Clinicians often hear people refer to the “rotor cuff” when the anatomical jargon term is rotator cuff. Essentially it rotates the humerus in or out and stabilizes the top of the arm (humeral head) into the shoulder socket (glenoid fossa).
This is a fairly accurate rotator cuff presentation:
I suppose it would seem odd for me to say, hearing the wrong pronunciation irritates me, but it does. It just grates on my professional ear. But I got to thinking, who pronounces those words that way? Is it somehow related to me? It seems that it is: my male gender and age group. With 40 years of practice I realize I haven’t heard the young use either of those terms, just those over 60 guys.
My first car, a 1962 Ford Fairlane (same generation as the over 60 crowd) didn’t have fuel injection or a computerized anything, but it did actually have a rotor (no doubt what the over 60 men are phonetically hearing). The sounds of the engine and the physical feel of its handling when driving, were the only diagnostic tools we had. Tuning up the engine required replacing the points and the distributor rotor and aligning them with a manual timing light (we looked, listened, and felt through the tune up). No oscilloscope or central mother board for that.
Today the surgeon does have all sorts of computerized diagnostic gear but the best way to assess the shoulder and the rotator cuff, specifically, is the same as for my ’62 Fairlane.
Look, listen, and feel:
1) Looking at the shoulder and comparing right and left (swelling, bulges, postural differences),
2) Audible patient feedback in the form of their reported history of the pain development, and
3) Physical response to the surgeon’s manual assessment tests; the feel from handling the patient’s joints, muscles, and ligaments; often comparing affected shoulder to the unaffected shoulder (tri-plane ranges of motion, warmth of tissues, and joint “end feels”).
It is something like checking the “shocks and pinions” of the Fairlane’s front end (now called rack and pinon) analogous to the “shoulders” or front wheel assemblies of the car.
Of course there are a lot of muscles to consider when someone complains of shoulder pain. The rotator cuff is specifically defined as the supraspinatus, infraspinatus, teres minor, and subscapularis. There are also teres major, 3 deltoid divisions, long and short heads of biceps, coraco- brachialis, and pectoralis minor muscles to differentiate out from pain caused by a rotator cuff injury (tendinitis, tendinosis, or tear).
A) Muscles can be palpated (physically felt by surgeons hands) for tone, contour, and temperature, B) stretched to assess muscle guarding and its affect on joint range of motion, and C) resisted contraction to identify muscle functional integrity. There may be more than 123 shoulder tests. Nothing pays for that much assessment and differential diagnosis.
Good news! Most rotator cuff tests can be quick scans (“look, listen, and feel”). Most patients usually know when and how the pain began, can point to a specific referral point of pain (the deltoid tuberosity), and automatically demonstrate the motion causing the pain. No x-ray, no MRI, no shot, no surgery, no worry. Invariably patient is referred to a physical therapist.
Can you prevent rotator cuff tendinitis?
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