What is the Rotator Cuff, and Why are There So Many Issues with it?

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So, what is the rotator cuff? Cup? Rotary cup? While most people have heard some form of the term rotator cuff, less really understand what it is, how it relates to shoulder function and why there are often so many issues involving it.

First of all, what is it? The rotator cuff is comprised of four muscles in your shoulder. They are the supraspinatus, infraspinatus, subscapularis and teres minor. All of these muscles attach from your scapula (shoulder blade) to your humerus (arm bone).

What does it do? The primary goal of the rotator cuff is to provide dynamic geometric centering of the humerus. In other words, your shoulder joint is a very shallow ball and socket joint. When you attempt to reach out and move your arm, the rotator cuff muscles work to keep the ball and socket of the joint in the correct position. Without this, when you try to reach overhead, for example, your humerus would rise up instead of staying in position. This can cause shoulder pain and impingement.

Why are there so many issues with the rotator cuff? After about the age of 30, perfusion (blood flow) starts to lessen to the muscles of the rotator cuff. This makes the muscles more susceptible to injury and less likely to heal once injured as you age. A change in daily activities, repetitive reaching, overhead tasks and physical inactivity can all have a role in rotator cuff health. Sometimes damage occurs as the result of an acute injury like a fall. Other times, injuries to the rotator cuff can happen over time due to chronic degeneration. Injuries can include tendinitis, partial tears or full tears.

What are the treatment options? There are a variety of treatment options depending on the injury. A conservative approach is generally the first choice which may include physical therapy, manual treatment, specific exercises and sometimes modalities for pain reduction. Depending on the specifics of the injury, the rotator cuff can often heal this way, and the patient will make a full recovery. For more severe cases that won’t respond to conservative care, options may include injections or surgery.

Are there ways to prevent injuries? While there is no guarantee you won’t experience injuries, it is possible to reduce your risk. By exercising regularly, avoiding painful and repetitive reaching tasks and keeping the muscles of your shoulder and mid-back strong and mobile, you can keep the supporting structures functioning in a way to minimize the risk of rotator cuff injuries. If you do start to feel pain in the shoulder, it is best to address the problem soon, before it turns into something more serious.

Dave Bearss, D.P.T., C.S.C.S., is a physical therapist who specializes in sports medicine and is a Certified Strength and Conditioning Specialist.

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