Today’s Subject: Rotator Cuff Strain or Tear

When I am taking a health history with my patients I always ask about previous injuries, a common reply will be something like “oh yeah, I did my rotator cuff a few years ago”, when I ask which muscle and what the mechanism was they generally look at me quite blankly, and rightfully so. Most people have no idea what a rotator cuff is and how it is associated with the shoulder.


For Therapists: The rotator cuff is made up of four muscles, Subscapularis, Infraspinatus, Supraspinatus, and Teres Minor. Understanding the action of the rotator cuff makes it easier to understand why people involved in repetitive throwing activities (e.g tennis players, golfers, and baseball pitches) develop such problems.
The muscles not only generate force needed by contracting concentrically but also act in the slowing down of the arm with eccentric contraction which prevents the arm from following the ball. The ligaments and capsule of the glenohumeral joint contribute minimally to the stability of the shoulder. Sprains of the shoulder joint rarely occurs unless there is a subluxation or dislocation. Due to the shallowness of the glenoid fossa the shoulder joint has a great deal of movement and little stability. The shoulder joint is the most dislocated major joint of the body and anterior dislocation is by far the most common (Wofford, Mansfield, Watkins 2005). This mechanism of injury is forced abduction and external rotation.

For Patients: The rotator cuff is made up of four muscles: Subscapularis, Infraspinatus, Supraspinatus, and Teres Minor. Teres Major is NOT part of the rotator cuff group, a common misconception. These four muscles help to stabilise and move the shoulder joint. The shoulder joint is a ball-and-socket joint so it allows the arm to move in many directions. Damage to any of the four muscles and the ligaments which attach the muscles to the bone can cause acute (sudden) injury or chronic (overuse) injury. It always pays to know which muscle has been injured, as each muscle has a particular range of motion, but testing can be done quite easily to figure this out.

Presentation/ Signs and Symptoms:
Localised pain and tenderness as well as referred pain, spasm, reduced range of motion and loss of function as well as associated weakness, heat, swelling, and a noticeable change in tissue texture.

For Therapists: Special tests include:
Hawkin Test, Neers test, Painful arch test, Drop arm test, and empty beer can test.
As muscles contract, tensile stress is applied to the muscle and tendon unit. In repetitive loading conditions this tissue may become strained. Most rotator cuff injuries present with weak abduction at 90 degrees and shoulder pain, dislocations will be present with high levels of pain and visible distortions (Chitow and DeLany 2002).


Predisposing Factors or Common Causes:
Inadequate warm up, insufficient joint range of motion, excessive muscle tightness or a muscle imbalance, fatigue and overuse as well as inadequate recovery,  previous injury, faulty technique and biomechanics, and the older the athlete the more susceptible to strains and tears injuries an individual becomes. Distal muscle dysfunction can lead to shoulder injury though kinetic chain that links one body area to another. For example: tight hamstrings lead to compensation of Quadratus Lumborum and lower back muscles which during specific activities require these muscles to work harder. When these muscles tighten they will begin to affect other muscles like Upper Traps, Levator Scapula etc. It doesn’t take long for the shoulder muscles to be affected.

Differential Diagnosis:
Bankart Lesion, Laberal Injury, Fracture of the Glenohumeral Joint

Conventional Treatment:
First aid of acute muscle strains, rest, ice, compression and elevation (RICE) to reduce bleeding and swelling. Strengthening exercise, electrotherapy, NMT, soft tissue therapy, stretching, and the last resort, surgery.

Myotherapy Treatment and Contra-indications:
Myotherapy is locally contraindicated in the acute phase (72 hours) depending on the degree of the strain or tear. Neuromuscular Techniques (NMT) are extremely beneficial. Massage of the surrounding areas may help in pain management, flushing the area with fresh nutrients and blood. Lymphatic drainage may also help reduce the swelling.
In the sub-acute stage massage could be used to align scar tissue and continue to assist the healing process.

Reference taken from Chitow and DeLany 2002, Clinical Applications of Neuromuscular Techniques.


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