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The rotator cuff is made up of four muscles the subscapularis, supraspinatus, infraspinatus and teres minor. Which attach the scapula to the upper arm. The tendons blend around the shoulder joint to provide stability around the shoulder joint when the arm is being used. Another main function of the rotator cuff is to provide rotation of the arm at the shoulder joint.
Strain/Tear of the Supraspinatus Tendon
This is the most commonly injured tendon of the rotator cuff. It is most commonly done in older athletes, competing in racquet or throwing sports after a period of inactivity. Injury may also occur when falling onto the shoulder or lifting or throwing a heavy object. Intense pain will be felt in the shoulder upon injury with subsequent pain ‘jabs’ when the arm is lifted outwards and upwards or rotated away from the body. Pain may also extend down the outside part of the upper shoulder (over the deltoid muscle).
In this case the rotator cuff tendons become inflamed and swollen over a period of time. This injury is common in swimming, especially freestyle or butterfly, or any activity that involves repetitive raising and/or rotation of the shoulder. The injury is characterised by pain with overhead activity ‘deep’ in the shoulder. Activities where the shoulder is below 90 degrees of elevation may be pain free. Pain may also be felt when pressure is applied to the front of the upper part of the shoulder. Another common symptom is weakness when raising the arm away from the body to the side at an angle of 90 to 120 degrees from the body. The shoulder should be rested and a phsi0otherapist consulted as soon as possible.
This injury is common in people who do a large amount of weight training, including ‘bench press’, ‘curls’ and ‘dips’. Pain in the upper front part of the arm above the biceps muscle is common and pain will be made worse by resisted bending of the elbow.
In extreme cases or in the older population, rupture of the biceps tendon is possible, characterised by pain during the activity and a tearing sensation above the biceps muscle bulk.
Pectoralis Muscle Tear
This injury occurs around the insertion of the pectoralis muscle in to the upper arm. It usually occurs when a large stress is applied to the ‘pec major’ muscle, for example during bench press, wrestling, shot put, discus or javelin. The injury is characterised by pain, swelling and bruising around the upper arm extending inwards and downwards towards chest as well as decreased strength in pulling the arm horizontally towards the body. There may be a visible deformity when compared to the other side.