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What makes up the rotator cuff?

The rotator cuff is a group of four muscles and their tendons that wraps around the front, back, and top of the shoulder joint.

The muscles are the supraspinatus, infraspinatus, teres minor and subscapularis, which help to provide stability for the shoulder joint.

What is a rotator cuff tear?

Like most musculoskeletal conditions, the most common mechanisms of a rotator cuff tear are separated into ‘repetitive micro-trauma’ and ‘traumatic injuries’. There are always exceptions to the rule, but the following is generally true for both types of injuries.

  • Repetitive Micro-trauma: In repetitive use injuries to the rotator cuff, repeated activities cause damage to the rotator cuff tendons. Over time, the tendons wear faster than the body can repair them and a micro-tear can develop within the tendons. Patients with repetitive use injuries to the rotator cuff often have complaints of shoulder pain prior to developing a complete rotator cuff tear.
  • Traumatic Injuries: Traumatic injuries to the rotator cuff are seen after events such as throwing, golf and falling on to an outstretched arm. The traumatic event can cause a rotator cuff tear by injuring the rotator cuff tendons. This mechanism is much less common than repetitive use injuries. If you have had a rotator cuff tendinitis before, you are more likely to have a tear of the tendon due to scar tissue formation, which renders the tendon inherently weaker than normal.

Who is most susceptible to a rotator cuff tear?

A rotator cuff tear is seen both in the young and old, but a complete tear is much more common if you are older.

In younger people, there is usually either a traumatic injury such as a fall, or the person is putting the tendon under significant load, as seen in athletes involved in throwing. Swimming is also a common source of shoulder injuries.

As you age, the muscle and tendon tissue of the rotator cuff loses some elasticity, and due to the inherent poor blood supply to the mid part of the tendon healing is slow and degenerative changes are often found.

Therefore the rotator cuff becomes more susceptible to injuries and is often damaged while performing everyday activities. This is the reason that rotator cuff tears are more commonly seen in older people.

How common are rotator cuff tears?

Not every rotator cuff tear causes significant pain or disability. In fact, autopsy studies have shown rotator cuff tears in up to 70% of people over the age of 80 and 30% of the population under the age of 70.

Clearly, all of the people with rotator cuff tears are not complaining of painful symptoms. However, in many individuals, a rotator cuff tear can cause significant disability, and prompt diagnosis and chiropractic treatment can have a profound improvement in symptoms and shoulder function.

Chiropractic treatment is very effective for grade I and II tears, but complete tears will need surgery.


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