Visualising the shoulder and it's 'cuff'

We physios talk a lot about the rotator cuff muscles of the shoulder. This includes their importance in shoulder stability and biomechanics, aiding in a good alignment of the humerus in the joint, the posture's effects of over loading and stressing these muscles and of course injury and pain at these very tendons and muscles.

Visualisation of these muscles and where they sit at the back of the shoulder and shoulder blade is super valuable. This simple picture can allow you to see why they are so important and at risk of injury or wear and tear over the years.

✅When working well, they hold the ball of the humerus into a good position within the shoulder joint 'socket' and stop it from rolling too far forward in the joint.

✅If your posture if too slumped or rounded at the shoulders, the work of these muscles is greater than it should be, often causing inflamed painful tendons, or 'tendinopathies.'

✅Shoulder bursitis and tendinopathies of the rotator cuff occur when the space available for these structures is compromised. Swelling, thickening, and inflammation can fill the small space under the acromion, causing pain and injury to the structures that lie below. This is called impingement and is very common.

✅Shoulder impingement issues can occur acutely or over a long period of time. Poor shoulder posture, excessive overhead and reaching activities, or imbalance of exercise at the gym can all cause these slow burning issues.

✅Sometimes the wear and tear of the impingement can cause tearing of the tendons, most commonly the supraspinatus muscle due to its location right up the top of the shoulder tip.

✅Conservative management of shoulder impingement issues involve lots of postural work (freeing the tight muscles at the front of the shoulders, stiff necks and upper backs) and strengthening of the upper back and the rotator cuff itself. Surgical management can range from scraping and creating more space up in the top of the shoulder, to stitching and repairing torn tendons, to relocating tendons with screws into the bone for more complicated operations. Recovery and rehab is a long long journey for some, with physios and clients spending months of time together!