Transcript Shoulder/Rotator Cuff Injury

Shoulder / Rotator Cuff
Injury
R. Daehn, B.A., M.L.S., C.P.T
May 2012
• the rotator cuff consists of muscles and tendons
in the shoulder
• these connect the upper arm bone with the
shoulder blade
• and hold the ball (humeral head) of the humerus
firmly in the shoulder socket
• the rotator cuff has greatest range of motion of
any joint in the human body
Muscles of the Rotator Cuff
Subscapularis
Shoulder Articulations
• Internal Rotation
• Anterior Stability
• Posterior Stability
Muscles of the Rotator Cuff
Supraspinatus
Shoulder Articulations
• Abduction
• External Rotation
• Internal Rotation
• Stabilization
The supraspinatus is the most often injured rotator cuff muscle. The inability to smoothly
abduct the arm against resistance may indicate a rotator cuff injury
Muscles of the Rotator Cuff
Infraspinatus
Shoulder Articulations
• External Rotation
• Transverse Abduction
• Transverse Extension
• Posterior Stability
The infraspinatus is the second most often injured rotator cuff muscle
Muscles of the Rotator Cuff
Teres Minor
Shoulder Articulations
• External Rotation
• Transverse Abduction
• Transverse Extension
• Posterior Stability
Injury
• any type of irritation or damage to rotator cuff
muscles or tendons
• tears usually occur in abnormal tendon areas
weakened by degeneration and impingement
• about half of the time, a rotator cuff injury can
heal with self-care measures or exercise therapy
Injury
Signs and Symptoms
• pain and tenderness in the shoulder, especially
when reaching overhead, reaching behind your
back, lifting, pulling or sleeping on the affected
side
• shoulder weakness
• loss of range of motion in the shoulder
• inclination to keep shoulder inactive
Injury
Causes
• Tendinitis – inflammation due to overuse or
overload
• Bursitis – bursa (fluid-filled sac between shoulder
joint and rotator cuff) can become irritated and
inflamed
• Strain or tear – stress from overuse; left
untreated, strain can weaken tendon and lead to
degeneration or sprain
Injury
Causes
•
•
•
•
normal wear and tear – increasingly after age 40
poor posture – slouching forward
falling – falling on arm or using arm to break fall
lifting or pulling – too heavy a weight or poor
technique
• repetitive stress – especially overhead movement
Exercise Goals
• Exercise within ranges of motion which do not
cause pain
• Emphasize rotator cuff strengthening
• Strengthen entire shoulder girdle
– including external rotators, rhomboids, trapezius (lower
fibers), latissimus dorsi, posterior deltoids, triceps,
biceps
• Stretch pectorals, anterior deltoids, subscapularis
Movement & Exercise Guidelines
Impingement Syndrome
Movement
Exercise
Contraindications Contraindications
• overhead with
internally rotated
shoulder
Exercise
Indications
• shoulder press
• rotator cuff
strengthening
• lateral dumbbell
exercises
raise with internally
rotated shoulder
• bench press
• upright row above
• lateral dumbbell
shoulder level
raise with
externally rotated
• incline bench press
shoulder
Movement & Exercise Guidelines
Anterior Instability
Movement
Exercise
Contraindications Contraindications
• external rotation
with >90˚ abduction
• horizontal
abduction
•
•
•
•
bench press
Pec deck
shoulder press
behind-the-neck lat
pulldown
Exercise
Indications
• rotator cuff
strengthening
exercises
• lateral and front
dumbbell raises
• upright row
Movement & Exercise Guidelines
Rotator Cuff Debridement and Subacromial
Decompression
Movement
Exercise
Contraindications Contraindications
• resisted overhead
movements
• shoulder press
• upright row above
shoulder level
Exercise
Indications
• rotator cuff
strengthening
exercises (starting
one month after
surgery)
• front dumbbell raise
Movement & Exercise Guidelines
Rotator Cuff Repair
Movement
Exercise
Contraindications Contraindications
• resisted overhead
movements
• shoulder press
• upright row above
shoulder level
Exercise
Indications
• rotator cuff
strengthening
exercises (starting
six weeks after
surgery)
• front dumbbell raise
Exercises
• rotator cuff exercises should be done at the end of
the workout to prevent fatigue of the small rotator
cuff muscles needed when using larger muscles
Exercises
Subscapularis
•
•
•
Cable
– Seated Shoulder Internal Rotation
– Standing Shoulder Internal Rotation
Dumbbell
– Shoulder Internal Rotation
• on bench
• on floor
Lever (selectorized)
– Shoulder Internal Rotation
– Upright Shoulder Internal Rotation
Exercises
Supraspinatus
•
•
Cable
– Front Lateral Raise
• Seated
Dumbbell
– Front Lateral Raise
See Lateral Deltoids for more exercises, particularly:
• Dumbbell
– Lying Lateral Raise
Exercises
Infraspinatus & Teres Minor
•
•
•
Cable
– Seated Shoulder External Rotation
• Standing
– Upright Shoulder External Rotation
Dumbbell
– Lying Shoulder External Rotation
• Incline
– Seated Shoulder External Rotation
– Upright Shoulder External Rotation
• with Support
Lever (selectorized)
– Shoulder External Rotation
– Upright Shoulder External Rotation
Stretches
Subscapularis
– Broomstick
– Doorway
Stretches
Supraspinatus
same as for Lateral Deltoids
– Fixed Bar
– Side Deltoid
Stretches
Infraspinatus & Teres Minor
–
–
–
–
–
Broomstick
Bent-over
Seated Bent-over
Side Lying
Side Lying Teres Minor
Sources
• Rotator Cuff Injury – Mayo Clinic
http://www.mayoclinic.com/health/rotator-cuff-injury/DS00192
• Rotator Cuff Repair – NSCA’s Essentials of Personal
Training. Human Kinetics, c2004; pp 543-6
• Rotator Cuff Rupture/Tear – WaterART Fitness. Instructor
Certification Program – Seniors and Specialized
Populations; pp 215-7
• Kinakin, Ken. Optimal Muscles Training. Human Kinetics,
c2004
• ExRx.net - Exercise Prescription
http://exrx.net