To any diehard baseball fan the phrase “rotator cuff tear” means a team member’s throwing arm will be out of commission for quite some time. What is a rotator cuff, and why is it such a common shoulder injury?
The rotator cuff is a group of four small muscles (supraspinatus, infraspinatus, teres minor and subscapularis) that covers the back and under surface of the shoulder blade and wraps around the outside of the arm near the ball and socket part of the shoulder. These muscles lay right on the bone and are covered by the better-known deltoid and biceps muscles. If you want to feel where the right rotator cuff is, take your left hand and place the palm of your hand on the top of your arm just below the bump on the top of your shoulder (the acromioclavicular joint).
The rotator cuff holds the upper arm in the shoulder joint and controls the arm’s rotation. To feel your right rotator cuff working, bend your right elbow at 90 degrees and keep it tucked into your side. Now use your left hand to push your right lower forearm and wrist in toward your stomach while you resist that motion. You will feel your rotator cuff muscle contracting in the top back part of your upper arm.
A way to test the strength of the right rotator cuff is to lie down on your left side and again bend your right elbow at 90 degrees, keeping it tucked in at your side. Your forearm will rest across your stomach. From this position, move your right hand and forearm up toward the ceiling and keep the right elbow pinned to your side and hold the elbow bent at 90 degrees. Add a one or two pound hand weight to your right hand and do 10 repetitions. (Make sure this has been cleared by your doctor). Now switch sides. Your right and left sides should be able to perform this test with equal effort and without pain.
Since the tendons of the rotator cuff attach right on the top part of the upper arm near the socket of the shoulder, they are easily pinched with such repetitive overhead activities as freestyle, butterfly or backstroke swimming. Serving a tennis ball or pitching a baseball repetitively can also create friction and microtears of the tendons, especially if the shoulder girdle (shoulder blade and collarbone) is imbalanced.
These imbalances occur when your back or pelvis has been thrown off center and your shoulder blades become unequal. In this situation, the attachments of the rotator cuff muscles on the shoulder blade receive unequal tension, which may place more stress on one side. This, in combination with an overhead or repetitive shoulder motion, sets up a likely scenario for problems.
A typical symptom of rotator cuff tendonitis is pain in the top of the arm and shoulder, especially when lifting the arm above eye level. In the more severe situation of rotator cuff tears, it may be difficult to lift the arm above shoulder level because of weakness as well as pain.
If you suspect that you have a rotator cuff injury, see your medical doctor. If anti-inflammatory medication doesn’t alleviate the problem, a referral to a physical therapist is often the next step. It is important to treat more than the symptoms of pain. It is necessary to determine the cause of the tendonitis or tear. An untreated shoulder girdle imbalance can increase the likelihood of further injury if no repetitive trauma caused the problem.
Strengthening specific to the rotator cuff muscles is key to full recovery. Unlike the larger shoulder muscles, the rotator cuff has a very specific function and motion, which is usually overlooked in a gym-strengthening program. Exercising the muscle in a variety of positions, including the test position mentioned earlier, is extremely important.
Remember that proper treatment of rotator cuff problems starts with a correct diagnosis and good total assessment of the situation that caused the problem.