The quarter-finals are well under way at Wimbledon but it’s not only tennis elbow that we see commonly in clinic with our tennis players. The shoulder can often be affected and specifically the rotator cuff.
Rotator Cuff Function
The main function of the rotator cuff is to maintain the humeral head in a central and depressed position through movement. This relies upon the action of the 4 rotator cuff muscles and the long head of biceps.
The four main muscles include:
Supraspinatus – ABDUCTS humeral head and lies on the coronal plane
Infraspinatus – EXTERNALLY rotates the humeral head
Teres minor EXTERNALLY rotates in abduction of 90°
Subscapularis internally rotates accounts for 53% overall strength of the rotator cuff
Ultrasound and MRI scanning can measure the extent (size) of a tear
Small tear: less than 1 cm
Medium tear: 1–3 cm
Large tear: 3–5 cm
Massive tear: greater than 5 cm – this is a ‘complete’ tear.
Signs and Symptoms
The main signs and symptoms of a rotator cuff tear can include:
- severe pain at time of injury
- pain at night
- pain with overhead activities
- positive painful arc sign (the arm out to the side at 90degrees)
- weakness of involved muscle
- shoulder stiffness
How can we injure the rotator cuff?
- Falling onto an outstretched hand
- Lifting something too heavy
- Alongside another shoulder injury (e.g. shoulder dislocation)
What does treatment involve?
Exercise is vital for strengthening the injured rotator cuff and this can be in a variety of ways that are tailored to the patient. Pain is often a feature which we can work around to ensure exercises are achieving what they should achieve rather than aggravating symptoms. Passive treatments can help with pain but recent research suggests exercise is the key!
Unfortunately some rotator cuff injuries don’t heal with conservative management and require surgery. This is what you can expect if you do have to have a rotator cuff repair…
Did you know?
Maria Sharapova had surgery to repair two rotator cuff tears in 2008 and has since suffered other problems with her shoulder.