Rotator Cuff Therapy Exercises

Frequently Asked Rotator Cuff Questions & Answers (FAQ)

The following rotator cuff questions are a selection of the most things I am most often asked.

The answers I have provided are generally short and to the point so if you want more information then please use the search facility on the website.

This should provide you with a more thorough, in depth answer.

I have tried to group the questions in sections. By their very nature some questions may fit within more than one category.

I have tried to make it the best possible fit and have not repeated any of the questions and answers.

Questions are grouped in the following basic categories

  1. Rotator cuff anatomy
  2. Rotator cuff Injuries and disease
  3. Rotator cuff symptoms
  4. Rotator cuff treatment
  5. Rotator cuff surgery
  6. Rotator cuff physical therapy
  7. Rotator cuff exercise

 

Rotator cuff questions and answers

 

Rotator cuff questions 1. Rotator cuff anatomy

Rotator Cuff Questions

Q. Where is the rotator cuff?

A. The rotator cuff is located in the shoulder

Q. How is the shoulder made up?

A. The shoulder is made up of three bones – the clavicle (collar bone), the humerus (upper arm bone) and the scapula (shoulder blade)

Q. What is the rotator cuff?

A. A group of four muscles that work together to provide shoulder stability and aid arm movement.

Q. What are the four rotator cuff muscles?

A. Supraspinatus, Infrapspinatus, Subscapularis and Teres Minor

Q. What does each of the muscles do?

A.     

  • Supraspinatus - Abducts (lifts) the arm
  • Infrapspinatus -  Externally rotates the arm
  • Subscapularis - Internally rotates the arm (major contributor)
  • Teres Minor - Internally rotates the arm (minor contributor)

Q. How are the rotator cuff muscles attached?

A. All the rotator cuff muscles form tendons at either end. All connect to the upper arm bone and the Scapula (shoulder blade)

Q. What else is in the shoulder?

A. There are two Bursa (Subcoracoid and Subacromial). A bursa is a lubricated sac of tissue that cuts down on the friction between two moving parts. In this case, the bursa protects the acromion and the rotator cuff from grinding against each other. There is also the Coracoacromial ligament that helps to form a vault for the protection of the Humerus.

Q. What is the Acromion?

A. The acromion process is an anatomical feature on the shoulder blade extending laterally over the shoulder joint.

The video below clearly shows how the shoulder and rotator cuff work together

 

Rotator cuff questions 2. Rotator cuff Injuries and disease

 

a. Rotator cuff tears

Rotator Cuff Tear

Q. What is a rotator cuff tear?

A. A rotator cuff tear is generally a tear in the rotator cuff tendon

Q. Where does a tear most often occur?

A. The rotator cuff tendon most often tears at the point it attaches to the Humerus

Q. Which rotator cuff muscle is most often torn?

A. The Supraspinatus

Q. What is the difference between a full and partial rotator cuff tear?

A. A partially torn rotator cuff is a tear in the tendon that has not been completely detached from the Humerus. A full, or full thickness, tear results in the tendon being completely detached from the Humerus. Please note that a tear does not have to extend throughout the whole width of a tendon.

Q. How else are tendon tears classified?

A. The size or width of the tear is often referred to e.g. a small partial tear

Q. How does a tear occur?

A. Tears can be acute – sudden onset caused by a trauma or chronic - develop over time due to weakness or disease

 

b. Impingement

Q. What is impingement?

A. Impingement of the rotator cuff is the squashing of the tendons under the acromion

Q. What causes impingement?

A. There are two basic causes weakness – as the rotator cuff weakens the Humerus is not held securely and can “ride up” and close the gap to the acromion and acromion spurs – The shape of the acromion varies person to person and this can reduce the space available to the rotator cuff tendons.

Q. What effect does Impingement have?

A. Impingement can lead to the rotator cuff becoming squashed and rubbing, this in turn can lead to tendon damage and tears

 

c. Tendonitis

Q. What is tendonitis?

A. A disease that affects the tendons

Q. What characterises tendonitis?

A. The tendons can become inflamed and sore

Q. What is tendinitis?

A. The same as tendonitis it is just a different spelling

Q. What is Tendonosis?

A. Again, often used in the same way the suffix “osis” refers to disease while the suffix “itis” refers to inflammation

Q. What is tendonopathy?

A. Often used as a more general term to cover a range of tendon diseases

 

Rotator cuff questions 3. Rotator cuff symptoms

Rotator Cuff Weakness

Q. What are the main symptoms of a rotator cuff tear.

A. Pain and weakness

Q. Where is the pain felt?

A. Most often over the point of the shoulder

Q. How bad is the pain?

A. This varies from person to person and is dependant upon the size of the tear and whether the tear was acute or chronic. It can be significant and lead to a lack of sleep.

Q. How long does the pain last?

A. Often the pain can diminish over a period of days. More often this can take a few months. In the case of a chronic tear the pain is likely to linger as the underlying cause will still exist.

