What is a Rotator Cuff Injury?

Rotator cuff conditions are one of the most common shoulder injuries that GPs see [1]. The shoulder’s rotator cuff muscles work together to help stabilise and move the shoulder (particularly overhead). Injuries to these muscles can affect your ability to exercise, work and even look after yourself. As the shoulder is a complex joint, diagnosing rotator cuff injuries can be difficult. Seeking further investigation from a GP is crucial to ensure that the necessary treatment is sought.
 

Rotator Cuff Anatomy

What are the Rotator Cuff Muscles?

The anatomy of the rotator cuff muscles is highlighted in the picture below. A group of 4 muscles called the infraspinatus, subscapularis, supraspinatus, and teres minor help support the shoulder joint. These muscles all originate from the scapula (i.e. shoulder blade) and connect to the humerus (i.e. arm bone).

What do the Rotator Cuff Muscles Do?

The rotator cuff muscles help move and support shoulder activities (particularly overhead). Whilst they are somewhat involved in all aspects of shoulder movement, they have main functions, which include:

• Outward and inward rotation (also known as external and internal rotation)
• Keep the shoulder joint centred and safe during activities
• Raising the shoulder above the head

  Synchrony between the scapula and humerus is essential for shoulder movement, particularly overhead activities (e.g. reaching up, exercise, etc.). Injuries to the rotator cuff muscles can cause poor and compensatory shoulder movements, leading to pain over time.
 

Source.

 

Rotator Cuff Injury Symptoms

Symptoms from rotator cuff injuries are generally consistent. However, the severity of the symptoms can vary, depending on the type, severity and cause of the injury. Examples of common symptoms include:

• Shoulder pain, especially when moving and lifting objects
• Inability to lift arms above 90 degrees or above head height (also known as the painful arc)
• Difficulty reaching behind the back without discomfort or pain
• Clicking or grinding sounds in the shoulder

 

Rotator Cuff Injury Causes

There are several causes of rotator cuff injuries that can either gradually or suddenly appear. Examples of common causes include [2]

• Traumatic or high-velocity accidents can cause injuries to the rotator cuff muscles, particularly in younger and active individuals. Examples include falling on an outstretched hand, suddenly lifting something heavy or contact sports. Rotator cuff tears are common during these incidents.
• Overuse and repetitive movements can also cause gradual shoulder pain. Older adults who are involved in labour-intensive jobs or activities are at risk of wear and tear in the rotator cuff muscles. Common conditions that occur in this population are shoulder tendonitis and/or rotator cuff tears.
• Ageing is another factor that leads to rotator cuff injuries. Over the years, the slow and gradual strain on the shoulder muscles can lead to degenerative changes in the rotator cuff muscles.

 

Rotator Cuff Injury Tests and Diagnosis

Seeing a GP is essential in receiving the necessary tests for a formal diagnosis. Rotator cuff injuries can be similar to other types of shoulder pain conditions, so self-diagnosis is not advised. Examples of tests that can facilitate diagnosis can be noted below.

Shoulder Assessment

Medical questioning and a physical examination performed by a GP can determine the possibility of a rotator cuff injury. Special tests can be used to stress the rotator cuff muscle groups to initiate a positive or negative response. GPs will also observe basic movements, such as your range of motion and strength.

Imaging investigations

Imaging techniques, such as MRIs and ultrasounds, can be referred by GPs to look at the structures in the shoulder. These tests will help determine any changes to the muscles and/or tendons of the rotator cuff. However, any structural changes viewed on MRI and ultrasound can also be coincidental [3]. Consulting your GP after the imaging assessment is valuable for determining the relevance of any positive findings.

• Examples of common rotator cuff injuries found on these investigations include:
• Rotator cuff tendinopathy (previous known as rotator cuff tendinitis)
• Partial or full-thickness supraspinatus tear
• Partial or full-thickness infraspinatus tear

 

Rotator Cuff Injury Treatments

Appropriate treatment for rotator cuff injuries will depend on the location, type and severity of the condition. A joint decision should be made to determine what treatment will suit both parties.

Pain medication

Especially during the early phases of rotator cuff injuries, pain medications can be prescribed by GPs to help alleviate discomfort. Managing pain and inflammation can help ease your symptoms during any day-to-day activities (e.g. work, sports, etc.) A short period of rest or reduced activity should be accompanied to assist with recovery.

Physiotherapy

For most rotator cuff injuries, your GP will recommend a physiotherapist who can assist or speed up your recovery. Physiotherapists are qualified health professionals that specifically treat musculoskeletal conditions (e.g. lower back pain, tennis elbow, etc.). Depending on your circumstances, your physiotherapist will utilise a combination of treatments, including exercise, massage, lifestyle modifications and dry needling. Several sessions are often required to see the best outcomes.

Cortisone Injection around the Shoulder

If symptoms persist after physiotherapy and/or pain medication, a cortisone injection may be recommended to settle inflammation and pain. Cortisone injections can provide temporary relief to assist with your day-to-day activities and rehabilitation. However, there can be adverse effects, especially with repeated injections - please discuss this with your GP before administering.

Shoulder surgery

Those with persisting symptoms or severe injuries (such as large tears) may consider shoulder surgery. Your GP will refer you to an orthopaedic shoulder specialist for further consultation.

Other treatments

Your GP may also recommend other treatments to help with recovery. Examples include:

• Acupuncture
• Shockwave therapy
• Platelet-rich plasma (PRP) injections
• Stem cell therapy
• Osteopathy

 

Recovery

Recovery from rotator cuff conditions will vary depending on the injury location, symptoms and severity. Many people living with mild to moderate injuries will be able to recover from non-surgical options and time. However, more severe injuries, particularly traumatic and full-thickness tears, may require a surgical opinion. However, the advantages between surgery and non-surgical treatment are yet to be concluded [2].
 

Complications

If not appropriately managed, rotator cuff conditions can lead to chronic pain and the possibility of further re-injury. These complications can affect your capacity to work, perform recreational activities and even personal tasks (e.g. cleaning your hair, putting on your bra, etc.). If you suspect a rotator cuff injury, seek immediate support from your GP to prevent long-term complications.
 

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  References

1. https://www.racgp.org.au/afp/2009/september/carpal-tunnel-syndrome/
2. Khatri, C., Ahmed, I., Parsons, H., Smith, N. A., Lawrence, T. M., Modi, C. S., ... & Metcalfe, A. J. (2019). The natural history of full-thickness rotator cuff tears in randomized controlled trials: a systematic review and meta-analysis. The American journal of sports medicine, 47(7), 1734-1743.
3. May, T., & Garmel, G. M. (2019). Rotator cuff injury.