Rotator Cuff Tears, Causes, Treatment and Symptoms-Physioscare

Rotator cuff tear
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This includes both rotator cuff tears and impingement syndrome. Fine adjustments of the humeral head within the glenoid is achieved by coordinated activity of four interrelated muscles arising from the scapula and is called rotator cuff.

Rotator Cuff Tear-
     Rotator Cuff Tear


Note: Rotator cuff comprises supraspinatus, infraspinatus, subscapularis and teres minor (Mnemonic SITS).

Role of Rotator Cuffs 

In the movement of abduction, supraspinatus steadies the head from above, infraspinatus depresses the head, and subscapularis steadies the head in front paralleling the action of the infraspinatus. This combined action allows the deltoid muscle to swing up the arm from a steady fulcrum irrespective of the position of the scapula.

Impingement Syndrome 
Rotator cuff tear which is commonly associated with supraspinatus tendon. Other causes like bicipital tendonitis, and intraspinatus tendonitis, subacromial bursitis, etc. may give rise to rotator cuff problems, but they are not that common.

Rotator Cuff Syndrome-
    Rotator Cuff Syndrome

Causes of impingement syndrome 
• Complete or partial rupture of rotator cuff.
• Supraspinatus tendonitis.
• Calcific deposits.
• Subacromial bursitis.
• Subdeltoid bursitis.
• Periarthritis.
• Bicipital tenosynovitis.

• Fracture greater trochanter.


Among the various causes mentioned above, supraspinatus tendinitis is the one that is commonly encountered and this gives rise to the impingement syndrome. Impingement occurs beneath the coracoacromial arch. The most vulnerable structures for impingement between the undersurface of the acromion and the head of the humerus are the greater tuberosity, the overlying supraspinatus tendon and the long head of biceps. The major site of compression is anterior to the angle of the acromion. Hence, the proper term is anterior impingement syndrome or painful arc syndrome.
Shoulder Motion With Rotator Cuff-
  Shoulder Motion With Rotator Cuff

Neer’s stages of impingement syndrome 

• Edema stage.
• Tendinitis and fibrositis.
• Rotator cuff tears and rupture of biceps tendon.
• Bone changes

Types of Impingement Syndrome 

Primary: Here impingement occurs beneath the coracoacromial arch and is due to subacromial overloading.

Secondary: This is due to relative decrease in the subacromial arch and is due to microinstability of the glenohumeral joint or scapulothoracic instability.

Posterior (Internal): Seen in overhead athletes like throwers, swimmers and tennis players. Here the supra- and infraspinatus tendons are pinched between the posterior and superior aspects of the glenoid when the arm is in elevated and externally rotated position. Among the three, primary impingement is more common.

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