The rotator cuff is an intricate structure of muscles and tendons that support and stabilize the shoulder. Made up of four muscles—the supraspinatus, infraspinatus, teres minor and subscapularis (SITS muscles)—the rotator cuff keeps the ball of the humerus, an upper arm bone, inside the shoulder socket and allows you to raise, lower and rotate your arm. The tendons of the SITS muscles attach the shoulder blade to the humerus.
Common Rotator Cuff Injuries
A bursa is a fluid-filled sac that protects and cushions bones and muscles. The fluid inside a bursa is thicker than water—it's actually similar to an egg white—and allows tendons to glide gently within the bursa, creating smooth movement of the shoulder and arm.
Sometimes repetitive motion, overhead lifting or infection can cause inflammation of the bursa, a condition called bursitis. Inflammation of the rotator cuff bursa is known as subacromial bursitis. In this situation, the rotator cuff tendons are unable to glide smoothly in the bursa, resulting in pain accompanied by limited shoulder movement and arm range of motion. You may feel pain in the shoulder and/or side of the arm with movement or at rest.
Most of the time, rotator cuff bursitis can be treated by a chiropractor. In addition to chiropractic adjusting to help get the joints and muscles around the shoulder and rotator cuff moving well, we may be able to help you with a rotator cuff stabilizing/strengthening exercise program as well as recommend other types of home-care therapies. Other types of treatments may be used in the office to treat the inflammation.
Rotator cuff tendonitis (tendinitis) is another inflammatory condition of the rotator cuff, and it is often linked to rotator cuff bursitis. Like bursitis, this tendonitis can be caused by repetitive motion and limits shoulder and arm range of motion. With tendonitis, the tendon itself is inflamed and irritated; however, the bursa is not affected.
Treatment for tendonitis is similar to that of bursitis and aims to reduce inflammation and pain while improving or maintaining joint motion and muscle elasticity near the shoulder. Both rotator cuff bursitis and rotator cuff tendonitis can cause rotator cuff impingement, in which the tendons of the rotator cuff are “caught” between bones and make arm and shoulder movement difficult. Without treatment, rotator cuff tendonitis can lead to a rotator cuff tear.
A rotator cuff tear is a tear in one or more of the rotator cuff muscles. Symptoms of a rotator cuff tear are similar to rotator cuff bursitis or tendonitis, with pain and limited shoulder and arm mobility. However, a rotator cuff tear may also make it difficult for you to lie comfortably on the side of the injured shoulder, and you may hear grinding, grating or cracking noises when you try to move your arm. A rotator cuff tear may not only be caused by overhead lifting or trauma; it may also be caused by degeneration of the rotator cuff muscle(s).
Rotator cuff tears are graded based on how much any of the rotator cuff muscles and tendons are torn:
- Grade 0 — no tendon or muscle tearing
- Grade I — muscle or tendon fibers are stretched but not torn
- Grade II — muscle or tendon fibers are partially torn
- Grade III — muscle or tendon fibers are completely torn
Grade 0, I or II tears can generally be treated with chiropractic care. In these cases, your chiropractor will work with you to stabilize and strengthen your shoulder, arm and back joints and muscles through chiropractic adjustments, targeted exercises and other therapies available in the office.
Chiropractors can assess your shoulder injury and provide you with treatment options for your condition. If necessary, an X-ray or MRI of the shoulder may be requested. Whether you have a known shoulder injury or are bothered by shoulder pain, chiropractic care can help.