The rotator cuff (RTC) is located in the shoulder and is comprised of four muscles: supraspinatus, infraspinatus, teres minor and subscapularis. These muscles function together to provide dynamic stability to the shoulder joint. Rotator cuff injury is commonly seen in overhead throwing athletes 1. It is also common in adults and can occur from "wear and tear" over time. RTC injuries are classified and treated based on severity.

Stage One: Rotator Cuff Strains

There are three stages for classifying rotator cuff injuries 234. The first stage is defined by inflammation of the suprspinatus tendon and is the least severe RTC disorder. These injuries typically occur in people under age 25. People with rotator cuff strains have pain in the outside of the upper arm, when reaching overhead and when attempting to sleep on the injured arm. Loss of shoulder movement can also occur because the arm is not being moved through its normal range of motion. These injuries are treated with rest, ice, anti-inflammatories, physical therapy to relieve pain, stretching and strengthening.

Stage Two: Rotator Cuff Tendinitis

Tendinitis and fibrosis of the RTC occurs in the second stage of RTC injury. This condition is similar to stage one injuries. Treatment for tendinitis also consists of rest, activity modification, medication, hot or cold applications and physical therapy. In addition, a cortizone steroid medication is sometimes done to decrease inflammation and pain. Chronic RTC tendinitis can lead to later RTC tears as the tendon frays due to continued inflammation.

Stage Three: Partial-Thickness Rotator Cuff Tears

Stage three RTC injuries include actual tearing of one or more of the four tendons. Partial-thickness tears are the less severe type of injury in this category. A partial-thickness tear means that part of the tendon is torn, but has not become detached. This type of injury is frequently treated with a course of physical therapy to attempt to restore range of motion and functional abilities. If this is unsuccessful, surgery may be indicated.

Stage Three: Full-Thickness Rotator Cuff Tears

Full-thickness rotator cuff tears, also called complete rotator cuff tears, occur when one or more tendons become completely detached from the bone. This condition requires surgical intervention to reattach the tendon(s) and clean out any bone spurs. A specific protocol of progressive exercises must take place after surgery to ensure the success of the repair and to help the person regain shoulder function.