Rotator Cuff

What is the Rotator Cuff? How is it injured? How do I fix it?

The rotator cuff is a series of four muscles that attach on the humerus. As the name implies, they allow rotation of the shoulder, but they also contribute to elevation. A commonly missed but vital function of the cuff is humeral head depression as the arm raises. Without going into boring physics, there is a “force couple” between the rotator cuff and the deltoid, which is the muscle that goes over the top of the shoulder. If the rotator cuff is functioning properly, it should move the head downward as the deltoid raises the arm up. Basically, the cuff “keeps the golf ball on the tee” as the deltoid raises the arm. With rotator cuff dysfunction or weakness, the ball goes upward and like the tall guy in a room with short ceilings, “smashes” into the roof of the shoulder. Because of that, a host of shoulder conditions can arise or be made worse if the cuff is ineffective. What complicates the situation is if you have bone spurs on the undersurface of the roof. In this situation, you may need surgery to “raise the roof” or clean out the spurs, and then get therapy to “lower the floor.” (P.S. Gotta give credit where credit is due – Tab Blackburn, a well-known therapist in the New Orleans area, coined those two phrases).

Many times, even with a rotator cuff tear, conservative therapy is attempted. It’s a good idea to see a physical therapist about this to get some ideas on how to treat it. We suggest no more than two times a week for no more than 6 weeks. If you are getting nowhere and have continued loss of or worsening function, you may need to get fixed. Hopefully, your therapist will tell you to work on motion and strengthening in “gravity eliminated” positions because the cuff doesn’t have to work as hard as in “anti-gravity.” To illustrate, the supraspinatus helps with arm elevation. It works against gravity in sitting or standing. However, if you lay on your back, raising the arm may be easier, less painful, and you may have more range of motion because it’s not working against gravity. The line of pull of the muscle is different. Does that make sense? We hope so. If not, try it yourself if you think you fit this description and you’ll see what we mean.

If you do need to get it fixed, talk with your physician about it. We are partial to physicians who are fellowship trained in sports medicine/orthopedics. They have spent extra time on soft tissue injuries to the knee and shoulder and are usually more proficient at it. That is not to say that if your physician is not, you shouldn’t go to them. All we’re saying is do your homework. We find that physicians who spend most of their day on these conditions as opposed to ones who “do a little bit of everything” have better results.

SHOULD I HAVE THEM OPEN ME UP, OR DO THIS ARTHROSCOPICALLY?

Again, this is up to your physician and their comfort level and preferences. You could line up five of them and you’ll have five different opinions. The “gold standard” continues to be the open or the “mini-open”, but support for arthroscopic repairs is mounting in the literature, and we’re seeing that people recover a little faster in the rehab setting just because it’s not as invasive. If your physician does a lot of arthroscopic ones and has good results with them, then give it a shot. Sometimes, your best bet however is talking to other people that have had him/her operate on them.