Q. What are the main symptoms of tendonitis?

A. Again, pain and weakness.

Q. Where is the pain felt?

A. Often as a deep ache in the shoulder and from the back of the shoulder to the point

Q. What other symptoms am I likely to have?

A. There may be inflammation, a burning sensation and the pain may increase as you lift the arm

 

Rotator cuff questions 4. Rotator cuff treatment

Rotator Cuff Motion

Q. How do I treat a muscle / tendon injury?

A. Immediately after an injury occurs use the R.I.C.E. method Rest, Ice, Compression and Elevation

Q. What do I do if pain persists?

A. See a doctor

Q. What can I be given for the pain?

A. You may be given pain killers and anti inflammatory drugs. Longer term if pain the persists an injection may be recommended

Q. Is surgery an option?

A. Yes, but not in all cases, see below

Q. What other treatment options are available?

A. Most rotator cuff symptoms can be effectively treated naturally and healthily by a program of rotator cuff exercise.

 

Rotator cuff questions 5. Rotator cuff surgery

Rotator Cuff Surgery

Q. What is done during rotator cuff surgery?

A. There area number of things the surgeon may do

  1. Tidy up the torn tendon removing any torn or damaged tissue (debridement)
  2. Reattach the tendon to the Humerus using sutures and suture anchors
  3. Remove any inflamed or diseased bursa (bursectomy)
  4. Bone shaved from the underside of the acronium to provide more space for the rotator cuff

 

Q. How long does the surgery take?

A. Generally no more than 2 hours

Q. Will I have a general anaesthetic?

A. The majority of rotator cuff surgeries are now performed with a localised anaesthetic block but some will have a general

Q. How is the surgery performed?

A. A lot of rotator cuff surgeries are now performed arthroscopically but full open repairs and mini open repairs are still undertaken. Discuss your options with your surgeon

Q. What is the rotator cuff surgery recovery time?

A. Initial recovery from surgery will take about an hour, longer term recovery is generally slow – up to 6 months and sometimes longer. This will depend upon age, general fitness and most importantly to adherence to a post operative rotator cuff physical therapy and rotator cuff exercise program

Q. How much does rotator cuff surgery cost?

A. That depends very much on where in the world you live but in the USA a typical cost will be between $10,000 and $15,000 this figure includes post op rotator cuff physical therapy

 

Rotator cuff questions 6. Rotator cuff physical therapy

Rotator Cuff Recovery

Q. What is rotator cuff physical therapy?

A. Rotator cuff physical therapy is a phase of treatment straight after an injury or surgery. This is how I define it.

Q. Why is rotator cuff physical therapy necessary?

A. To restore range of movement as soon as possible

Q. Are there any other benefits?

A. Yes, beginning rotator cuff physical therapy quickly will reduce the build up of scar tissue, reduce pain and significantly increase the pace of recovery

Q. Do I need a qualified physical therapist or can I do this myself

A. My advice would be to seek qualified help at this time. Some exercises will be assisted and they can ensure you use the correct form. It is too easy to damage already stressed muscles and tendons. You will be expected to continue the exercises at home.

Q. What types of rotator cuff exercise will I be asked to do during rotator cuff physical therapy?

A. Anything that improves range of movement and strength without putting a strain on the tendons. Examples include

  1. Pendulum swings
  2. Assisted movement in all planes
  3. Isometric exercises

Q. What else should I be doing to help the exercises work?

A. Continue to apply ice after exercise and warm up before hand. If you can’t manage anything too rigorous then take a hot bath or shower, anything to get the blood flowing.

Q. Can I get others involved?

A. Absolutely YES! Someone, a friend or relative, to help with assisted exercise, to encourage, to cajole to share your success –invaluable in my opinion\

 

Rotator cuff questions 7. Rotator cuff exercise

Rotator Cuff Exercise

Q. Why do I need to do rotator cuff exercise?

A. Two main reasons. 1. To reduce pain and weakness following an injury or disease and 2. To prevent an injury from occurring

Q. What is the best rotator cuff exercise?

A. There isn’t one!

Q. Why do I need a range of rotator cuff exercises?

A. The rotator cuff has four muscles all need to be exercised to maintain strength and balance

Q. How do I ensure I exercise all four muscles?

A. Ensure your rotator cuff exercise program includes internal and external rotation exercises and abduction exercises.

Q. What equipment do I need?

A. Simple answer is none. That said light dumbbells and resistance bands will improve the results and make the exercises more varied and interesting

Q. Do I need to join a gym?

A. No, you can all of this at home

Q. How long do I have to do the exercises?

A. Initial restoration of function and strength can take six months, but why stop? Maintain the program to avoid repeat problems

Q. What else can I do?

A. Build in a range of stretching exercises

Q. What must I do when exercising?

A. Stay safe and follow the basic rules

  1. Warm up and try to exercise where it is warm
  2. Stop on pain, there should be some discomfort but not pain
  3. Complete a range of exercises
  4. Gradually increase weights and resistance to build strength
  5. Cool down properly and include some stretching
  6. Eat well
  7. Take plenty of fluid when exercising
  8. Breathe during exercise – do not hold your breath
  9. Try to be relaxed with shoulder down
  10. Have some fun

I have tried to include as many rotator cuff questions as possible. I appreciate that everyone will have their own particular questions and I simply can not cover everything here.

If you have read the above and still have questions then check out the website search facility and I am certain you will find the answer.

If you can not find an answer to your rotator cuff questions let me know and if I can help I will, it’s easy to get in touch.

Stay Healthy

Steve




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