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Rotator Cuff Injury
The shoulder is the most mobile joint in the body, with lots of range in every direction. To make this possible there are 4 key muscles deep in the shoulder to keep it stable; supraspinatus, subscapularis, infraspinatus, teres minor.
Together they make up the rotator cuff, a "cuff" of muscles, keeping the shoulder centered in its socket as it moves through its large range of movement. However, there is not a lot of space in the shoulder and these muscles are moving within narrow spaces, shortening and lengthening as the shoulder moves up to 180°. Unfortunately this can lead to injury.
Different types of shoulder injuries?
There are 3 common injuries of the rotator cuff:
1. Impingement:
Should Impingement occurs when the supraspinatus muscle becomes trapped under the acromion (front of the shoulder blade) and pushed into the bone. Each person's acromion is shaped differently resulting in decreased space underneath, making some people more susceptible to impingement than others (Balke et al., 2013).
2. Tendonosis:
Tendonosis is irritation at the tendon where the muscle attaches onto the bone. This typically occurs with repetitive movements (such as swimming a racquet, swimming, overhead movements). This results in over use of the tendon. A common misconception is that the tendon is inflamed (however this is typically not the case) and is then commonly misdiagnosed as "tendinitis".
3. Tear:
Rotator cuff tears typically occur as a result of trauma e.g. impact with high load or strong contraction. However tears can also be a-traumatic if the muscle is not well conditioned (due to age, overuse, illness or medications).
Management
Mangement of each of these conditions is variable depending on type and extent of injury. Tendinopathy rarely requires surgery unless there is progression to a tear. Sugical management is available for rotator cuff tears and impingement of supraspinatus. Tears can typically be well treated without surgery (Kuhn et al., 2013) and there has been shown to be no difference between surgical and exercise based management of impingements (Saltychev et al., 2014).
Assessment
Assessment by a physiotherapist will assist in determining the extent of deficits in range, strength and function. This will be used to determine selection of appropriate treatment and exercises.
Regardless of whether it is an impingement, tendinosis or tear a similar treatment progression is followed:
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Plan management: to improve comfort and decrease fear of pain with movement
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Restoration of range: for greater availability of movement.
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Static Strength: to build strength within restored range
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Strength through range: for pain free movement of shoulder
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Return to function: for unrestricted use of the shoulder in day to day activities and/or sport.
Please note that you should always consult with your doctor or physiotherapist prior to attempting these exercises. Alternatively, feel free to call us on 1300 16 16 88 to speak to one of our physiotherapists to see whether these exercises are suitable for you.