What Is the Rotator Cuff Exactly?

The rotator cuff is a group of tendons and muscles that are located in the shoulder and upper back area, connecting the upper arm to the shoulder blade. The tendons of the rotator cuff provide stability to the shoulder area and the muscles allow the shoulder to rotate.

Your shoulder is made up of three bones: your upper arm bone that is called the humerus, your shoulder blade known as the scapula, and your collarbone that is named the clavicle. The shoulder is a ball-and-socket type joint where the ball, or head, of your upper arm bone fits perfectly into a shallow socket in your shoulder blade area.

The rotator cuff tendons and rotator cuff muscles play a pretty important role since they are what keeps the arm in the shoulder socket. There is a network of four muscles that come together as tendons to form a covering around the head of the humerus and that is what we call the rotator cuff. The rotation and ability to lift the arm comes from the rotator cuff, so as you can imagine, when it is causing pain, it can be rather debilitating and very frustrating.

The muscles in the rotator cuff include the teres minor, the infraspinatus, supraspinatus and the subscapularis. There is also what is known as a lubricating sac, or bursa, which is located between the rotator cuff and the bone on top of your shoulder called the acromion. The bursa is what allows the rotator cuff tendons to freely move and glide as you engage your arm in any motion or activity. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.

 

Symptoms of Rotator Cuff Problems

An injury to the rotator cuff area can make it very painful and annoying to lift your arm out to the side. Tears that happen suddenly usually cause intense pain right away, indicating that there is a problem. There may even be a snapping sensation and immediate weakness in your upper arm area. When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears typically occur in the supraspinatus muscle and tendon; however, other parts of the rotator cuff may be involved in an injury.

Tears that develop slowly over time due to overuse also cause pain and arm weakness. You may feel pain in the shoulder area when you lift your arm to the side, or you may feel pain that moves down the arm. The pain may be mild and only noticeable when performing common activities that require you to lift your arm over your head. Eventually, the pain may become more noticeable, even when the arm is at rest. Some of the most common symptoms of a rotator cuff tear include:

  • Pain at rest and at night, particularly if lying on the affected shoulder
  • Pain when lifting and lowering your arm or with specific activities
  • Weakness when lifting or rotating your arm in different directions
  • Crepitus, which is a grating sound or sensation produced by friction between the bone and cartilage or a crackling sensation when moving your shoulder in certain positions

Rotator Cuff Exercises and Stretches

Try to do this program for 4 to 6 weeks, unless otherwise specified by your doctor or physical therapist.

Once you have recovered, you may want to continue with these exercises as part of a great maintenance program. Performing these exercises 2–4 days a week can help maintain strength and range of motion in your shoulders.

 

Warm Up

It’s best to warm up the muscles before doing these, or any, exercises.

Choose a low-impact activity for 10 minutes such as walking, riding a stationary bike, elliptical or even arm circles, forwards and backwards, while marching.

Remember: You should not feel pain during an exercise. Talk to your doctor or physical therapist if you have any pain while exercising. If you are not sure how to do an exercise, or how often to do it, contact your doctor or physical therapist.

 Rotator Cuff Stretching Exercises

Crossover Arm Stretch

Stand with feet hip-distance apart. Relax your shoulders and gently pull one arm across your chest as far as possible, holding at your upper arm area, not the elbow (avoid putting pressure on the elbow area). Hold the stretch for 30 seconds and then relax for 10–15 seconds and repeat 5 times on each side.

 

Back Rotation

Hold a stick or small hand towel rolled lengthwise behind your back grabbing one end with one hand, and lightly grasp the other end with your other hand. Pull the stick or towel horizontally so that your shoulder is stretched to the point of feeling a stretch without pain. Hold for 20–30 seconds and then relax for 10–15 seconds. Repeat 4 times on the each side. Maintain good posture, standing with feet hip-distance apart, knees slightly bent and keep your core tight.

 

Pendulum

Lean forward with knees slightly bent and place one hand on a counter or table top for support. Allow the other arm to hang freely at your side. Gently swing your arm forward and back 3–4 times, then repeat the exercise moving your arm side-to-side 3–4 times. Next, move the arm in a circular motion 3–4 times. Repeat the entire sequence with the other arm. Careful not to round your back or lock your knees. Do 2 sets of 10 on each side.

 

Rotator Cuff Strengthening Exercises

Standing Row

Using an elastic stretch band or a resistance band of comfortable tension, make a loop with the elastic band and put it around a doorknob or sturdy post. You can tie the ends together or, if using the common resistance bands, grab the handles with one hand. Stand in the start position holding the band with your elbow bent and at your side. Keeping your arm close to your side, slowly pull your elbow straight back. Then slowly return to the start position and repeat. Do 3 sets of 10 squeezing your shoulder blades together as you pull.

 

Upward Rotation

Similar to the exercise above, make a 3-foot-long loop with the elastic band and attach the loop to a doorknob or other stable location. Stand holding the band with your elbow bent at 90° with knuckles/fist facing forward at shoulder height. Maintain the positioning with your upper arm and shoulder, making sure your elbow stays in line with your shoulder; then slowly raise your hand until the forearm is vertical. Return to the start position and repeat. Perform 3 sets of 10.

 

Inward Rotation

Using the same band, stand holding the band with your elbow bent and at your side, fist vertical and facing forward. While keeping your elbow close to your side, bring your arm across your body then return to starting position and repeat. Perform 3 sets of 10.

 

Outward Rotation

This time, instead of rotating inward, simply rotate the arm away from the body. Stand with feet hip-distance apart, knees slightly bent and abs tight. Using the same band, arm down at your side then bend the arm at the elbow. Keeping your elbow close to your side, slowly rotate your forearm outward and away from the body, then return to the starting position. Squeeze your shoulder blades together as your rotate away from the body.