Transcript Rotator Cuff Disease

Rotator Cuff Muscles
Rotator Cuff Muscles
• Four muscles, that form a “cuff”
surrounding the head of the humerus and
compress (hold down) the head of the
humerus into the glenoid fossa during
movement
• The “SITS” muscles
–Supraspinatus
–Infraspinatus
–Teres Minor
–Subscapularis
Rotator Cuff Muscles
• Not very large
• Must possess strength and muscular
endurance
• Performing repetitious overhead activities
(throwing, swimming, and pitching) with poor
technique, muscle fatigue, or inadequate warmup and conditioning leads to failure of rotator
cuff muscle group in dynamically stabilizing
humeral head in glenoid cavity
• Leads to further rotator cuff problems such as
tendonitis and rotator cuff impingement within
subacromial space
Functions
• Maintain and stabilize the
humeral head in the glenoid
fossa of the scapula
–Prevent subluxation or
dislocation of the humerus
• Assists to abduct, medially and
laterally rotate the shoulder
Supraspinatus
O: Supraspinous fossa
of scapula (above
the spine of the
scapula)
I: Superior surface of
the Greater Tubercle
of Humerus
Actions:
• Abduction
• Superior support of
glenohumeral joint
Integrated Functions of
Supraspinatus
• Assists in eccentric
deceleration of humeral
adduction
• Works with the other rotator
cuff musculature to dynamically
stabilize the humeral head in
the glenoid fossa
Infraspinatus
O: Infraspinous fossa
of scapula (below the
spine of the scapula)
I: Greater Tubercle of
Humerus
Actions:
• Lateral (external)
rotation of humerus
• Posterior support of
GH joint
Integrated Functions of
Infraspinatus
• Assists in eccentric
deceleration of medial rotation
of the humerus
• Works with the other rotator
cuff musculature to dynamically
stabilize the humeral head in
the glenoid fossa
Teres Minor
O: Upper two thirds and
dorsal surface of
lateral border of the
scapula
I: Greater tubercle of
humerus inferior to
infraspinatus insertion
Actions:
• Lateral (external)
rotation of humerus
• Stabilizes humeral
head
Integrated Functions of Teres
Minor
• Assists in eccentric
deceleration of medial rotation
of the humerus
• Works with the other rotator
cuff musculature to dynamically
stabilize the humeral head in
the glenoid fossa
Subscapularis
O: Subscapular Fossa
of Scapula
I: Lesser Tubercle of
Humerus
Actions:
• Medial rotation
(internal) of
humerus
• Anterior support of
Glenohumeral Joint
Integrated Functions of
Subscapularis
• Assists in eccentric
deceleration of lateral rotation
of the humerus
• Works with the other rotator
cuff musculature to dynamically
stabilize the humeral head in
the glenoid fossa
Rotator Cuff Disease
• Rotator cuff injuries are common
among certain populations
• The most commonly injured
muscle is the supraspinatus due to
its poor blood supply
• Common conditions
–Rotator Cuff Tears
–Tendonitis, Bursitis
–Impingement Syndrome
Rotator Cuff Tears
• Tears and/or injury are typically related to
degeneration, instability, bone spurs,
trauma, overuse and diminished
strength/flexibility related to the aging
process.
• Supraspinatus most commonly torn at
insertion and Infraspinatus is second
• People that are involved in repetitive
overhead sports including swimming,
volleyball, baseball, softball, tennis,
gymnastics, etc. are also at risk
Tendonitis
• Symptoms:
– Pain is often described as a dull ache or sharp pain
along the top of the shoulder or upper lateral arm
– Pain with overhead use of the arm
– Night pain, especially when sleeping on the affected
arm
– Pain when trying to reach behind the back
– Shoulder weakness and stiffness
• Symptoms associated with tendonitis normally
respond to rest, ice, anti-inflammatory medication and
therapeutic exercise.
• Recovery time varies from two-four weeks or several
months
Shoulder Impingement Syndrome
• The space between the undersurface of the
acromion and the superior aspect of the
humerus is normally narrow and is maximally
narrow when the arm is abducted
• Any condition that further narrows this space
can cause impingement.
Shoulder Impingement Syndrome
• Pinching of the supraspinatus, long head
of the biceps brachii, or subacromial bursa
under the acromial arch.
