Does Your Shoulder Hurt? Is it Your Rotator Cuff?
Updated: Nov 24, 2022
What is the Rotator Cuff?
The rotator cuff is a group of muscles that move your shoulder joint. They are deep inside you your shoulder joint.
The cuff is really the tendons of these muscles. The muscles together are called the rotator cuff muscles.
The muscle hold the joint together. They also control the way the joint moves. If your rotator cuff muscles are weak, or your coordination is off, things get pinched.
What Gets Pinched?
It has to do with the shape of your shoulder joint. The joint is technically a ball and socket joint.
Similarly, your hip is also a ball and socket joint. The hip has a deep socket the ball sits in. Your hip joint doesn't move a lot because of the deep socket.
Your shoulder joint socket is just a shallow depression, not a deep socket. It looks like a golf ball sitting on a golf tee. This is why your shoulder joint can move a lot.
You shoulder joint also has a "roof." Your collar bone and the end of your shoulder blade come together above the ball and socket. Where you collar bone and shoulder blade meet is call the "AC joint." The AC joint forms the roof.
Your rotator cuff muscles go from your shoulder blade and attach to your bone just below the ball. The rotator cuff tendons go between the ball and the AC joint. When things go wrong, the rotator cuff muscles and tendons get pinched between the ball and the roof.
At first, the pinching just causes pain and inflammation. The pinching ends up causing fraying and degeneration of the rotator cuff tendons. You end up with shoulder pain that limits your activity.
Fixing Your Rotator Cuff with Physical Therapy
The studies are all in. Physical therapy is as good as surgery to treat rotator cuff impingement or degenerative tears.
With good physical therapy we restore flexibility, coordination, and strength of the shoulder. This stops the rotator cuff from getting pinched. The pain and inflammation go away and you get back to your normal life.
Why Do Some People Have Surgery?
For very large tears where there is no strength in the shoulder, surgery might be the only option. Also, if the rotator cuff is betting pinched by a bone spur sometimes surgery is needed to remove the spur.
Even when people have large tears or a bone spur problem a lot of orthopedic surgeons will still try physical therapy before surgery. That's because even with these conditions people can get back to normal with just good physical therapy and avoid surgery.
Do I Need an MRI to See What's Wrong?
The simple answer is no. Most people, most of the time, don't need an MRI.
Almost everyone with shoulder pain will have something on an MRI. Most of these people don't need surgery. Sometimes it can seem worse than what is seen on the MRI. Sometimes it looks like a minor problem on the MRI but the person can't move their arm. The MRI is probably responsible for a lot of people getting surgery that may not need it.
What Should I Do if My Shoulder Hurts?
Get it looked at by a good physical therapist. You are safe - we don't do surgery. It's OK to wait a few weeks. If it still hurts, you should start physical therapy treatment.
It's best to get started when it's just pain and inflammation. It's easier to get better. You won't need a lot of treatment. But like a lot of things people ignore their pain. Some people end up taking pain medication to mask it. Eventually the pain will get worse and you won't be able to do your normal activities. At that point PT can still get you better but it will take a lot longer.
Christopher DiPasquale, PhD, PT, OCS, SCS, CHT is a physical therapist at Performance Physical Therapy & Sports Medicine, with offices in Hebron and Colchester, Connecticut. He is board certified by the American Board of Physical Therapy Specialties in Orthopedic Physical Therapy and Sports Physical Therapy and a Certified Hand Therapist by the Hand Therapy Certification Committee. Visit pptsm.com for more information. You can also call the Hebron office at 860-228-4883 or Colchester office at 860-537-3014.