January 2022 Blog Post: Rotator Cuff Injury

What makes up the shoulder?

The shoulder is made up of a complex of joints, muscles, and ligaments all collectively resulting in multi-directional motion. The shoulder includes the glenohumeral (GH) joint, acromioclavicular (AC) joint, and sternoclavicular (SC) joint. The shoulder girdle includes the commonly known rotator cuff muscle group, also referred to as “SITS” creates movement of the shoulder. This does not include associated muscles which help elevation, retract, protract and depress the scapula.

“SITS” stands for... Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. Each muscle assists in shoulder rotation, abduction and adduction. Additional muscles such as deltoid, teres major, rhomboids major and minor, and latissimus dorsi also assist in shoulder range of motion.

The GH joint also includes important soft tissue and ligamentous structures, labrum, joint capsules and bursa which are static stabilization for the shoulder and prevent dislocation and subluxation in addition to the rotator cuff muscles and scapular rotators which provide dynamic stability.

How does the shoulder get injured?

Due to the ball and socket shoulder joint, it is much more likely to develop injury, laxity or instability. Shoulder laxity and instability is a relatively normal increase in passive motion of the humeral head on the glenoid.

Shoulder injuries and rotator cuff disease can be caused by falls, forceful passive motion, vascular insufficiency, traumatic dislocation or fracture, ligament injury, capsular tightness, anatomical abnormalities, muscle imbalances or nerve lesions.

Often these mechanisms of injury result in impingement syndrome, labrum tears or injury to rotator cuff muscles. Dependent upon what muscle is injured or portion of the labrum that is torn will result in tension and instability at the shoulder, weakness, pain and loss or range of motion.

How can we address the injury?

Not all rotator cuff injuries require surgical intervention and may not worsen over time; your doctor will assess and determine need for surgery. Therapeutic intervention can increase stability and strengthen surrounding muscles to prevent need for surgery, if the tear is not severe or a total tear.  Conservative care will include assessment of range of motion, strength, and pain to develop a skilled plan of care to target areas of limitation. If a patient is following surgical intervention, a period of immobilization may be needed with a brace or sling following active range of motion, passive range of motion and strengthening exercises. Ascend Hand Therapy can complete all skilled evaluations and follow up care needed.

 

References:

Klein, J. S. (2021). Ch 38 Rotator cuff tendinopathies and tears. Elsevier eBooks for Practicing Clinicians. Retrieved January 4, 2022, from https://expertconsult.inkling.com/read/skirven-rehabilitation-hand-upper-extremity-7e/chapter-38/rotator-cuff-tendinopathies-and

Ditwiler, R. E. (2021). Anatomy and Kinesiology of the shoulder. Elsevier eBooks for Practicing Clinicians. Retrieved January 4, 2022, from https://expertconsult.inkling.com/read/skirven-rehabilitation-hand-upper-extremity-7e/chapter-4/chapter004-reader-0

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