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Download Shoulder/Rotator Cuff Injury
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Shoulder / Rotator Cuff Injury R. Daehn, B.A., M.L.S., C.P.T May 2012 • the rotator cuff consists of muscles and tendons in the shoulder • these connect the upper arm bone with the shoulder blade • and hold the ball (humeral head) of the humerus firmly in the shoulder socket • the rotator cuff has greatest range of motion of any joint in the human body Muscles of the Rotator Cuff Subscapularis Shoulder Articulations • Internal Rotation • Anterior Stability • Posterior Stability Muscles of the Rotator Cuff Supraspinatus Shoulder Articulations • Abduction • External Rotation • Internal Rotation • Stabilization The supraspinatus is the most often injured rotator cuff muscle. The inability to smoothly abduct the arm against resistance may indicate a rotator cuff injury Muscles of the Rotator Cuff Infraspinatus Shoulder Articulations • External Rotation • Transverse Abduction • Transverse Extension • Posterior Stability The infraspinatus is the second most often injured rotator cuff muscle Muscles of the Rotator Cuff Teres Minor Shoulder Articulations • External Rotation • Transverse Abduction • Transverse Extension • Posterior Stability Injury • any type of irritation or damage to rotator cuff muscles or tendons • tears usually occur in abnormal tendon areas weakened by degeneration and impingement • about half of the time, a rotator cuff injury can heal with self-care measures or exercise therapy Injury Signs and Symptoms • pain and tenderness in the shoulder, especially when reaching overhead, reaching behind your back, lifting, pulling or sleeping on the affected side • shoulder weakness • loss of range of motion in the shoulder • inclination to keep shoulder inactive Injury Causes • Tendinitis – inflammation due to overuse or overload • Bursitis – bursa (fluid-filled sac between shoulder joint and rotator cuff) can become irritated and inflamed • Strain or tear – stress from overuse; left untreated, strain can weaken tendon and lead to degeneration or sprain Injury Causes • • • • normal wear and tear – increasingly after age 40 poor posture – slouching forward falling – falling on arm or using arm to break fall lifting or pulling – too heavy a weight or poor technique • repetitive stress – especially overhead movement Exercise Goals • Exercise within ranges of motion which do not cause pain • Emphasize rotator cuff strengthening • Strengthen entire shoulder girdle – including external rotators, rhomboids, trapezius (lower fibers), latissimus dorsi, posterior deltoids, triceps, biceps • Stretch pectorals, anterior deltoids, subscapularis Movement & Exercise Guidelines Impingement Syndrome Movement Exercise Contraindications Contraindications • overhead with internally rotated shoulder Exercise Indications • shoulder press • rotator cuff strengthening • lateral dumbbell exercises raise with internally rotated shoulder • bench press • upright row above • lateral dumbbell shoulder level raise with externally rotated • incline bench press shoulder Movement & Exercise Guidelines Anterior Instability Movement Exercise Contraindications Contraindications • external rotation with >90˚ abduction • horizontal abduction • • • • bench press Pec deck shoulder press behind-the-neck lat pulldown Exercise Indications • rotator cuff strengthening exercises • lateral and front dumbbell raises • upright row Movement & Exercise Guidelines Rotator Cuff Debridement and Subacromial Decompression Movement Exercise Contraindications Contraindications • resisted overhead movements • shoulder press • upright row above shoulder level Exercise Indications • rotator cuff strengthening exercises (starting one month after surgery) • front dumbbell raise Movement & Exercise Guidelines Rotator Cuff Repair Movement Exercise Contraindications Contraindications • resisted overhead movements • shoulder press • upright row above shoulder level Exercise Indications • rotator cuff strengthening exercises (starting six weeks after surgery) • front dumbbell raise Exercises • rotator cuff exercises should be done at the end of the workout to prevent fatigue of the small rotator cuff muscles needed when using larger muscles Exercises Subscapularis • • • Cable – Seated Shoulder Internal Rotation – Standing Shoulder Internal Rotation Dumbbell – Shoulder Internal Rotation • on bench • on floor Lever (selectorized) – Shoulder Internal Rotation – Upright Shoulder Internal Rotation Exercises Supraspinatus • • Cable – Front Lateral Raise • Seated Dumbbell – Front Lateral Raise See Lateral Deltoids for more exercises, particularly: • Dumbbell – Lying Lateral Raise Exercises Infraspinatus & Teres Minor • • • Cable – Seated Shoulder External Rotation • Standing – Upright Shoulder External Rotation Dumbbell – Lying Shoulder External Rotation • Incline – Seated Shoulder External Rotation – Upright Shoulder External Rotation • with Support Lever (selectorized) – Shoulder External Rotation – Upright Shoulder External Rotation Stretches Subscapularis – Broomstick – Doorway Stretches Supraspinatus same as for Lateral Deltoids – Fixed Bar – Side Deltoid Stretches Infraspinatus & Teres Minor – – – – – Broomstick Bent-over Seated Bent-over Side Lying Side Lying Teres Minor Sources • Rotator Cuff Injury – Mayo Clinic http://www.mayoclinic.com/health/rotator-cuff-injury/DS00192 • Rotator Cuff Repair – NSCA’s Essentials of Personal Training. Human Kinetics, c2004; pp 543-6 • Rotator Cuff Rupture/Tear – WaterART Fitness. Instructor Certification Program – Seniors and Specialized Populations; pp 215-7 • Kinakin, Ken. Optimal Muscles Training. Human Kinetics, c2004 • ExRx.net - Exercise Prescription http://exrx.net
