Most people have heard of the rotator cuff, even if they have been lucky enough not to have had a problem with their shoulders. Since few people really understand what this structure is, let alone what might be going wrong, let’s explore what it’s all about.

The “rotator cuff” is a general term for a group of muscles at the shoulders that tend to be susceptible to common injuries. The shoulders are complex joints with various muscles acting to stabilize as well as mobilize the upper limbs. When you think about it, “stability” and “mobility” are really opposing functions, and this is the inherent problem with these dynamic joints.

In order for the shoulders to be as mobile as we need them to be, a certain amount of stability must be sacrificed. If the stabilizing function of the shoulder is overcome by too much mobility, injuries can result. If you look at the shoulder joint on a skeleton you might be surprised to see how vulnerable it appears. The head of the humerus (arm bone), scapula (shoulder blade) and the clavicle (collar bone) together form a partial ball-in-socket that appears much less sturdy than the one found at the hip joint. While this may seem like poor design, it is impressive that the interaction of the ligaments and muscles in the area make the joint strong enough to, well, shoulder our burdens.

The term rotator cuff describes four of the smallest muscles that act on the shoulder. While the label is often applied to any type of shoulder pain, the rotator cuff is comprised specifically of the supraspinatus, infraspinatus, teres minor and subscapularis muscles. Obviously, these muscles function to rotate the shoulder, but they also play an important role in stabilizing and protecting it. The most common rotator cuff injury occurs to the tendon of the supraspinatus muscle. Since the supraspinatus runs from the top of the shoulder blade and under a bone to attach at the front of the shoulder, it is susceptible to impingement, or pinching under this bone. This is particularly common in people who perform a lot of overhead activities or work with their arms elevated.

While some minor rotator cuff injuries will resolve themselves with some ice and rest, more serious ones like a tendon tear may require surgery. For the majority of the rotator cuff injuries that fall between these two extremes, there are a number of conservative, non-invasive treatments that can be effective, such as ultrasound or soft tissue therapies like myofascial release (or “ART®”). It is always advisable to try a regimen of conservative treatment for mild to moderate musculoskeletal (MSK) injuries first, as the risks and side effects of surgery make it a last resort.

Rotator cuff injuries and other problems with the musculoskeletal system can be complicated to diagnose, especially with all the muscles, ligaments, bones and joints acting together. It is important to get an accurate diagnosis from a healthcare professional knowledgeable in MSK medicine in order to facilitate the best treatment options. As a (clearly biased) case in point, I co-authored a paper recently published in JMPT (the Journal of Manipulative and Physiological Therapeutics) that demonstrated fourth-year chiropractic interns possessed significant competency in MSK medicine. Whoever you may choose to consult for a rotator cuff injury or any other MSK complaint, it is always best to do so as early as possible to give yourself the best chance of complete recovery.