Rotator Cuff Injury

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The rotator cuff is a group of muscles which work together to provide the Glenohumeral (shoulder) joint with dynamic stability, helping to control the joint during rotation (hence the name).

The rotator cuff muscles include:
  • Supraspinatus
  • Infraspinatus
  • Teres Minor
  • Subscapularis

Supraspinatus and Infraspinatus are the most commonly injured rotator cuff muscles. Due to the function of these muscles, sports which involve a lot of shoulder rotation – for example, bowling in cricket, pitching in baseball, swimming, kayaking – often put the rotator cuff muscles under a lot of stress.
Problems with the rotator cuff muscles can be classed into two categories – Tears of the tendons/muscles, and inflammation of the tendons (often called tendinopathy or tendonitis).

Acute Tear:
This tends to happen as a result of a sudden, powerful movement. This might include falling over onto an outstretched hand at speed, making a sudden thrust with the paddle in kayaking, or following a powerful pitch/throw.

The symptoms will usually include:
  • Sudden, tearing feeling in the shoulder, followed by severe pain through the arm
  • Limited movement of the shoulder due to pain or muscle spasm
  • Severe pain for a few days (due to bleeding and muscle spasm) which usually resolves quickly
  • Specific tenderness (“x marks the spot”) over the point of rupture/tear
  • If there is a severe tear, you will not be able to abduct your arm (raise it out to the side) without assistance
Chronic Tear:
A chronic tear develops over a period of time. They usually occur at or near the tendon, as a result of the tendon rubbing against the overlying bone. This is usually associated with an impingement syndrome.
  • Usually found on the dominant side
  • More often an affliction of the 40+ age group
  • Pain is worse at night, and can affect sleeping
  • Gradual worsening of pain, eventually some weakness
  • Eventually unable to abduct arm (lift out to the side) without assistance or do any activities with the arm above the head
  • Some limitations of other movements depending on the tendon affected
Investigation:
The following examples are for information purposes only. We highly recommend seeing a sports injury professional or Doctor to receive a full assessment of your injury.

Special Tests:
There are a range of tests which can be performed which are used to indicate certain injuries:
  • Empty Can Test
    You will be asked to put your arm out in front of you at a 45 degree angle to your body, with the thumb pointing to the floor (as if holding an empty can). The therapist will ask you to raise your arm whilst they resist your movement. This tests the supraspinatus tendon.

  • Drop Arm Test (Codman’s Test)
    Your arm will be moved above your head, and you’re asked to gently lower your arm to your side. If you can’t do this slowly and under control, or have severe pain in doing so, it suggests a tear in the rotator cuff

  • Abrasion Sign
    You will be asked to sit and raise your arm to your side with the elbow bent. You will be asked to rotate your arm forwards and backwards. If there is any crunching noise (crepitus) there may be some inflammation or degenerative changes.

  • Neer’s Sign
    The therapist will position your arm with the thumb facing down and at a 45 degree angle to your body. They will then lift your arm up, above your head. If you experience pain or discomfort, you may have an impingement of supraspinatus.

  • Hawkins-Kennedy Test
    Your arm will be raised in front of you to 90° and the elbow bent. The therapist will then medially rotate (turn the wrist down and elbow up) the arm. If this causes pain you probably have an impingement of Supraspinatus.



Rotator Cuff Injury Rehabilitation
The following guidelines are for information purposes only. We recommend seeking professional advice before beginning rehabilitation.

