The shoulder joint (glenohumeral joint) is one of the joints in the human body which is included in the "ball and socket" type. This type of joint is the most flexible joint, because it has the largest range of motion compared to other types of joints. Due to its high mobility, the glenohumeral joint has less stability when compared to other types of joints.
What is the Rotator Cuff?
The rotator cuff is a group of muscles that helps stabilize the shoulder joint. The rotator cuff muscle group consists of four types of muscles, namely supraspinatus, infraspinatus, teres minor and subscapularis. All rotator cuff muscles originate on the scapula and insert on the superior humeral head.
- The subscapularis muscle inserts on the lesser tubercle of the humerus and plays a role in internal rotation movements.
- The supraspinatus muscle inserts on the greater tubercle of the humerus and plays a role in the abduction movement at the initial 30 degrees.
- The infraspinatus muscle inserts on the greater tubercle, but is located inferior to the supraspinatus, this muscle plays a role in external rotation movements.
- The teres minor muscle inserts on the greater tubercle of the humerus and is located inferior to the infraspinatus, this muscle also plays a role in external rotation.
Injury to the rotator cuff can take the form of tendinopathy, or even a half tear, or even a full tear. There is no specific definition to describe a rottator cuff injury. The severity is indicated by which tendon is injured, or how large the muscle tear is.
Classification of Rotator Cuff Injuries
Rotator Cuff injuries based on Collin et al are classified into several types, namely:
- Type A: Supraspinatus and superior subscapularis tear
- Type B: Supraspinatus and subscapularis tears
- Type C: supraspinatus, superior subscapularis and infraspinatus tears
- Type D: supraspinatus & infraspinatus tears
- Type E: supraspinatus, infraspinatus and teres minor tears
Gambar : Lädermann A, Denard PJ, Collin P (2015)
Risk Factors for Injury
- Age
- Smoke
- Family history of injury
- Bad posture
- There is a history of injury to the shoulder
- Hypercholesterolemia
- Activities that require hand raising movements
Signs and Symptoms
- Pain around the shoulders
- Inability to carry out the movement of raising the arms above the head
- Pain when carrying heavy objects
- Tenderness at the insertion of the rotator cuff muscles
- There is atrophy of the supraspinatus or infraspinatus muscles
The Role of Physiotherapy in Rotator Cuff Injury Cases
- Pain management
Physiotherapy will help you in managing the pain felt by the patient with the help of manual techniques and electrophysical modalities. The use of physiotherapy modalities, such as heat or ice, ultrasound, or electrical stimulation, can help reduce inflammation, improve circulation, and relieve pain.
- Strengthening and stabilization exercises
Physiotherapy will create a special exercise program designed to strengthen the muscles around the shoulder, including the rotator cuff, to increase stability and support shoulder function. These exercises can help correct muscle imbalances that may be causing injury.
- Education
Physiotherapists provide education to patients about their condition, including an understanding of the rotator cuff, causes of injury, and risk factors. This education also involves information about activities to avoid and behavioral changes that may be needed to support healing. The physiotherapist will also provide advice on modifications to daily activities that can help avoid excessive stress on the shoulder and facilitate the healing process.
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Reference :
- Lädermann A, Denard PJ, Collin P. Massive rotator cuff tears: definition and treatment. Int Orthop. 2015 Dec;39(12):2403-14. doi: 10.1007/s00264-015-2796-5. Epub 2015 May 1. PMID: 25931202.
- May T, Garmel GM. Rotator Cuff Injury. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547664/
