The Rotator Cuff is made up of four muscles and their corresponding tendons (Supraspinatus —– far and away the most commonly injured Rotator Cuff muscle, Infraspinatus, Teres Minor & Subscapularis). These four muscles surround the shoulder and fire in sequences that allow the arm to move in virtually any direction desired.

The Rotator Cuff as seen from the back. At the very top is the Supraspinatus Muscle. When a Rotator Cuff is injured, the Supraspinatius is the culprit about 95% of the time. Remember though that most of what doctors call "Rotator Cuff Injuries", are actually injury to muscles or tissues in the pictures below.

Superficial Muscles of the Front Shoulder. Many shoulder problems arise in the muscles of the front shoulder and chest, as well as the muscles of the upper arm. Although these pictured muscles are muscles of the shoulder, they are not Rotator Cuff muscles.

Deep Muscles of the Front Shoulder. As you can guess from looking at the picture, Biceps Tendon problems are a frequent cause of shoulder problems.


The shoulder is the most flexible joint in the body.  In order to attain this high level of flexibility, something must be sacrificed. And that something is stability. In the shoulder, stability is sacrificed for flexibility. This makes the shoulder not only the most flexible joint in the body, but the most unstable as well.

The shoulder problems that I deal with on a day to day basis are the result of trauma or repetitive activities (jobs, sports, car wrecks, etc).  However, it must be understood that in many (maybe even most) cases, patients have no real idea what has caused their shoulder problem.  They just know that it hurts and does not function like it used to.

Sometimes people completely rupture (tear in half) a Rotator Cuff muscle, or tendon. Unfortunately, this is typically a surgical issue. However, people will very often overload the fascia (SEE OUR FASCIAL ADHESION PAGE) that surrounds not only the individual muscles that make up the Rotator Cuff, but surrounds the entire shoulder as well.

As you have already read on our TENDINOPATHY PAGE, the collagen fibers that make up tendons can also become deranged due to overuse or traumatic injury. Again; bear in mind that all of this often occurs with no overtly visible damage on MRI.

These so-called minor sprains, strains, or “tendinitis” of the Rotator Cuff can be extremely painful to the point of being debilitating. Traditional medical treatment fails because the standard therapies (cortisone & anti-inflammatory medications) simply cover symptoms without addressing the underlying cause (not to mention, these drugs degenerate all collagen-based connective tissues).  Stretches and strengthening exercises alone are not usually enough to fix the problem, or prevent it from becoming chronic.

Our clinic employs some of the same modern diagnostic techniques and treatment modalities used by professional and college athletic teams. These techniques allow us to determine which part of the Rotator Cuff is injured —– or whether the Rotator Cuff is even the culprit at all.  If scarring is found, we break the microscopic adhesions and scar tissue which has formed around the area of injury.

The typical Rotator Cuff problem that I treat can usually be effectively dealt with in a small number of in-office treatments. The patient is first checked for microscopic adhesion and scarring in the shoulder area and Rotator Cuff. If present, it is treated. Patients are then given specific and simple stretches / exercises to perform at home. If patients are going to respond, it will happen within one or two visits (not that one or two treatments will be enough to “fix” the problem {see our COLLAGEN-BASED CONNECTIVE TISSUE page}, but you will know whether or not the treatment is working). Many people experience relief of symptoms and increased shoulder function immediately after (or even during) their first treatment.



One more thing before we leave this page — Post-Surgical Shoulders.  I cannot tell you how many times that I have successfully treated people who have already gone through an unsuccessful Rotator Cuff Surgery.  Unless your Rotator Cuff is torn in half, you owe it to yourself to try just one treatment to see if it will help.  I have seen numerous patients over the years who have been told that they have a torn Rotator Cuff (as diagnosed by MRI).  However, they responded to my treatment as readily as someone with a fascial injury or tendinopathy.

In the similar way that much of the adult American population is walking around with no low back pain; studies have proved that 50% of this group have lumbar (low back) disc bulges.  I believe the same thing is true of shoulders as well.  Many people have slightly “torn” Rotator Cuffs that do not cause symptoms.  However, when people do something to get the shoulder hurting, and then go to the doctor for testing, these tears show up on MRI.

These “tears” are an easy scapegoat —- something visible and simple to point to as the probable cause of pain. If you are diagnosed with a Rotator Cuff Tear, but then prescribes therapy and exercises to “fix” it; my guess is that although he may not admit it, your doctor feels the same way.

Again, if you have any question as to the validity of your diagnosis of a “Rotator Cuff Tear”, have us check it out.




Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s