The rotator cuff

One of the major joints that cause pathology and consequently pain is the shoulder. This is due to its great mobility. Today, continuing with this joint, we are going to develop on the rotator cuff. If you need a refresher on the anatomy of the shoulder, it is recommended to refer to the previous entry entitled the shoulder and its instability.

According to a 2015 article by Macias and Perez-Ramirez, rotator cuff injuries are the leading cause of shoulder pain and functional disability.

What is the rotator cuff?

The rotator cuff is composed of four scapulohumeral muscles: supraspinatus, infraspinatus, teres minor and subscapularis. They serve as dynamic stabilisers of the joint, support the capsule to prevent excessive movement, and allow the joint to move. The greater tuberosity of the humerus serves as the insertion site for three muscles: supraspinatus, infraspinatus, and teres minor. The lesser tuberosity of the humerus serves as an insertion for the subscapularis muscle.

In terms of movement, they all perform the function of external rotation with the exception of the subscapularis muscle which assists in internal rotation.

dolor de hombro

What is the incidence of rotator cuff injuries?

We mentioned earlier that it is the shoulder injury par excellence, but it is also worth noting the high incidence in the population. 28% of people over 60 years of age have a complete tear, and this percentage even reaches 65% in people over 70 years of age. There is a 50% risk of bilateral ruptures in those over 60 years of age. 50% of subjects with an asymptomatic lesion of this type will develop symptoms within 3 years and 40% may develop progression.

What types of rotator cuff injuries occur?

Having seen that the incidence of injury is very high, it is necessary to classify the types of injury that can occur. The correct classification of the injury will determine whether the treatment will be appropriately adapted and good results will be achieved.

If injuries are classified according to the mechanism that causes them, they can be defined as follows:

  • Primary compression: Combined effect of extrinsic compression of the coracoacromial arch and tendon degeneration due to ageing. It is more frequent in people over 40 years of age.
  • Secondary compression: Secondary to anterior glenohumeral instability; occurs in young people.
  • Strain: Due to repeated microtrauma during the deceleration phase, which produces an eccentric overload on the cuff. Tears appear on the underside of the cuff and injuries to the biceps insertion-circumduct complex. It can occur in people who play sports or work with overhead arm movement.
  • Acute trauma: Following high-energy trauma or contact sports. The most common mechanism is forced adduction and active abduction against resistance.

Once the origin of the injury is known, it is important to know the type; there are various rotator cuff injuries, the main ones being partial and complete tears. Different differential diagnoses should always be considered, from tears to tendinopathies, bursitis, osteoarthrosis, adhesive capsulitis, among others.

How to diagnose rotator cuff injuries?

As with most injuries, diagnosis begins with a good anamnesis, physical examination and specific tests. In physiotherapy, the most frequently used tests are:

  • Upper Apley manoeuvre: assesses the entire rotator cuff.
  • Job’s manoeuvre: assesses the supraspinatus muscle.
  • Posterior elbow flexion test: assesses the subscapularis muscle.
  • Impingement test: assesses an impingement of the subscapularis tendon.

Subsequent medical tests are performed to confirm clinical suspicion. The most common tests include X-ray (to check the bony arrangement of the joint), ultrasound and MRI (to obtain soft tissue information).

What is the treatment for rotator cuff syndrome?

The treatment chosen depends on several factors such as the mechanism, type of injury and the involvement of other structures. As with most pathologies, there are two main types: surgical and conservative; both of which may or may not be accompanied by pharmacological support.

However, a conservative approach is recommended as the initial treatment modality for rotator cuff injuries. Physiotherapy is less prone to complications and less expensive than surgery, and one type has not been scientifically proven to have better results than the other. Therefore, the process will be started in most mild to medium cases with conservative treatment and, if unsuccessful, surgery.

  • Surgical treatment

Indicated when the soft tissue injury is massive and involves a complete tear of the muscle or tendon or is associated with a process in which the circulation adjacent to the shoulder is affected.

