Rotator Cuff Syndrome
What is rotator cuff syndrome?
Syndrome is one of those medical catch all words. It’s a little like disease and problems.
It’s not one that I am particularly fond of as in my opinion it is far too general. I prefer a diagnosis, wherever possible, to be specific, detailed and accurate.
In writing this I looked up a medical definition of the word syndrome and have quoted it below.As you can see it really just amounts to an identifiable range of symptoms happening together. So, rotator cuff syndrome and rotator cuff disease are terms, often used, in an initial diagnosis of a rotator cuff problem.
syndrome/syn·drome/ (sin´drōm) a set of symptoms occurring together; the sum of signs of any morbid state; a symptom complex.
Rotator cuff syndrome is a little different however. The term rotator cuff syndrome is often used to describe a condition more commonly known as rotator cuff impingement. Often the two terms are used together as rotator cuff impingement syndrome. This is not a general catch all diagnosis but a specific problem that affects the tendons of the shoulder rotator cuff.
Rotator cuff impingement
Rotator cuff impingement is one of the major causes of rotator cuff disease. Similarly, rotator cuff impingement is also a major cause of rotator cuff tears. How and why this occurs is what I want to focus on now.
The Shoulder Joint
Rotator cuff syndrome has two major causes, but the result is always the same, more of that later. The picture above shows the shoulder rotator cuff relationship. As you can see the rotator cuff muscles (supraspinatus, Infraspinatus, Subscapularis and Teres Minor) pass between the Humerus and the Acromion. It is as the tendons pass under the Acromion that they get squashed or “impinged”. So what of the two causes
Firstly, the acronium comes in a variety of slightly different shapes. It can be hooked to varying degrees and can also have bone spurs attached. These physical characteristics can reduce the space beneath the Acronium that the rotator cuff tendons pass through.
Secondly, if the rotator cuff muscles are weak they will fail to stabilise the Humerus (upper arm bone). This will allow the Humerus to “ride up” especially when the arm is raised. This “riding up” is what results in the rotator cuff tendons becoming squashed.
Rotator cuff syndrome – resulting symptoms
The severity of a cuff syndrome is often divided into three distinct phases. It is a useful guide, but it can not be looked at rigidly. There is a fair degree of overlap between the phases. The symptoms will gradually worsen through the phases with no direct intervention.
Risks of developing rotator cuff syndrome
As can be seen above, the risks of developing a syndrome, or rotator cuff impingement, increase with age. It is known that approximately 34% of the population has a rotator cuff tear at the time of death. The exact cause is not often attributable directly to cuff syndrome. This is because a large percentage of patients will not have had the problem diagnosed as they were not in pain for a long period.
There is a certain amount of contradictory evidence relating to occupation. Those with a sedentary lifestyle are known to be at greater risk of impingement later in life. This is because the rotator cuff muscles have not been sufficiently worked and are weak as a result. They can not hold the Humerus tightly enough and it rides up trapping the tendons.
Those people with a manual or heavy job show a lesser incidence of impingement. This is because the rotator cuff is strong. The exceptions are those people whose trade involves a lot of overhead work; scaffolders, plasterers, painters etc. The act of lifting the arm reduces the space available to the tendon which can become squashed.
The risks are always greater in the dominant arm.
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