Shoulder Impingement Syndrome
• Overuse or repetitive microtrauma
sustained in the overhead position may
contribute to shoulder impingement
• Shoulder pain and rotator cuff disease are
common in athletes involved in sports
requiring repetitive overhead arm motion
(e.g., swimming, baseball, volleyball,
tennis), overhead workers, and sedentary
people
Causes of Shoulder Impingement
Syndrome
• Bony abnormalities (hooked acromion)
• Muscle imbalances:
–Weak lateral rotators (infraspinatus
and teres minor) and shortened medial
rotators of the shoulder (subscapularis,
pectoralis major, anterior deltoid,
latissimus dorsi, and teres major) results
in inadequate stabilization of the
humeral head in the glenoid fossa
Causes of Shoulder
Impingement Syndrome
• Poor posture
• Repetitive overhead motions
• Overuse of the shoulder (baseball
pitchers, swimmers, tennis
players…)
• Poor exercise form
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Signs and Symptoms of Shoulder
Impingement Syndrome
Pain usually in the anterior deltoid
Weakness and decreased range of
motion
Pain is exacerbated by overhead or
above-the-shoulder activities
Night pain
Difficulty sleeping, particularly when the
person lies on the affected shoulder
Exercise Guidelines
• Strengthen the shoulder lateral rotators
and abductors
• Stretch the shoulder medial rotators and
adductors
• Strengthen the rotator cuff muscles
• Strengthen the shoulder girdle muscles
(levator scapula, trapezius, rhomboids,
pectoralis minor, and serratus anterior)
Exercise Guidelines
• Contraindicated Exercises:
–Full range bench press, triceps dips,
full range push-ups, behind-the-neck
exercises (e.g., lat-pull, military
press, pull-up) upright rows, supine
triceps pullovers, DB pullovers
• Be careful of:
–Anything overhead (if painful)
–Most “pressing” exercises
–Anything heavy
–“Pulling” exercises
Upright Rows
• Avoid!
• This exercise places the shoulder in medial
rotation as the shoulder is abducted, a position
that does not allow sufficient space for the
greater tubercle to clear the acromion process
• Onset of pain from Upright Rows often is not
immediate, although it may be
• Accelerates rotator cuff degeneration. If you do
them, you risk developing chronic tendonitis or
bursitis
Isometric Exercises
• Not generally used with a healthy
shoulder population
• Used primarily when range of motion
is limited due to injury or surgery
• Contraindicated for people with
hypertension or any form of
cardiovascular disease. Isometrics
increase blood pressure and heart
rate, so they should be avoided.
Rotator Cuff Isometric Exercises
• 10 to 15 repetitions
• Hold for 10 seconds
• Isometric Shoulder Lateral Rotation Against Wall
(push outward)
• Isometric Shoulder Medial Rotation Against Wall
(push inward)
Exercise Guidelines
• Sets: 1-3
• Repetitions: 10-15
• Weight (DB’s, Tubing, Bands):
–Light
–0-5 pounds
• Rest Intervals: 60 seconds
• Hold each stretch for 20 seconds and
repeat for 2-3 repetitions
Rotator Cuff Active Range of Motion Exercises
• Active Range of Motion: movement of a joint
provided entirely by the individual performing
the exercise, there is no outside force aiding in
the movement
– Scapula: retraction, protraction, elevation,
depression, upward rotation, and downward
rotation (necessary for rotator cuff stability)
– Glenohumeral Joint: flexion, extension,
abduction, adduction, horizontal abduction
and adduction, lateral and medial rotation,
and circumduction
Rotator Cuff Strengthening Exercises
• Shoulder Shrugs with Body Weight, Tubing, or DB’s
• Standing Shoulder Extension with
Band/Tubing
• Scaption:
– Between Flexion and Abduction
– Laterally rotate shoulders and perform DB
raises (0-5 pounds) at 45 degrees with thumbs
up (scapular plane)
Rotator Cuff Strengthening Exercises
• Standing Bilateral Shoulder Lateral Rotation with
Tubing
• Standing Unilateral Shoulder Lateral Rotation with
Tubing/Band
• Standing Unilateral Shoulder Medial Rotation with
Tubing/Band
• Supine Bilateral Shoulder Lateral Rotation with Tubing
(lying supine, hip flexed, tube around bottom of foot)
Rotator Cuff Strengthening Exercises
• Prone Scapular Exercises:
– Shoulder Extension to Plane of Body
– Horizontal Shoulder Abduction with Thumbs Up
– Shoulder Lateral Rotation
• Side-lying/Standing Lateral and Medial Shoulder
Rotation with Towel Rolled in Armpit
• Push-Up Plus Against Wall (scapular protraction)
Rotator Cuff Stretching Exercises
• Standing Pulling Towel or Golf Club Behind the Back
(medial and lateral shoulder rotation) (do not bring
head forward
• Pectoral Stretch Against Door/Wall (laterally rotate
shoulders to 90 degrees)
• Standing Rolled Towel, Golf Club, or Broomstick
Behind the Back (shoulder extension) (do not bring the
head forward)
• Seated Shoulder Lateral Rotation Against Wall
• Posterior Deltoid Stretch
• Seated with Hands Clasped Bilateral Shoulder Flexion
with Scapular Protraction Against Table