Rotator Cuff Muscles
The rotator cuff muscles are the group of muscles in the upper arm and shoulder area that support the or stabilize the shoulder area. The four muscles that make up the rotator cuff are the supraspinatus, infraspinatus, subscapularis, and the teres minor muscles. Interesting sounding names which have interesting jobs to do.

Collectively the muscles work together with three other muscles, the teres major, the coracobrachialis, and the deltoid to move the arm and shoulder area so we as humans can do work like chopping wood, rowing a boat, or something fun like throwing a baseball or football.
The rotator cuff muscles would be relatively unknown if it weren’t for our propensity to over do things like throw a baseball for instance. Of course there are many causes of rotator cuff injuries other than tossing a baseball. Swimming is one of the other major sports where the rotator cuff muscles become injured. Even conductors of symphonies can wear out the tendons of one or more of theses muscles. However, a sudden blow to the shoulder area or falling on an extended arm may also cause damage to the muscles and tendons.
Rotator Cuff Muscle Injuries
Unfortunately, as we grow older things like arthritis can cause constriction in the area and lead to wearing on the tendons and thusly affecting the rotator cuff muscles. It is the tendons that are most torn and not the muscles, so when you hear of rotator cuff injuries think about worn, frayed or detached tendons.
In most cases it is repetitive moving of the area that leads to the breakdown of the fibers in the tendons. Much like the belts on the motor of your car, as the rotator cuff muscles are continually used or abused they start to break down. Good news for most people is the pain usually acts to deter most people from using them to the point of breakage.
Of the four rotator cuff muscles the supraspinatus is the muscle most affected. The supraspinatus starts out in an indention in the scapula under what is known as the spine of the scapula. The scapula is the big bone on the back behind the shoulder on both sides of the body. The spine of the scapula is the projection that runs mostly vertically from the center of the back to the should and arm intersection.
Starting at this fossa (indention) the subscapularis heads toward the arm by traveling along the top of the spine of the scapula. At the arm/shoulder intersection the spine of the scapula turns up and projects forward to form the bony projection on the top of the shoulder right where the arm starts to hang down. It is also where the clavicle on the front of your shoulder area ends. This called the acromion or Greek for highest. This is the area where most of the injuries occur.
The supraspinatus must run under the acromion to allow it’s tendon to attach to the humerus (upper arm bone). When the supraspinatus muscles contract they cause the arm to go away from the body, an action known as abduction. This action combined with the other rotator cuff muscles allows us to lift our arm to throw for instance. When the supraspinatus muscle contracts the tendon is stretched under the acromion. Constant stretching of the tendon against the acromion leads to wear and tear.
Trauma To The Rotator Cuff Muscles
It is the overuse of this muscle tendon that cause the problem. The tendon was designed to be able to withstand maybe 100 years of normal arm action. The repetitive motion of throwing or swimming or conducting an orchestra is where the problem lies.
As noted before, trauma can also be a cause for the rotator cuff injury. It can be damaged in the initial incident or can be damaged slightly and the slight tear can deteriorate with time. Most slightly damaged tendons recover with proper care whereas a major tear will require surgery.
The injury to the rotator cuff muscles can be caused by blunt force trauma, as stated before, falling on an outstretched arm, and repetitive motions usually associated with sports.
The symptoms of rotator cuff injury are
Recurrent, constant pain, particularly when reaching overhead
Pain at night that prevents you from sleeping
Shoulder muscle weakness, especially when lifting the arm
Popping or clicking sounds when the shoulder is moved
Limited range of motion in the shoulder joint
If you have any or all of these symptoms a trip to your doctor can help verify if you have any damage in the rotator cuff muscles. He will examine the area by doing a couple of specialized tests.
1) Xrays can tell if there is any problems with the bones in the area such as fractures or bone spurs.
2)Arthrogram is a test that injects a dye into the muscle. The doctor then looks on xray or MRI to check for leaking of the dye which may mean a tear is present.
3)MRI scans can reveal the tendon and any tears may be visible with this procedure.
4)Arthroscopy is basically inserting a small camera into the area to look around for abnormalities.
5)Ultrasound can be used to check for inflammation or tears
Is Surgery Necessary?
The treatment of rotator cuff injuries is decided by the extent of the injury, pain in the area, and extent of limited mobility. The first course is to treat it non surgically with rest, ice to help with any swelling, NSAIDS for pain and inflammation, topical cremes to help with pain, and maybe with Corticosteroid injections if the injury warrants it.
Once the pain and inflammation are under control, physical therapy will be prescribed to get the area back to as close to full strength as possible and to bring back the range of motion and mobility to the rotator cuff muscles.
If surgery is needed the first thought is to perform arthroscopic surgery to limit the amount of damage to shoulder area. If that is not an option then the doctor will perform full surgery by opening up the shoulder area. Of course, that is the last choice and done only when absolutely necessary.
After surgery full recovery can be in as little as 2 months and up to 6 months or longer depending on the type of surgery and the patients ability to follow the required rehabilitation schedule.
If you feel you have the symptoms described above visit your doctor to have him evaluate your rotator cuff muscles for injury.

