When it comes to the shoulder, everyone knows of the rotator cuff. "That guy tore his rotator" is often heard when someone is discussing an injury to an athlete or just another person in general. Perhaps the most common self diagnosed injury is " I have a bad rotator from years of blah blah" The problem is this "rotator" as most call it is much like the core we discussed a couple weeks ago, in that it is not a separate muscle, but rather a collection of muscles which are known as the SITS muscles.
SITS are four magical muscles that pretty much determine how much movement and function an individual will have with their shoulder. As you can already guess, the SITS are responsible for rotational movements of the arm, but if these muscles are not working properly they can affect more than just a golf swing. First lets take a look at these SITS muscles shall we?
Supraspinatus- Muscle responsible for moving the arm away from the body, or abduction.
Infraspinatus- Muscle reponsible for externally rotating the arm
Teres Minor- Muscle is also responsible for external rotation
Subscapularis- Muscle responsible for internal rotation
Now, as you can imagine things are not always as simple as you first see. I only labeled the movements of the SITS muscle were to show their function in planar function , however they play a supportive role to the shoulder as a whole as seen below.
The shoulder is made up of three major bones: the Humerus, or upper arm, the Scapula, or the wing bone and the Clavical, or collar bone. The rotator works to keep the head of the humerous inside the glenoid fossa forming the glenohumeral joint. Basically, they keep the ball portion of the arm bone in the socket portion of the shoulder. The SITS muscle come together over this part of the shoulder with their tendons, which act as a covering of sorts to help attach the arm to the shoulder and thus, allows proper lifting and rotation of the arm. (see a previous post on joints and tendons). There is also a little lubricating object called a bursa, which help the tendons of the rotator cuff move more swiftly.
When we hear about someone tearing their rotator, a couple of things can cause this. If you were playing basketball and fell down and stretched your arm out to soften the landing you can tear the rotator cuff. You can also break a bone, most often the collar bone or even dislocate the shoulder. Injury is where this is going, as it is one of the major cause of rotator problems. The other is the wear and tear we go through during life or degeneration of the cuff. This is caused from overuse of the shoulder, particularly in the form of swinging motions or over head pressing motions as well. Common injuries that occur are:
- A partial tear is like an early sign that the tendon is being damaged or fraying as it is known. It is not torn per-say, but it is like a cord beginning to fray and becoming unstable.
- A full tear can be a hole or rip in the tendon, but still attaches to the bone, but can be as as sever as the tendon coming off the head of the humerus.
- The inflammation of that little bursa sac can also lead to bursitis and cause discomfort while the shoulder is in movement (although not a rotator injury in the base definition, however it can often be a side effect of rotator injuries).
So how can you tell if you may have some sort of rotator injury? Well there are a few common signs to watch out for all of which can be moderate to sever (the higher level would probably warrant a check up) such as:
- Pain in the shoulder while just resting or when slight pressure is applied to the area. Sleeping on the arm will tend to cause a fair amount of pain when there is an injury.
- If you experience pain or weakness when lifting your arm in general or any type of rotational movements are accompanied with pain.
- If you hear cracking or popping noises while the shoulder is in use that is accompanied by pain (we all have herd someone's or our own pop, but painless popping is usually an okay sign) This may also be an early sign for other injuries like arthritis or labrum tears.
The problem I see with the degeneration of the rotator cuff in people is ignoring the early warning signs. Most people chalk up a simple pain to age or just a simple pain and pass it off. As time goes on they start to take an aspirin to deal with the increased pain and finally it becomes to the point of severe pain, which causes a cessation of activities and movements. Treatment comes in many forms, the simplest, which I often preach is rest and limiting the activities that cause the pain, followed by monitoring the shoulder to see it the pain subsides. Of course, therapy or working with a trainer of some type, is a great way to catch these imbalances before they occur or early enough to strengthen the SITS muscles back to adequate form. Finally, medical interaction may be needed in the form of steroid injections or even surgery.
When it comes to the rotator cuff or problem with any portion of the body, prevention is the key. If we do miss the early signs it is always a good idea to do what we can to prevent further injury and rebuild the strength of said area to optimize it's function from the point of discovery. Avoiding surgery is always a great idea and not relying on constant steroid injections is not a bad idea either, so keep an eye on those shoulders and know some of the early warning signs of what could be a rotator injury. On the flip side, now that you know a little more about the cuff be sure to appreciate the complexity of it and how it is indeed no mere muscle, but a complex team responsible for our rotational freedom.
Rotator Cuff Information
“It is not the length of life, but the depth.” - Ralph Waldo Emerson
*I am not a doctor or a licensed physician. I am in no way diagnosing anything and recommend that you speak to your physician before making any medical decisions.
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