By: Mike Bills, MS PT
The rotator cuff is responsible for the rotation and movement of the entire shoulder joint and all of your arm.
WHAT DOES A ROTATOR CUFF PROBLEM FEEL LIKE?
If you have ever had pain, soreness, stiffness, pinching, cracking or popping in your shoulder or in your upper arm, you most likely have had a rotator cuff problem. If you have ever felt stiffness, difficulty moving one arm as far as the other, weakness in your shoulder or arm, you have had a rotator cuff problem.
WHAT IS YOUR ROTATOR CUFF?
In order to better understand how your rotator cuff works you need to know what it is. The rotator cuff is made up of a group of muscles that surround your shoulder and shoulder blade. In comparison to other muscles in your body, these muscles are actually very small but also extremely important. It is their small size that makes them so vulnerable as well as prone to injury and problems. All of the muscles in the rotator cuff attach to a specific part of your shoulder blade at one end, and then a specific site on the humerus, the bone in your upper arm. Just like other muscles in the body, the rotator cuff muscles attach to bones via a tendon. They also twist and fit through many tight spaces in your shoulder joint. These qualities make them inherently weak and very vulnerable even with every day activities. The rotator cuff has two major functions:
- To stabilize the shoulder and shoulder blade so that any part of the arm can move
- To create and or participate in movement of any part of the arm.
HOW DOES THE ROTATOR CUFF WORK?
Anytime you do anything with your arm, whether it is to write on a piece of paper, type, turn the steering wheel, reach into a cabinet etc., your rotator cuff is working. If you are writing, you will need your rotator cuff to hold the shoulder blade, upper arm and forearm steady so that you can write. If you have ever watched an elderly person write and noticed their hand is very jittery, this is partly because they are not getting the necessary stability from their shoulder blade and upper arm. This is a perfect example of the rotator cuff needing to provide stability.
When you move your arm and reach into a cabinet for example, your rotator cuff is doing both of its major functions at once. It has to hold the shoulder blade still so that the upper arm can reach for something. The rotator cuff muscles are then supposed to contract in a specific pattern that will rotate/move/raise the upper arm so that you can reach to the shelf in the cabinet. These are two very common actions that we take for granted until the rotator cuff stops doing its job correctly.
HOW DO ROTATOR CUFF PROBLEMS USUALLY START?
You can start having rotator cuff problems for any number of reasons. Typically a rotator cuff problem will start due to repetitive use of the arm. For example, raking leaves, painting a room, cleaning shelves, or any other list of things that involve repeating the same motion over and over again. Another reason for rotator cuff problems to start is performing overhead activities. Other reasons for rotator cuff problems include overstretching your arm, falling and landing on an outstretched arm or on your shoulder directly.
In all of these examples, the rotator cuff muscles are being overworked, over stressed, injured etc. When any of these things are happening, the muscles themselves are becoming tight or fatigued. When the rotator cuff muscles become tight and fatigued, the space in your shoulder joint will close up, (one of the jobs of the rotator cuff is to stabilize the joint and keep the space open) and this will in turn pinch on the rotator cuff itself or other structures in the shoulder. Additionally, when the rotator cuff gets tight or fatigued or put under too much stress, it will not hold the shoulder blade still the way that it should. This will result in compensatory movements occurring in the shoulder and upper arm, which leads to added pressure and stress on the rotator cuff itself, the bursa in the shoulder or any other number of nearby structures.
This all leads to pain, stiffness, soreness and difficulty with movement. What we will usually hear from patients dealing with a rotator cuff problem is that they have stopped using their arm for those things that bothered them (reaching up, tucking in a shirt, etc). In reality, what is happening is the rotator cuff is still not functioning properly and the problem, while it feels better now, it actually getting worse. This is most commonly how bursitis and rotator cuff tears occur. A person starts experiencing soreness and stiffness in their shoulder when they reach behind them to tuck in their shirt or put on a coat, so they stop doing these motions or modify how they do them. They needed to do so because the rotator cuff was not keeping the joint open when they were reaching behind to put that coat on and something was getting pinched on the joint and causing the pain. But avoiding that motion doesn’t change the fact that the joint is not functioning properly.
WHAT SHOULD I DO IF I THINK I MIGHT HAVE A ROTATOR CUFF PROBLEM?
