The shoulder joint is a complex joint that allows for a great deal of mobility. This increased mobility of the shoulder joint creates a large degree of instability within the joint itself. Due to the instability of the shoulder joint, the joint must rely heavily on the rotator cuff for support and stability. The rotator cuff is made up of four muscles, the supraspinatus, infraspinatus, teres minor and subscapularis. The function of the rotator cuff is to initiate and stabilize the shoulder joint during movement by maintaining humeral head contact within the glenoid fossa. When the rotator cuff is injured, pain and dysfunction of the shoulder may result.
Contributing Factors
A rotator cuff tear or rupture is most commonly seen in the supraspinatus at its insertion point near the long head of the biceps tendon. Rotator cuff tears are rarely seen before the age of 50, but are very common in patients 60 years and older. The main cause of rotator cuff tears are thought to be due to a combination of shoulder impingement (extrinsic factors), chronic degenerative changes (intrinsic factors), and poor vascularity. In the young athlete, trauma is the most likely cause of a rotator cuff injury. Other contributing factors include abnormal bony anatomy, occupation, excessive upper extremity use, overhead lifting, poor posture, and sports such as baseball and tennis.
Symptoms
Symptoms of rotator cuff pathology vary greatly depending upon the severity of the injury. The most common symptom of a rotator cuff injury is pain on the front or back of the shoulder. The pain will usually be exacerbated with overhead activities, reaching behind your back and/or during the night while sleeping. Generalized shoulder weakness may also be noticed, especially with overhead lifting.
Treatment
Depending upon the severity of the injury, an initial trial of conservative therapy is usually recommended. The goal during the initial phase of therapy is to reduce pain and inflammation of the involved rotator cuff tendon(s). This is accomplished with rest, ice, modifications to your activities of daily living, and NSAID’s. The second phase of therapy is to improve shoulder mobility, range of motion, strength (especially the rotator cuff) and restore scapulothoracic rhythm. This phase of therapy primarily focuses on therapeutic exercises of the shoulder joint and surrounding musculature in accordance with manual therapy techniques like those discussed in our plantar fascia article. One of our favorite exercises for the rehabilitation of rotator cuff injuries is the “W.” This exercise can be done using a resistance band (see video below) or a TRX suspension trainer. The purpose of the “W” is to strengthen the external rotators (infraspinatus and teres minor) along with the lower traps. The final phase of therapy is directed towards restoring function, ultimately returning you to your preinjury state.
Mike Reinold does a great job explaining how to perform the “W” exercise.
If you think that you may be experiencing symptoms of rotator cuff pathology you should contact SportsPlus or your local healthcare provider for an appointment so that you can receive a correct diagnosis and treatment plan.
Dr. Zugschwerdt is a chiropractic physician at SportsPlus in Pleasanton, CA