  • Conservative treatment

Processes with little soft tissue injury such as shoulder impingement or instability, or in chronic non-traumatic tears or where there is a contraindication to surgical treatment.
It is initially based on rest, modification of physical activity and work, avoiding shoulder flexion of more than 90 degrees, and then rehabilitation to recover and increase movement. Then a programme of rotator cuff strengthening and scapular stability should be initiated. Simultaneous to this, passive stretcher work to reduce symptomatology and support with kinesiology taping.

How to perform rotator cuff taping?

Supraspinatus kinesiology tape:

If we take into account the 4 muscles that form the cuff, the supraspinatus is the one that will be most affected. For this reason, a kinesiology tape application is described for it. In this case with a Y-technique around the muscle belly, but it can also be done with an I-technique at the same time.

Functional taping for shoulder tendinopathy:

Functional bandage for general musculotendinous problems of the shoulder, for clinical or sporting purposes. Adhesive elastic bandage is used for the proximal anchorage and the rest of the tape. It is interesting to use it in combination with kinesiology anterior application.

Kinesiology tape for a painful shoulder:

Kinesiology tape for a painful shoulder. It is a general application, it can be used for a frozen shoulder as well as for a global cuff injury. The important thing is to adapt it to the symptomatology and origin of the patient’s injury. In this example we are going to use a toning technique for the deltoid muscle (I+Y straps), together with a scapular support technique (Y-strap).

The importance and incidence of shoulder injuries leads to the conclusion that it is very difficult to escape from such an injury. As a patient, it is a priority to use the guidelines to avoid aggravating the injury and to go to the healthcare professionals for optimal treatment. As a health professional, it is essential to know the injury, its types and origin, to work in a multidisciplinary way and to achieve the patient’s improvement in the shortest possible time.

 

Made by the Technical Department of Calvo Izquierdo S.L.

 

 

 

How to cite this blog:

  • Calvo Izquierdo. BLOG: the rotator cuff [Internet]. Calvo Izquierdo SL. 2024. Available at: https://calvoizquierdo.es/blog-the-rotator-cuff/

Bibliography:

  • Jain N, Wilcox III R, Katz J, Higgins L. Clinical Examination of the Rotator Cuff. American Academy of Physical Medicine and Rehabilitation, Jan 2013; Vol. 5: p.45-56.
  • López Espinosa O, Pérez Solares A, Mejía Rohenes LC. Description of the most frequent type of rotator cuff injuries at the Hospital Regional General Ignacio Zaragoza. Revista de Especialidades Médico- Quirúrgicas 2008; 13(4): p.173-176.
  • Sánchez Sánchez F, Llinares Clausi, B. Cruz Gisbert J. Rotator cuff pathology in the work environment. University of Barcelona, Master’s Degree in Evaluative Medicine. Ed. 2006- 2007, p. 1-21.
  • Sánchez, Alepuz, Calero Ferrándiz, Carratalá Baixauli (2008). Updates in arthroscopic treatment of the rotator cuff. Servicio de Cirugía Ortopédica de Unión de Mutuas Unidad de Artroscopia Clínica Sanchez Alepuz. Valencia, Spain: CSA
  • Macías, SI. Pérez-Ramirez, LE. (2015) Eccentric strengthening in rotator cuff tendinopathies associated with subacromial impingement. Current evidence. Surgery and Surgeons. Vol 83; p. 74-80.
  • Kase, J. Wallis, T. Kase (2003) Clinical therapeutic applications of the kinesio taping method, 2nd edition.
  • Kase, K. (2003) Illustrated Kinesio Taping, 4th edition.
  • Selva, F. (2015) Neuromuscular Taping Manual of practical applications. Physi-Rehab-Kineterapy-Eivissa. 2nd edition.
  • Castillo, J. (2020) Bases y aplicaciones del vendaje neuromuscular. Formación Alcalá. 2nd edition.
  • Aguirre, T. Agirre, J. (2018) Vendaje neuromuscular kinesiotape en fisioterapia. Biocorp Europa. 1st edition.
  • Sijmonsma, J. (2007) Taping Neuro Muscular. Aneid Press, 1st Spanish edition.
  • Kendall’s (2007) Musculos, pruebas funcionales postura y dolor. Marbán. 5th edition.
  • Martínez, JL. Martínez, J. Fuster, I. (2006) Lesiones en el hombro y fisioterapia. Aran. 1st edition.
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