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What Exactly Is the Rotator Cuff?

Last updated on March 11, 2021 By Josh Ripp PT, DPT, CSCS Leave a Comment

biker with immense shoulder pain

The Anatomy

Ah, the infamous rotator cuff. Nearly everyone knows someone who has injured it, but what is a rotator cuff? During my physical therapy career, I have heard individuals call this a rotator cup, rotary cuff, rotor cup, and many other alternatives, but do not worry because we understand what you mean.

shoulder joint xrayFirst, a rotator cuff is not just one object in your shoulder, but instead 4 different muscles. The name rotator cuff comes from these muscles forming a “cuff” around the ball-and-socket shaped glenohumeral joint. This ball-and-socket joint is problematic, because unlike your hip, the “ball” is substantially larger than the “socket”, which generates more instability. This is where the role of soft tissue comes into play to help assist in stabilization so frequent subluxations or dislocations do not occur.

The rotator cuff muscles (infraspinatus, supraspinatus, subscapularis, and teres minor) play a vital role in stabilizing your glenohumeral joint as well as other general shoulder movements. Since there are 4 muscles that make up the rotator cuff, this is the reason why individuals who injure this part of their shoulder may present so differently, depending on which muscle was damaged. Saying I “tore my rotator cuff” is an extremely general phrase, since it does not narrow down which muscle or muscles of the rotator cuff were specifically damaged. More often than not, the muscle injured is the supraspinatus due to its relatively small size but frequent loading of large forces.

rotator cuff muscles

As seen in the images above, the rotator cuff muscles originate from the scapula, also known as the shoulder blade, and insert onto the humerus where the muscles will pull on this bone for stabilization and movement. As they near the humerus, they become tendonous with the tendon portion of the muscle often being the part that is torn.

tennis player with shoulder pain

How Does One Injure It?

There are two types of injuries that can occur with the rotator cuff which we categorize as macrotrauma vs. microtrauma.

Macrotrauma injuries are when a large enough force at that instant supersedes the force which the rotator cuff can sustain. These types of injuries are often seen with falls, motor vehicle accidents, lifting too heavy of an object, etc.

Microtrauma injuries are due to the nature of repetitive overhead activities throughout a lifetime that eventually wears the rotator cuff muscles down enough to the point where they develop tears within the tissue. Individuals who are at a greater risk for microtrauma to the rotator cuff are overhead athletes (e.g. swimmers, baseball players) and those who are in manual labor professions (e.g. electricians, painters).

elderly woman experiencing shoulder pain

Unfortunately, once we age past 60 years old, we all become at higher risk for rotator cuff injuries due to the continuous use of our shoulders during our younger years. This is a large part of why the elderly population seems to have many more shoulder problems than younger generations.

As we age, blood supply to the rotator cuff starts to slowly diminish which decreases the integrity of the muscles, and may lead to weakening and fraying of these muscles. While this is microtrauma in nature, it also places the older individual at a higher risk for a macrotrauma event. That heavy suitcase you have been lifting your whole life without any issue may eventually reach the point where the weight is too much for the weathered rotator cuff, and as you go to lift it in the overhead bins, *SNAP*, and your rotator cuff is now torn.

rotator cuff tear

The Treatment

People hear their rotator cuff is torn and often automatically assume the worst… surgery. But that is not necessarily the case for all individuals. While some may tear the muscle or muscles severe enough where surgery is needed, others may rehabilitate it completely back to normal with a combination of rest, physical therapy, and medication.

Full/Complete tears will not heal back together, thus surgery is needed for these injuries if one wishes to have full movement and strength back, but partial tears often depend on the extent of the tear. If the tear is small enough and has a good blood supply to it, then structured physical therapy which emphasizes the strengthening of the rotator cuff can return that individual back to pain free shoulder movement.

physical therapist helping man with shoulder injury

Regarding physical therapy for the rotator cuff, strengthening of the shoulder in all planes of motion is important to returning the muscles to their pre-injury strength. This is true for both injuries that do and do not require surgery. Also, since your rotator cuff muscles originate from the scapula, strengthening your periscapular muscles (muscles that surround the scapula and align it in the correct position on your back) is vital to long term rotator cuff strength.

Filed Under: Orthopedic Injury, Physical Therapy Tagged With: Shoulder



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About Josh Ripp PT, DPT, CSCS

Josh Ripp PT, DPT, CSCS has a B.S. in Exercise Science and a Doctorate of Physical Therapy from Saint Louis University in St. Louis, Missouri. Josh has primarily focused on patients with orthopedic & sports injuries. He has worked with many high school & collegiate athletes representing a wide range of sports. He has been a member of the American Physical Therapy Association since 2016. Returning to full functional capability and preventing further pain are important aspects to Josh’s philosophy of rehabilitation.

FTC Compliance Disclaimer: PhysioDC.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com; proceeds from product sales help cover the operational & maintenance costs for the site.

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DISCLAIMER: The information on this site is for Educational Purposes Only and is not designed to diagnose, treat, mitigate, prevent or cure any health conditions. The U.S. Food and Drug Administration has not evaluated statements about these health topics or any suggested product compositions. Answers to questions submitted are merely the opinion of the physical therapist and should not be taken as a prescribed course of action. Any advice given by the therapist must be cleared with the treating physician involved in direct patient care. The person posing the question absolves the responder of any liability in regards to opinions given. PhysioDC insists that all patients receive approval from a prescribing physician prior to starting a structured exercise program involving any of the exercises included on this site. PhysioDC.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com; proceeds from product sales help cover the operational & maintenance costs for the site.