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Peer Reviewed by:

MaristelBarrientos,MichaelTronske,&JanelleCatublas
Rotator cuf
The rotator cuff is a group of muscles and tendons that forms underneath

and supports the glenohumeral joint. It connects the upper arm (humerus)

and the shoulder blade (scapula). The muscles allow the shoulder to rotate. It

is critical in maintaining dynamic stability of the joint and is fundamental for

almost all shoulder movements. Each muscle contains a tendon which

connects to the humerus and attaches under the scapula where a cuff is

formed around the humerus.

Anatomy/Physiology

Diagram from an anterior/posterior view displaying how the


ligaments and muscles make up the rotator cuf.

The rotator cuff consists of four main muscle groups: Subscapularis,


Supraspinatus, Infraspinatus, and the Teres minor.

Subscapularis [sub-skap-u-laris]

Entire surface right below the scapula


This muscle is not only the strongest but largest muscle out of the four that

make up the rotator cuff. Its location is under the shoulder blade and it

reaches out to the front of the upper arm where the humerus is located. As

we can see in the diagram to the right a person experiencing muscle pain on

the underside of the shoulder blade and has difficulty rotating the joint is

most likely suffering from subscapularis muscle pain. The function of the

subscapularis is to allow to arm to flex and rotate inward. The significance of

this muscle is that it helps to prevent the humerus from dislocating.

Considering this is the most used muscle in the shoulder, it is the muscle

involved and responsible for movements needed in swimming, throwing,

hitting, etc. etc.

Supraspinatus [supra-spi-natus]

Above the spine of the scapula. Holds the head of the humerus in

the glenoid fossa.

Responsible for shoulder abduction: lifting the arm in a jumping jack like

motion and pulling the humeral head towards the midline of the body like in

a bench press. It is necessary for movements like a baseball pitcher cocking

back to throw, a gymnast performing wand exercises or a golfer driving a ball

down the fairway. Having a proper amount of strength and endurance in this

muscle as well as all other rotator cuff muscles is crucial in preventing

abnormal and excessive movement in the humeral head.


Infraspinatus [infra-spi-natus]

Below the spine of the scapula

This muscle is the main external rotator out of the four muscles that make up

the cuff. Its location is under the scapula. Not only is it responsible for

external rotation, but also for extension of the shoulder and horizontal

shoulder abduction. If contracted it would externally rotate the humerus. On

a day to day basis we use this muscle to perform an activity like brushing

your hair.

Teres minor [terez minor]

Slightly below the Infraspinatus superior to the Teres Major

Long narrow muscle that aids with the external rotation of the shoulder along

with infraspinatus. As the humerus rotates laterally, it allows the teres minor

muscle to activate its range of motion. Its secondary function allows for

abduction of the arms. The location of this muscle is exterior to the scapula.

The teres minor is important because it is used to keep the humerus in its

proper position in correlation to the scapula.

*The acronym SITS is commonly expended to remember these names.


Location of pain (red) based on specific muscle injuries

Injuries
Common injuries with the shoulder are usually directly related to the rotator

cuff muscles. Severity of these injuries can range from a minor case of

adjectation due to inflammation or excruciating pain due to a severe tear.

Luckily, most injuries to the rotator cuff can be repaired or treated through

injections, therapy and/or surgery.

Rotator cuff tear: A tear in the tissues connecting muscle to bone tendons,

around the shoulder joint. There are two types of rotator cuff tears, partial

and full thickness tears. A partial tear is a tear that doesnt completely

severe a tendon. A full thickness tear severs the tendon into two separate

pieces and requires definite surgery.

Rotator cuff tendinitis: Swelling of the tissues that connect the muscle and

bones in the shoulder. The tendons in this area are irritated or inflamed,
resulting in a dull ache or stiffness. Usually occurs when there is overuse of

the shoulder, and is most common in people who play sports.

Rotator cuff impingement: The acromion, a bone in the shoulder area, can

rub or impinge the tendon in the shoulder and cause irritation or

inflammation. Whenever you raise your arm above your shoulder, the space

between the acromion and the rotator cuff begins to narrow, so excessive

movements like these result in impingement.

Frozen shoulder: A stiffness and pain in the shoulder joint caused by the

shoulder capsule thickening and becoming tight. Stiff tissue bands begin to

develop which limits the amount of synovial fluid in the joint, making it

harder to move the shoulder in any direction.

Treatment
There are different treatment options available for injuries dealing with the

rotator cuff, all depending on the type of injury sustained. If there has been a

tear in the rotator cuff, an arthroscopic surgery may be the best option. In

this procedure, a small camera and tools are inserted through incisions to

reattach the tendon to the bone. An open tendon repair surgery may be

another option. Your surgeon will work through a larger incision to reattach

the damaged tendon to the bone. Open tendon repairs typically have a

longer recovery time than that seen with more minimally invasive

procedures done arthroscopically. If there is recurring pain but no surgery


needed, one can receive physical therapy to help ease the aches. The

physical therapy exercises can help by regaining lost strength and flexibility

in the area. If physical therapy is not working or doesnt show signs of

promotion, a doctor may recommend certain injections to help the process.

A steroid injection into your shoulder joint is a viable option, especially if the

pain is interfering with your sleep, daily activities or exercise.

References

Floyd, R. T. (2017). Manual of structural kinesiology. Place of publication not


identified: Mcgraw-Hill Education.

Subscapularis-Muscle . (n.d.). Retrieved February 16, 2017, from


http://www.healthline.com/human-body-maps/subscapularis-muscle

What is the Teres Minor? (n.d.). Retrieved February 16, 2017, from
http://www.wisegeekhealth.com/what-is-the-teres-minor.htm

Human-Muscles: Infraspinatus. (n.d.). Retrieved February 16, 2017, from


http://www.sportsinjuryclinic.net/anatomy/human-muscles/infraspinatus

Written by Janelle MartelMedically Reviewed by. (n.d.). Rotator Cuff Tendinitis.


Retrieved February 16, 2017, from http://www.healthline.com/health/rotator-
cuff-tendinitis

Shoulder Impingement/Rotator Cuff Tendinitis-OrthoInfo - AAOS. (n.d.).


Retrieved February 16, 2017, from http://orthoinfo.aaos.org/topic.cfm?
topic=a00032
Widmer, B. (2011 January). Frozen Shoulder-OrthoInfo- AAOS. Retrieved
February 16, 2017, from http://orthoinfo.aaos.org/topic.cfm?topic=a00071

Rotator Cuff Tears. (n.d.). Retrieved February 16, 2017, from


http://www.cedars-sinai.edu/Patients/Health-Conditions/Rotator-Cuff-
Tears.aspx?gclid=CjwKEAiAlZDFBRCKncm67qihiHwSJABtoNIgS5yHy-
aIYKAQsz76sVQRgEz8_RrEUgrJeg3LpaFf6hoCiWDw_wcB