What is the Rotator Cuff?

By Kayla Kranda – CC’s Staff

What is the Rotator Cuff?

Rotary cup? Rotary cusp? Rotisserie cup?

The rotator cuff – It’s a term commonly heard, but not often understood.
So, what exactly is the rotator cuff? The rotator cuff is a group of 4 muscles that work together to stabilize and move the shoulder joint. These muscles include the supraspinatus, infraspinatus, teres minor, and subscapularis. Injury to the rotator cuff is often seen as shoulder pain, weakness, and loss of range of motion. Injuries can include tears, impingement, acute inflammation, or chronic degeneration.

Rotator cuff tears are becoming more prevalent because of an aging population and increased levels of activity in older adults. Partial thickness tears become more common after the age of 40 and peak in those age 50-60. Full thickness tears are present in 5-40% of those over 60 years old.1

Tears can be classified in multiple ways:
-Amount of tissue involved (partial thickness vs full thickness)
-Size of tear (small, medium, large, or massive)
-Type of tear (acute/traumatic, chronic/degenerative/wear and tear, or acute on chronic)
-Symptomatic vs asymptomatic

Treatment is based on symptoms, extent of tear, chronicity of tear, and functional deficits. Certain patient populations have been found to benefit from an initial course of conservative treatment (AKA physical therapy).2 This includes patients > 60 years old with chronic full-thickness tears, patients of any age with large or massive tears along with irreversible muscle changes, and patients with rotator cuff tendinopathy, partial thickness tears, or small full thickness tears. According to the literature, conservative treatment can be effective in 73-80% of patients.3 However, there are also certain patients where early surgical intervention has been found to be more effective.2 This includes active patients < 60 years old with acute tears or those with chronic full-thickness tears > 1-1.5 cm but without chronic muscle changes.

Goals of physical therapy following a rotator cuff injury or surgery are to reduce pain, improve range of motion, and improve strength in order to improve function including the ability to perform activities of daily living, work related tasks, and recreational activities.

Sources:
1. Boissonnault WG, Badke MB, Wooden MJ, Ekedahl S, Fly K. Patient outcome following rehabilitation for rotator cuff repair surgery: the impact of selected medical comorbidities. J Orthop Sports Phys Ther. 2007; 37(6): 312-319.

2. Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012;31(4):589–604.

3. Edwards P, Ebert J, Joss B, Bhabra G, Ackland T, Wang A. Clinical Commentary Exercise Rehabilitation in the Non-Operative Management of Rotator Cuff Tears: A Review of the Literature. Int J Sports Phys Ther. 2016; 11(2): 279-301.