Rotator Cuff Tendonitis/Tear

The most common musculoskeletal complaint in chiropractic and orthopedic practices is back pain. The second most common is shoulder pain. The most infamous injury of the shoulder is injury to the rotator cuff. The rotator cuff is comprised of 4 muscles attaching from the scapula (shoulder blade) to the head of the humerus (the large bone of the upper arm). The 4 rotator cuff muscles are the supraspintaus, the infraspinatus, the teres minor, and the subscapularis. The diagram below shows the orientation of the rotator cuff muscles. (anterior=front, posterior=back)

The supraspinatus controls initiating the elevation of your arm out to the side (the first 30 degrees). It also stabilizes the shoulder when your arm is elevated at 90 degrees (held directly out to the side). The main action of the infraspinatus is external rotation of the shoulder (think when a pitcher cocks his arm back during a throw). It also stabilizes the posterior aspect (or back part) of the shoulder. The teres minor assists the infraspinatus in its actions. The subscapularis, the only muscle on the anterior aspect (front part) of the scapula, internally rotates the arm (think when the pitcher follows through his throw).

Rotator cuff tendonitis is inflammation of the tendons attaching the muscles to the bone. It usually occurs due to overuse or repetitive trauma. Simply put, it is an irritation of the rotator cuff tendons causing pain and/or weakness of the shoulder. Rotator cuff tears are a more serious condition. Partial-thickness tears of the rotator cuff muscles are divided into 3 categories: grade I, grade II, and grade III, depending on the severity of the tear. A full thickness tear is just as it sounds - the muscle is completely torn and detached.

A hallmark symptom of rotator cuff injury is shoulder pain during the night, especially when lying down to sleep. Rotator cuff injury is often caused by overuse during overhand motion, such as throwing a baseball or freestyle swimming. However, this injury is not limited to athletes. Many people can develop rotator cuff injuries by seemingly insignificant motions that damage the tendons over time.

So how does this fit into the chiropractic picture? For one, an orthopedic/sports chiropractor can properly diagnose your shoulder injury. Depending on the severity of the injury, some conservative care can be utilized to facilitate healing and strengthening of the damaged rotator cuff. Some physiotherapy modalities, such as the cold laser, aim to help speed up the recovery process. However, in order to prevent too lengthy of a blog, I will not go into detail how these modalities function.
Chiropractors do excellent work when looking at the shoulder as only a part of a piece of the movement lever. The rotator cuff muscles are only a part of what's known as the upper extremity kinetic chain. From a physics standpoint, whenever you move your shoulder, there is an energy transfer that travels from your core, up your back, across your scapula and first rib, into the shoulder, and down your arm. However, the kinetic chain should be a topic discussed completely on its own.

Your orthopedic/sports chiropractor is well qualified to examine and treat your rotator cuff injury. Conservative management of rotator cuff tendonitis/tears have shown to be successful in eliminating pain, strengthening the involved structures, and returning athletes and others to normal activity. Depending on the severity of your tear and activity status, you may be referred for a surgical consultation. However, surgery should not be your first option. It is possible to heal your injury before a surgical intervention is required. Ask your orthopedic or chiropractic physician about conservative management for your shoulder.