The rotator cuff makes the headlines in shoulder pain as much as the sciatic nerve in low back and leg pain. It’s almost like referring to any brand of tissue as a “Kleenex®”, as if they are one and the same. Because it’s so popular, I thought I’d talk about it a bit.

The rotator cuff is a group of four different muscles that help stabilize and move the upper arm bone (humerus). Specifically, the rotator cuff helps stabilize the ball-and-socket (or gleno-humeral) joint of the shoulder to prevent a dislocation; as well as help raise and rotate the arm. The muscles of the rotator cuff include the supraspinatus, infraspinatus, subscapularis, and teres minor. Usually, injuries to the rotator cuff involve a tear or degeneration of the tendon(s), most often the supraspinatus tendon.

The supraspinatus tendon is tucked under the (acromio-clavicular or AC) joint formed between the collarbone and the tip of the shoulder blade (acromion). This joint is on the top of the shoulder where the strap of your bag may rest. The supraspinatus tendon often becomes compromised during activities that include prolonged overhead movements; such as in sports like baseball, volleyball, tennis, acrobatics, etc.. Essentially, the tendon continuously gets damaged (possibly leading to a tear) from being “impinged” under the AC-joint. This can result in pain, weakness, and/or limited range of motion of the arm. There are other ways that injuries to the rotator cuff muscles occur, but impingement is a common one.

Now, when an injury involves damage to the rotator cuff muscle(s), they are usually deemed to be the problem. Conventional treatments are often directed at exercises for rehabilitating the rotator cuff, therapeutic ultrasound, oral or injected anti-inflammatories, or surgery in severe cases.

My approach to rotator cuff syndrome is a bit different. I usually find that injuries to the rotator cuff muscles and tendons often do not stem from an inherent problem with the rotator cuff. Instead, I usually find that the main problem lies within the larger muscles of the other shoulder joints that help to prevent the humerus from “impinging” under the AC-joint; and that help stabilize the shoulder blade and collarbone. Usually, when I get the other, larger muscles firing properly and restored to their normal length, the rotator cuff muscle(s) will not become compromised and then allowed a chance to heal and function properly. Additionally, I evaluate the joints and correct the movement of the shoulder blade, collarbone, and humerus when necessary. Specialized treatments for ligaments, tendons, connective tissue (fascia), and even skin may also be employed. Lastly, evaluating the cervical spine for joint dysfunction is critical, as the nerves that exit the cervical spine control the muscles of the shoulder. Eventually, a rehabilitative program targeting the appropriate muscles causing the problem is undertaken. This is aimed at preventing a recurrence of the problem and a return to normal activities.

So even if you’ve been diagnosed with rotator cuff syndrome or impingement syndrome; it would be prudent to have your entire shoulder complex and cervical spine evaluated for dysfunction to determine the ultimate cause of the problem.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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