Torn Rotator Cuff Symptoms, Treatment and Remedy
Rotator Cuff and Shoulder Anatomy
The shoulder comprised of many muscles, tendons and ligaments is an integral component of upper body movement. When injured by a fall or repetitive stress such as over lifting, it can can easily cause them to slip out of alignment by as little as a few millimeters causing shoulder weakness, pain, inflammation and severely limit the use of the arms in normal movements.
The joint where the upper bone (humerus) of the arm meets the shoulder (scapula and acromion process) is called the rotator cuff which is where most shoulder injuries occur.Untreated, a tear to the rotator cuff can cause a loss of activity, interfere with occupation, and persistent pain with restricted upper body movement.
What is the Rotator Cuff?
The Rotator Cuff muscles surround the front, the back, and the top of the shoulder joint.
The Rotator Cuff tendons attach the muscles to the bone and allow movement in the shoulder and provide strength to hold the ball in its socket. When the muscles contract, they pull on the rotator cuff tendon, causing the shoulder to rotate upward, inward, or outward.
The Rotator Cuff ligaments attach bone to bone and provide stability to the shoulder joint bones. Smooth movement between the bones, muscle and other soft tissue is provided by several bursae (fluid filled sacs) and synovial fluid (lubricates your joint).
Rotator Cuff Tendons and Muscles
The rotator cuff itself is a group of 4 tendons located at the top of the humerus. These tendons are called the subscapularis tendon, the supraspinatus tendon, the infraspinatus tendon, and the teres minor tendon.
These tendons surround the front, back, and the top of the shoulder socket to connect the humerus to the rotator cuff muscles. When the attached muscles contract,(subscapularis muscle, the supraspinatus muscle, the infraspinatus muscle, and the teres minor muscle), the pull on the tendons causes the shoulder to rotate up or down, back or front, in or out.
These muscles, along with the teres major and the deltoids (the deltoids are what you would consider the major muscles of the shoulder anatomy; they're the muscles you see when you roll up your t-shirt sleeve), keep the shoulder's ball and socket joint firmly in place and stabilize the shoulder. These muscles work together as a unit rather than individually.
Thus, rotator cuff injuries commonly involve more than one of these muscles or tendons. If any of the 4 main rotator cuff tendons or muscles become injured it can often lead to injury of any of the other three and will increasingly affect the stability of shoulder, degree of injury, and time to heal. A slight injury left untreated can lead to a much more complex injury.
The supraspinatus is the most commonly torn of all the rotator cuff tendons. Located at the back of the shoulder blade it is the uppermost muscle of the rotator cuff . The supraspinatus muscle primarily helps bring the arm directly out to the side (known as abduction) and also is involved with other shoulder movements.
The subscapularis is the largest and the strongest of the rotator cuff muscles. It completely covers the front of the shoulder blade. This muscle is attached to the front of the humerus which allows the upper arm to move inward toward the center of the body internal rotation).
The infraspinatus muscle located at the back, runs from the bottom of the shoulder blade across to the top of the humerus. This muscle works with the teres minor muscle to move the arm outward, away from the center of your body (external rotation).
The teres minor muscle sits below the infraspinatus and runs at the same angle attaching just below the greater tubercle of the humerus bone. The teres minor also assists with the outward rotation of your arm from the center of your body (external rotation).
Other main muscles in the shoulder area include:
- the deltoids
- the subclavius
- the trapezius
- the teres major
- serratus anterior
- pectoralis minor
- levator scapulae
Shoulder Bones and Ligaments
The bone structures inside the shoulder that are significant to the rotator cuff include the humerus, the scapula, the acromion process, the clavicle, the greater tubercle, and the glenoid cavity.
The humerus (upper arm bone) runs from your elbow to your shoulder and meets at the rotator cuff with a ball-like end known as the greater tubercle. This is the 'ball' part of the ball and socket joint in your shoulder.
The scapula (shoulder blade) is a triangular shaped bone with 2 bony projections at the top, right at your shoulder cuff. One of these projections is referred to as the acromion and it sits above the humerus. The other is called the coracoid process and it sits in front of the acromion and below the clavicle. Where your humerus meets your scapula there is a very shallow concave 'socket' known as the glenoid cavity (also called the glenoid fossa).
