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Shoulder Injuries – Rotator Cuff

Common sporting shoulder injuries include dislocations, Acromioclavicular joint injuries, rotator cuff injuries, labral tears, thrower’s shoulder, biceps injuries, bursitis and fractures. Contact sports such as Rugby, AFL, Wrestling, Ice Hockey, Hockey and boxing to name a few, have a higher rate of dislocations and ACJ injuries. Rotator cuff tears and bicep lesions are more common in sports involving explosive heavy weight lifting or lifting weights above the head, laying sports requiring the arm to be moved over the head repeatedly as in tennis, baseball (particularly pitching), swimming and working with the arm overhead for many hours. . Fractures around the shoulder are seen with sports involving crashes and falls from heights. This article will highlight injuries to the rotator cuff muscles; how they are caused, diagnosed and what we can do for treatment and prevention.

The rotator cuff

Muscles involved
Infraspinatus, Teres Minor, Subscapularis and Supraspinatus

Muscular function:

The rotator cuff muscles balance the forces of the deltoids which act to raise the arm and in doing so forces the humeral head superiourly towards the acromion and coracoacromial arch. The rotator cuff muscles (especially supraspinatrus) counteract this action by preventing or limiting the head of the humerus moving superiourly when the arm is raised, which if not prevented will cause impingement of the subacromial structures.

Supraspinatus

Acts with deltoid to abduct the arms, assists in stabilising the shoulder joint and resisiting downward dislocation. It also assists in holding the head of the humerus in the glnoid fossa.

Infraspinatus and Teres Minor

These muscles outwardly rotate the head of humerus, they depress the head of humerus and prevent it from jamming against the acromion process during flexion and abduction of the arm. They also assist in prevention of dislocation of the shoulder especially when the humerus is in an abducted position.

Subscapularis

Stabilisers the glenohumeral joint especially in preventing dislocation during forced lateral rotation of the abducted arm.

Rotator cuff strains:

The most injured rotator cuff muscle is the supraspinatus. Strains or tearing of the rotator cuff may be caused by overuse, falling on an out stretched arm and violent fast arm motions. E.g. Baseball pitching and outfield throwing.

Supraspinatus

Symptoms

Pain or weakness on resisted arm abduction

Weakness can be indicated by the need to hitch the shoulder in resisted arm abduction compared to non injured side

Visual inspection may reveal muscle atrophy during resisted arm abduction compared to non injured side

Infraspintus and Teres Minor

Symptoms
Pain and or weakness performing resisted outward rotation of the humerus compared to the non injured side. Also possibly resisted shoulder retraction and depression

Subscapularis

Symptoms
Pain and/or weakness performing resisted inward rotation of the humerus compared to the non injured side

Exercise rehab for the rotator cuff
Prior to commencing rotator cuff rehab, the scapula stabiliser muscles should be strengthened first then the rotator cuff.

Scapular stabilisation

Good scapula control is necessary to provide a stable base for arm movement to provide congruence with the head of humerus and correct positioning of the scapula.

Exercises such as:
Single handed row over a bench
Wall push ups
Push ups
Behind the head lat-pull downs

Note: Hold the scapula in a retracted position during the action

  • Consider NSAIDS, ultrasound, R.I.C.E where appropriate
  • Light weights are required as these muscles are small
  • Technique modifications

Stretching

  • Incy wincy spider
  • Codmans pendulum (small-larger circles)
  • Posterior capsule
  • Overhead towel side to side and shoulder depression hands behind hips

Infraspinatus/Teres minor

Stretching

  • Horizontal arm flexion and adduction with gentle force

Subscapularis

  • Focus on internal rotation (similar to infra and teres minor)

Prevention

All stretches and exercises should be incorporated into the training programme you have especially within the warm up to prevent injury and to maintain the rotator cuff in a healthy and fully functioning condition.

Biceps tendinosis

This injury is primarily caused by force being applied during repeated arm abduction movements. Take swimming for example, this injury can occur when the swimmer is using an excessively wide arm pull that results in medial rotation of the humerus as force is applied during the pull phase of the arm-stroke. This action results in the long head of the biceps tendon rubbing against the lateral side of the bicepital groove causing frictional stress on the tendon, abrading, inflammation and pain.
Poor technique in conjunction with repetitive action is the primary cause

Stretching

Arm in an adducted position elbow extension with shoulder hyperextension to gently stretch biceps tendon

Technique correction

Repeated incorrect technique will only result in re-occurence of the injury despite repeated treatment

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Malcolm Calcutt

In the last century, a mechanical fitter by trade. Now re-invented as a Soft Tissue Therapist that uses past skill sets to enable better understanding of your presentation. Loving the ability to have a difference in peoples lives through greater awareness and education. Quiet time is traveling, exploring our past around the world, Antiquities hold so much lost knowledge and understanding about being human.

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