The rotator cuff muscles provide stability to the shoulder joint and are responsible for coordination of the fine movements of the shoulder. The rotator cuff muscles originate on the scapula (aka shoulder blade) and taper down into tendons as they attach onto the head of the humerus.
When we hear the term “rotator cuff tear,” it typically refers to a tear in the tendon rather than a tear to the muscle belly.
What do the rotator cuff tendons look like? The best way that I can describe them would be to liken them to small ropes that have been flattened down with a hammer (for some reason, a meat tenderizer comes to mind). Take these flattened ropes and give them a waxy coating. There you have it.
Just like in a typical rope, rotator cuff tendons are comprised of many individual fibers that run in parallel. Tendons have the capacity over time to “fray” just as a rope frays with time and usage. Many people who have done significant overhead activity over time (throwing, swimming, weight lifting) have rotator cuff tendons that display this “wear and tear.” A partial rotator cuff tear is, in essence, analogous to the fraying of rope.
Last week I heard an orthopedic surgeon describe a partial rotator cuff tear to a patient. He said, “If your rotator cuff is a one hundred page book, ten or twenty pages of the book are torn.”
Will the tendon still function even though it is partially torn? The answer is, generally speaking, yes. We do, however, want to be realistic in regards to activity modification. The rotator cuff tendons sit underneath the acromial shelf of the scapula. Often there will be a rubbing of the tendons up against the shelf with repetitive overhead motions.
There is also published research that notes a decreased amount of space “under the shelf” with normal aging of the shoulder. Plan accordingly as you age. Maybe those handstand push ups are not such a good idea?
Image credits: Top © imelenchon/Morguefile.com; 2nd St22/Fotolia
Dresden Moomaw says
Hi there, I was recently at the doctor because my shoulder has been causing pain, it s popping in 1 spot 4 times, when I roll my shoulder or move it up and down. There is 2 big pops and 2 smaller pops right under my clavicle, its almost like a throbbing pain (sometimes a 10, sometimes a 5) from my neck closest to clavicle down to my upper arm.. There is also a small pop at the end of my shoulder when i move or turn my arm from regular position to the right. I was told that I for sure have severe Tendonitis.. I had tendonitis in my ankle and did exercises to “strengthen” my ankle and I am still having problems with it! I don’t want to have the same issue with my shoulder because its my right shoulder and I am right handed.. I feel like i should asked to be sent somewhere that specializes in these type of things, I know I will have physical therapy due to weakness and pain.. But do you think asking if they can send me to one of the recommended orthopaedist and see what they can do would be a good idea? I am 19 and soon to be on my own and I don’t want my shoulder “giving out” like my right ankle when I am using it to carry something…
Dan Baumstark, MSPT, CHT says
A shoulder orthopedist consult is a good idea. I would also see a PT who specializes in shoulders. Based on your other question in the ankle blog, you might be one of these “hyper-mobile” people??? Bring it up with the doc and see if they agree?
Hi, I have been having this strange sensation/pain behind and under my collarbone, when I lift my arm up and twist it a little outside, I feel like the collarbone presses or overlaps over something (tendon or muscle, I don’t know) and it hurts, like a 4/10. It began overnight, I woke up with tense neck and trapezius, and I still having this tension. Have been 3.5 weeks like this.
Dan Baumstark, MSPT, CHT says
I would see the doc about it. You have a lot of structures under the collarbone (muscles, ribs, the brachial plexus). You probably slept on that side and compressed the collarbone into your ribs. To be safe, have the doc check it out.