Ligaments are soft tissue bands that connect one bone to another. The joints of the shoulder that are primarily responsible for movement are held together by several strong ligaments. They include the coracoclavicular ligaments, the coracoacromial ligaments, the superior transverse scapular ligament, the coracohumeral ligament, the acromioclavicular ligament, and the glenohumeral ligaments.
Inside the shoulder there are three joints; the glenohumeral joint, the acromioclavicular joint (A/C joint) and the sternoclavicular joint.
The glenohumeral joint is a joint where the greater tubercle (humeral head at the top of the arm bone) meets the shoulder socket of the scapula, called the glenoid cavity or glenoid fossa. Inside the joint, the labrum (a form of cartilage) cushions the humeral head against the glenoid.
This joint is considered the ball and socket joint of the shoulder. The humerus sits against the glenoid cavity. Since the ball does not fit directly inside socket of the glenohumeral joint, it is the labrum, muscles, and tendons that hold the ball of the humerus against the glenoid fossa providing stability between your scapula and your humerus.
Due to this shallow socket and the scapula 'floating' above the rib cage (connected to the clavicle by ligaments, muscles and tendons) the shoulder is able to move around freely in several directions ,making the shoulder the most mobile joint in the body and also the least stable joint most prone to injury.
The acromioclavicular joint (A/C joint) is a gliding joint between the clavicle and the acromion. The acromion is a bony projection that comes off the scapula and forms the point at the outside edge of your shoulder. The acromioclavicular joint allows you to rise your arm over your head. If this joint dislocates it is commonly known as a separated shoulder.
Bursae in the Shoulder
There are 4 main bursae in the shoulder; the subacromial bursa, the subcoracoid bursa, the subscapular bursa, and the subdeltoid bursa.
Bursae (plural for bursa) are the fluid filled sacs that cushions so the bones and soft tissue move smoothly within the joint. The bursae also act as padding to protect soft tissue from the bony points on the scapula, coracoid, and acromion.
The subacromial bursa is the most susceptible to bursitis in the shoulder. It's located in the subacromial space, between the acromion and the humeral head (greater tubercle), and is used frequently during shoulder movement to reduce friction. The risk of impingement of this bursa in the subacromial space is high because the area is small.
How to Heal A Rotator Cuff Injury? Treatment and Remedy.
Rotator cuff injuries are very common, especially in people over 40 years of age. Most problems involve damage and irritation to the rotator cuff soft tissues (muscles, ligaments, tendons and bursa) rather than the bones, as they move frequently within a tight space.
A rotator cuff injury usually begins as inflammation caused by some form of small but continuous source of irritation, such as repetitive overhead motions from sporting activities, work tasks or daily chores, which can lead to tendonitis, tendinosis, frozen shoulder, impingement, or bursitis.
The first indication of a rotator cuff injury is shoulder pain when lifting, reaching or lifting the arm. A minor injury is just soreness and twinges with certain shoulder movements.
Untreated, a minor shoulder injury can quickly a become major rotator cuff injury. A major injury can involve one or more soft tissue structures and can range from a small tear to a complete separation.
Simple tears can be healed successfully without surgery. Major tears may require surgery. Your Orthopedic Doctor can evaluate your situation and will most likely order an MRI and even possibly an X-Ray of the affected area.
He will advise rest, ice, and compression be applied to the shoulder. He may also advise NSAID medication such as Tylenol, Advil, or aspirin.
REST means to not perform any movement which causes shoulder pain. This is difficult because we use our shoulders with every arm movement, but necessary to let the shoulder heal. Rest does not mean to over stress the opposing shoulder which could lead to tears in both shoulders.
The ICE will stop the pain and also remove the inflammation.
The COMPRESSION will keep fluid from seeping into the injured area and pooling (swelling).
The shoulder is a difficult area to apply ice and compression which is why many orthopedic surgical hospitals and physical therapists use ice compression wraps in their practices. A Cold One Shoulder Wrap is designed to provide icing and compression to the shoulder area for time recommended by MDs.
The wrap provides icing to the:
- top of the shoulder,
- front of the upper body,
- back of the upper body,
- and to the upper arm.
The complete icing solution for the shoulder.