The rotator cuff consists of muscles, cartilage and tendons that work together to keep the bones of the shoulder in place. The four muscles of the rotator cuff are the subscapularis, the supraspinatus, the infraspinatus and the teres minor along with the teres musclotendinous attachments. The rotator cuff can become injured due to repetitive motion, overuse, trauma or deformities of the anatomy of the cuff.
Rotator Cuff Syndrome
Rotator cuff syndrome is defined as any damage that occurs to the rotator cuff due to injury, overuse or anatomy. People who consistently perform repetitive motions that involve raising the upper arms more than 30 degrees over horizontal are at higher risk of experiencing rotator cuff syndrome. With this type of motion, repeated movement of the muscles and tendons put pressure on the bone, which in turn causes the top of the shoulder blade to rub across the rotator cuff. Over time, this rubbing will lead to what is called rotator cuff impingement.
Stages of Rotator Cuff Impingement
Rotator cuff syndrome is divided into three stages, according to severity of injury. Stage one is due to injury that has occurred because of overuse. In stage one, swelling and/or bleeding occurs in rotator cuff. At stage one, rotator cuff syndrome can either be healed or it can progress to stage two. At stage two, inflammation or the tendon and scar tissue develops. At stage three, the tendon either ruptures or tears and surgery plus aggressive therapy is performed to correct the cuff.
Surgery
Surgery is dependent upon the severity of the rotator cuff injury and is most often suggested when there is a partial to full-thickness muscle tear. Surgery can relieve pain, strengthen the cuff and increase the function of the shoulder. Most rotator surgeries are done laproscopically, and repairs are performed on the muscle, bone and tendon. Aggressive physical therapy is required after surgery to rehabilitate the shoulder.
Stages of Physical Therapy
Rehabilitation of the rotator cuff after surgery is mandatory because it restores strength and functionality to the cuff. There are four phases of rehabilitation, which include a passive phase, active phase, strengthening phase and a full activity phase. In the passive phase, the physical therapist performs light movement exercises on the shoulder for up to six weeks. This allows for restored mobility to the tendon without any strain. In the active phase, the tendons are healed enough so that the therapist can perform arm weight movement without any added resistance. This phase can last up to 12 weeks. In the third phase, the tendons are strong enough for the focus to be shifted to the muscles of the cuff. During this phase, the patient adds weight or a resistance band to their rehabilitation exercises. In the final phase, core exercises to correct posture and give the shoulder stability are included in the patient's exercise program. The patient can return to full activity after four to six months of rehabilitation.
