How are we able to throw a ball, swing a golf club, or ‘smash’ a shuttlecock with a badminton racquet? These are all enabled by the rotator cuff, which can easily sustain injury, as we’ll discuss with our shoulder specialist and principal physiotherapist, Chye Tuan.
Introduction to the rotator cuff
The rotator cuff is best described as a muscular wrap made up of four key tendons that enables and supports arm movement at the shoulder by providing stability to the ball-and-socket joint. These four points — supraspinatus, infraspinatus, teres minor, and subscapularis — are known to industry practitioners as S.I.T.S.
How the rotator cuff works
The S.I.T.S. is like a very strong hook that grips the ball-and-socket joint of the shoulder. With the help of a stable scapula, it facilitates the dynamic rotation of the ball joint within the socket, enabling it to have the greatest degree of movement available in our body.
Explaining a rotator cuff injury
The most commonly injured member of the rotator cuff is the supraspinatus, the outermost ‘hook’ of the four muscles. It is placed in a vulnerable location, sandwiched between bony structures of the shoulder; this tapered space narrows further with overhead movements. Therefore, repeated overhead movements like those while playing badminton or tennis can lead to injury.
Sudden trauma to the rotator cuff can also result in injury. Examples include sudden forceful movements like throwing a ball, falling on an outstretched hand or a sharp increase in intensity of overhead activities, such as sudden increase in resistance or repetitions.
In some cases, a rotator cuff injury can be due to an anatomical irregularity of a hooked acromion, a bony extension of the shoulder blade that encroaches into the sandwiched space.
Scale of a rotator cuff injury
A rotator cuff injury, most commonly in the supraspinatus muscle, can range from a mere impingement, a mild strain or inflammation to degenerative changes, a partial tear or a full rupture.
Symptoms of a rotator cuff injury
If you feel any of the following sensations or discomfort, you would most likely have sustained a rotator cuff injury:
Pain in lifting arm overhead or behind the back
Radiating pain or ache down the lateral upper arm
Difficulty sleeping on the affected/injured side.
In the event that you are experiencing any of these symptoms, do seek medical advice to avoid further complications.
Rehabilitation for a rotator cuff injury
Because the rotator cuff, particularly the supraspinatus, is prone to further injury, it is best to refrain from excessive overhead arm movements. In shoulder physiotherapy, strengthening the surrounding muscles and establishing ‘motor control’ (or neuromuscular system) are high on the agenda. These can include:
Improving spinal posture for optimal scapula positioning.
Training surrounding muscles to work together to ease pressure on the rotator cuff.
Stretching and mobilising the shoulder.
Resistive loading of the muscle to stimulate repair.
Integrating localised muscle contraction with regional parts.
Gerber, C., Schneeberger, A. G., Beck, M., & Schlegel, U. R. S. (1994). Mechanical strength of repairs of the rotator cuff. Bone & Joint Journal,76(3), 371-380.
Cofield, R. H., Parvizi, J., Hoffmeyer, P. J., Lanzer, W. L., Ilstrup, D. M., & Rowland, C. M. (2001). Surgical repair of chronic rotator cuff tears. The Journal of Bone & Joint Surgery, 83(1), 71-71.
Teefey, S. A., Rubin, D. A., Middleton, W. D., Hildebolt, C. F., Leibold, R. A., & Yamaguchi, K. (2004). Detection and quantification of rotator cuff tears. J Bone Joint Surg Am, 86(4), 708-716.