What is a Rotator Cuff Tear?

The shoulder joint is comprised of the humeral head (the location where the upper arm meets with the shoulder) and the glenoid (the shoulder socket). Surrounding its circumference, there is a protective, ring-like cartilage layer, called the shoulder labrum. It acts as an insertion site for the rotator cuff tendons and muscles, which serve to keep the humeral head firmly in the glenoid. However, impingement of the shoulder joint, caused by the misalignment of the rib cage, shoulder blade, or the upper arm, can result in rotator cuff tears. This can lead to shoulder pain and instability.

The Rotator Cuff Muscles

The rotator cuff is comprised of four muscles: the supraspinatus, the infraspinatus, the subscapularis, and the teres minor. It is possible to get a tear in any of these muscles, but the most common tears are in the supraspinatus muscle.

The supraspinatus is a small muscle at the top of the shoulder that holds the humeral head to the scapula (shoulder blade). It is responsible for stabilizing the upper arm and shoulder abduction (upward, away from the body movement).

The infraspinatus is a triangular shaped muscle, located right underneath the supraspinatus muscle. It serves as the major external rotator in the shoulder, which is responsible for extension and external rotation movements of the upper arm.

The subscapularis is another triangular-shaped muscle located on the front side of the body, which acts as an internal rotator and stabilizer for the shoulder, especially in relation to the biceps muscle.

The teres minor is a muscle located on the back side of the shoulder and aids in external rotation at the elbow and the hand.

How Does This Happen?

Rotator cuff tears, especially in the supraspinatus muscle, happen due to the restriction caused by pronounced shoulder impingement. Shoulder impingement is the result of the misalignment of the shoulder blade, rib cage, or the upper arm. This is because if a muscle is too tight, it can create compensatory movement distortions in other parts of the body. For example, a hiked hip can lead to constriction of the rib cage and inefficient breathing patterns. This, in turn, leads to uneven shoulders, which then can cause shoulder impingement. On the other hand, if a muscle is too loose, it can allow for too much flexion and movement, resulting in instability of the joint. The constant friction, wear and tear on the shoulder can cause tears in the rotator cuff.

In summary, common activities and factors which may contribute to a rotator cuff injury include: bad posture, atypical gait, improper training technique, instability in the upper arm and shoulder blade, instability in the lumbo-pelvic hip axis, and restriction of the rib cage.

Signs of A Rotator Cuff Tear

• Discomfort sleeping at night especially on the affected side
• Dull, aching pain on the affected side
• Weakness in the arm, biceps area
• Trouble with overhead/lifting movements

How Do You Fix This?

For most the most severe rotator cuff injuries, it may require medical/surgical procedures in order to repair it. However, rest, physical therapy, injections, medications, stabilization exercises can help heal the injury. We would recommend the following exercises to help stabilize the shoulder joint:

• Release - pec major active release- 2 min on both sides
• Activate - 4-point serratis press 2x20 on both sides
• Integrate- Lying prone scaption w/breathing focus 2 x 20