Rotator Cuff Injuries, the Scapula and Impingement Syndromes – Part 1

A rotator cuff tear is a very common injury. These injuries are usually caused by either repetitive motion or trauma. These injuries in the older population are often due to a decrease in elasticity of muscles and tendons that occurs with the aging process.

No matter what the cause, the location of pain from a rotator cuff tear is often quite difficult to pinpoint. Patients often describe the pain as being a broad area of involvement over the shoulder. Often the pain of a rotator cuff tear radiates down their arms and elbows.

If the rotator cuff is only partially torn then the pain the patient experiences will probably be their most predominant complaint. If there has been a complete tear of the rotator cuff the patient will not be able to perform certain motions with their shoulder.

When it comes to diagnosis, rotator cuff tears will not be seen on X-rays; usually an ultrasound or MRI (magnetic resonance imaging) is needed to confirm the tear. In most cases a physical examination is all that is needed to diagnosis this condition; that is unless there are indications of a complete tear, such as a complete inability to perform certain motions.

Fortunately, most rotator cuff tears do not need surgery. On the other hand many rotator cuff tears can cause significant disability if left untreated. Conservative treatments and exercise rehabilitation should always be tried before surgery is performed.

In most cases a rotator cuff injury can be treated within a short period of time with soft tissue procedures (Active Release, Graston Technique, Myofascial Release, Massage Therapy) and exercise alone. However, in other cases, what appears to be a simple rotator cuff injury often involves several other areas of the body. To resolve these cases a more complex understanding of shoulder biomechanics is needed. Without this understanding acute injuries often become chronic shoulder problems.

Seeing the bigger picture

To get a better understanding of shoulder problems let’s consider some common examination findings. Because the mechanisms of these injuries are very similar, it is common to see similar examination findings. For example, the follow examination findings are often seen in injures caused by overhead throwing or overhead reaching:

1. Shoulder joint instability (Glenohumeral instability).

2. Abnormal shoulder blade motion (Scapular Dyskinesis).

3. Restricts in internal shoulder rotation.

In part two of this Blog we will cover shoulder joint instability.

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