Rehabilitation of rotator cuff injuries should consist of:
  • Reducing initial pain and inflammation
  • Identifying and correcting any shoulder abnormalities that might increase the chance of rotator cuff injury
  • Regaining full shoulder mobility
  • Strengthening the rotator cuff muscles and others surrounding the joint.
Stage 1: To reduce the pain and inflammation.
  • Apply cold therapy or ice to the shoulder. This will help reduce pain and inflammation. Apply ice for up to 15 minutes every 2 hours, gradually reducing the frequency of applications as the shoulder improves.
  • Rest the shoulder. Do not do anything that causes pain. Every time you cause pain, you are making the injury worse. If you need to use a sling to restrict movement then do so but only for a few days.
  • NSAID's or anti-inflammatory medication (e.g. ibuprofen) may help in the early stages. Always check with your Doctor before taking medication if you are not sure.
  • Apply massage therapy. Simply applying pressure to the tendon initially may be all that is needed. As pain reduces, cross friction techniques may be applied.
Stage 2: To re-establish range of motion and strength (usually 5 to 7 days after injury).
  • Improving range of motion is achieved through mobility exercises. These involves gradually increasing the range of motion the joint will go through without pain and specific stretching exercises to stretch all muscles around the shoulder joint.
  • Massage techniques can help to improve greatly the condition of the rotator cuff muscles, therefore allowing more joint flexibility and better response to strengthening exercises.
  • Strengthening exercises concentrate more specifically on the external rotator muscles (the ones that rotate the arm out) and the scapular stabilisers (muscles that support the shoulder blade). It is also important to strengthen the whole joint.
  • Strengthening exercises should only be done if they are pain free and in conjunction with stretching exercises.
Stage 3: To return the athlete to competition or specific training.
  • These exercises need to be specifically tailored to the athletes sport. For example throwers would start throwing a tennis ball against a wall. Five sets of 20 throws gradually increasing the number of sets and number of repetitions assuming no pain during, after or the next day.
Mobility Exercises:
Stretching should be done as soon as pain will allow and maintained throughout the rehabilitation process and beyond. Little and often is generally better than a big effort for a few days and then forget it as soon as the injury has settled down.

Strengthening Exercises:

Static (or isometric) exercises do not involve any movement. The patient pushes against a stationary object such as a wall, doorframe, or resistance provided by another person.

Because there is no movement, static exercises can be performed soon after injury, usually within 3-7 days, provided they are pain-free. If any exercises are painful, then do not continue with them. Rest for a longer period until they are comfortable.

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Lateral Rotation
  • The photograph opposite shows static lateral rotation performed against a wall.
  • Push against the wall, start off gently, (e.g. about 50% max) and gradually increase the intensity.
  • Keep the shoulder and upper arm still.
  • Aim to hold the position for 10 seconds, relax for three seconds and contract again for 10 seconds.

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Medial Rotation
  • Stand facing the corner of the wall, with the palm and lower forearm against the wall (the other side from the photo opposite).
  • Push against the wall, as if trying to rotate the forearm towards the body, keep the shoulder and upper arm still.
  • Again, start off at 50% for 10 seconds, repeated twice. Gradually increase the intensity, duration and repetitions.

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Abduction
  • Stand side-on to a wall, with the elbow bent and side of the forearm against the wall.
  • Push outwards, against the wall, as it trying to lift the arm above the head.
  • Start at 50%, hold for 10 seconds and repeat twice. Gradually increase as above.

Resistance Band Exercises
Resistance bands are great for strengthening the shoulder muscles. They can be used in many different positions and can easily be progressed as your strength improves. Tie one end of the band to something sturdy at waist height, such as a door handle (make sure the door is closed!). Always start with the band just taught to make sure you are working the muscles through the whole range. These exercises can replace the static exercises (above) as soon as pain allows (usually 7 days plus)

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Lateral Rotation
  • Hold the untied end of the band in the injured hand
  • Keep the elbow bent by your side and start with the forearm/hand close to your stomach
  • Make sure you keep the elbow in as you rotate the shoulder so that the arm moves away from the stomach as far as you can.
  • Slowly return to the start position
  • Repeat this 10 times initially (provided it is pain free).

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Medial Rotation
  • Turn around so that the attachment point of the band is on the same side as your injured shoulder
  • Make sure the elbow is bent and by your side
  • Start with the arm laterally rotated, with the forearm away from the body (the end position of the above exercise)
  • Rotate the shoulder so that the forearm moves in towards your stomach as far as you can.
  • Keep your elbow still and by your side throughout.

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9/23/2015 16:00:24

can help with this

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