heal tendon tears.

4) Regenerative medicine (i.e. platelet-rich plasma)

The last treatment can actually heal a rotator cuff tendon tear. This treatment involves using a component of a patient’s own blood to attempt to stimulate tendon healing. The blood is drawn and spun into different components. The platelets component is rich in substances that can heal damaged tissue.

Through this process, platelet-rich plasma (i.e. PRP) is the substance that is created. Used to signal to the body to heal the tendon, a doctor can inject PRP into the injured rotator cuff tendon.

Overall, PRP can produce positive results for smaller partial tears while a larger tear will have less of a chance of healing. Unfortunately, these treatments are rarely covered by insurance.

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Conclusion

In the end, you now have a much better idea of what the rotator cuff is, how it can get injured, and different ways to treat these injuries. If you have any questions about the rotator cuff, schedule an appointment with your doctor or comment below.

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Matthew Bassan, DO
Dr. Matthew Bassan is a sports medicine and family medicine physician with a special interest in wellness and prevention. He received a Bachelor of Science in Kinesiology, the study of human movement, from the University of Maryland. After medical school at Nova Southeastern University in Florida, he did his residency in family medicine in Long Island, NY. During residency, he worked with patients that had many of the illnesses and chronic diseases that he hopes to prevent in his career through the advocacy of physical activity and exercise. He then completed a sports medicine fellowship in New York. He trained at a practice in Manhattan seeing patients from Broadway dancers and weekend warriors to those wishing to become more active. His career interests are to promote proper nutrition, physical activity, and a healthy lifestyle in order to optimize wellness, achieve personal fitness goals, and prevent illness. He aims to help patients through obstacles and injuries to get them back to what they enjoy. After fellowship, he spent a year with an orthopedic practice and is now a sports medicine and weight management specialist for a private practice in New Jersey.

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