WTF is a Rotator Cuff?
Many people have heard of the rotator cuff and either have, or know someone who has, experienced an injury to it - but what is it exactly, and what does it do?
If you guessed that it has something to do with the shoulder, you are correct - but could you explain it further than that? After years of working with patients to rehab rotator cuff injuries and surgeries, I’ve learned that even people who have undergone rotator cuff repairs have little understanding of what it is or its importance. Let me enlighten you.
The rotator cuff is a group of four muscles that surround the shoulder joint. These muscles include the supraspinatus, infraspinatus, teres minor, and subscapularis. The rotator cuff has two primary functions:
The rotator cuff contributes to rotation (I know, would’ve thunk!) of the shoulder.
The subscapularis contributes to internal rotation - such as the motion to put your hand on your chest
The other 3 muscles produce external rotation - such as the motion to reach your arm out to get a jacket on
The rotator cuff helps stabilize the shoulder when at rest, lifting the arm overhead and out to the side, pushing, and pulling.
The shoulder is a ball and socket joint. As your arm lifts overhead, the rotator cuff essentially pulls the ball downwards into the socket so it doesn’t knock into the roof (this is what “impingement” refers to, if you’ve ever heard of that)
Why do these things matter?
Rotation of the shoulder is essential for arguably all of the movements we make with our arms, from tasks as simple as putting on a seatbelt, to intense tasks such as swinging a tennis racket or throwing a ball.
The stabilization that the rotator cuff provides helps protect the joint from excessive force, which leads to things like arthritis. Additionally, rotator cuff stabilization is important for maintaining proper posture and positioning during activities such as lifting, reaching overhead, and pushing or pulling.
Why do rotator cuff injuries happen?
The rotator cuff muscles and tendons are relatively small compared to others, and are often ignored in exercise programming. When the activities we perform exceed the capacity of these small muscles and tendons, they are prone to degeneration and sometimes, even tears.
Unexpected heavy lifts or catching, falling and catching yourself on an outstretched arm, and repetitive overuse over time are the most common culprits of rotator cuff issues. They are also common in wheelchair users, as they use their arms for mobility all day long.
How do I prevent a rotator cuff injury?
Strengthening the shoulder in all planes, especially rotation and overhead, will improve the mechanics and tolerance of the shoulder to movement and load, and reduce the risk of injury.
Maintaining good upper back and shoulder strength and mobility reduces excess stress on the shoulder joint and can reduce the risk of degeneration happening over time.
I have a known rotator cuff injury/tear. Do I need surgery?
Many existing rotator cuff injuries respond well to conservative (non surgical) treatment. This involves improving shoulder and upper back mobility, strength, and movement mechanics.
If you have already tried improving the strength and mobility of your shoulder and you continue to experience pain and limitations in your daily activities, surgery may be indicated. The good news is, your time in rehab prior to surgery was not a waste, as you have already improved your range of motion and strength, which will assist you in the rehab process.
Key Takeaways:
The rotator cuff (not cup) consists of 4 small muscles in the shoulder that function to create rotation in the shoulder and stabilize the joint when reaching overhead, lifting, and carrying.
Rotator cuff injuries are common, but you can reduce your risk of injury by improving your mobility and strength.
Existing rotator cuff tears can often be treated without surgery, depending on how they occur and to what degree. However, in many cases when surgery is indicated, improving range of motion and strength in the shoulder will still improve outcomes in the long term.
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