Rotator Cuff Injury and Shoulder Tendonitis
The rotator cuff is a group of four muscles that helps to lift your arm up over your head and also rotate it toward and away from your body. Unfortunately, it is also a group of muscles that is frequently injured by tears, tendonitis, impingement, bursitis, and strains. The major muscle that is usually involved is called the supraspinatus muscle. The other rotator cuff muscle are: subscapularis, infraspinatus, and teres minor. Rotator cuff problems are usually broken up into the following categories listed below. If you’re not sure which one of these you have, start with rotator cuff tendonitis.
Rotator cuff tendonitis
This is also known as impingement syndrome or shoulder bursitis. Usually this occurs in people 30-80 years of age, and usually the weakness in the shoulder is only mild to moderate. Rotator cuff tendonitis, also known as “bursitis” or “impingement syndrome” occurs when the rotator cuff gets irritated on the under surface of the acromion. The reason this begins in the first place is a source of some debate. Some people are born with a “hooked” acromion that will predispose them to this problem. Others have rotator cuff weakness that causes the humerus to ride up and pinch the cuff. This means that the bursa — a water-balloon type structure that acts as a cushion between the rotator cuff and acromion/humerus — gets inflamed.
Rotator cuff tears
These occur usually in people who have had tendonitis for a while and are starting to experience more weakness. It can also happen in someone who tries to lift something too heavy and feels a pop in the shoulder. A rotator cuff tear occurs when the tendonitis in the rotator cuff gets so bad that it wears a hole through the rotator cuff tendon. Since the tendon is what connects the rotator cuff muscle to your humerus bone, when the tendon is torn, you have weakness in the shoulder. Usually these tears occur in people who have had shoulder pain for some time (called a “chronic rotator cuff tear”). This is, by far, the most common type of rotator cuff tear. However, tears sometimes happen in people who do not have a history of shoulder problems. These people try to lift something that is too heavy and feel a pop in their shoulder, usually with immediate pain (this is called an “acute rotator cuff tear”). Usually the diagnosis is made with an examination by your osteopath. He or she can do special tests to determine how weak your rotator cuff muscles are. In addition, the doctor can check your motion to see if stiffness has developed. X-rays can show bone spurs in people with rotator cuff tears. Often these bone spurs helped to create the tear. Sometimes an MRI is ordered. This can show the osteopath with great detail the rotator cuff tendon and where it is torn. If your osteopath suspects a partial thickness tear (the tendon is not torn all the way through, just part of the way), an MR-arthrogram may be recommended (with consultant referral). This involves an injection into your shoulder before the regular MRI.
Mainly occurs in younger patients, typically
15-30 years old. The rotator cuff is irritated because the shoulder is loose in
the socket. This often happens in baseball pitchers, swimmers, and other
throwing athletes. The pain of both of these types of bursitis is usually
better with rest or even using some heat over the areas of pain. This is the
most common type of bursitis.
Phase 1 - Isometric exercises.
The subscapularis is the anterior stabilizer of the rotator cuff and responsible for internally rotating the shoulder. It is best strengthened by holding your arm in front of the body, with the arm flexed to 90 degrees, and rotating the hand to touch the belt. The exercise can be performed while lying on your back with the elbow close to your side and flexed ninety degrees. Lift the weight until it is pointing toward the ceiling and then lower it slowly. Add small amounts of weight as you progress, making sure you are in minimal pain at all times. If it gets too painful, stop and rest.
The supraspinatus is strengthened by holding out your arm straight in front of the body, with the thumbs pointed toward the floor. Slowly elevate the weight to above the head. Stop if pain is produced in any portion of this motion, as the rotator cuff is under maximal stress in this position. As you feel better, you can slowly introduce small amounts of weight to continue strengthening of the muscles.
The infraspinatus is strengthened by holding your arm (and later on, a weight) in the position of the ski pole just prior to planting the pole. By rotating the arm from the neutral straight ahead position, to the externally rotated (out to the side) position, the infraspinatus and teres minor are strengthened. Again, this exercise can also be performed while lying on your side with the elbow close to your hip, and flexed ninety degrees. Rotate the weight until it is pointing toward the ceiling. Shoulder exercises are best performed with relatively light weights and multiple repetitions. The logic behind stretching and strengthening the inflamed rotator cuff in order to speed healing and functional performance is as follows: the inflamed tissue is characterized by increased fluid between the cells, increased numbers of new blood vessels and inflammatory type cells. As a result of this inflammatory reaction, new collagen tissue is laid down in an effort by the body to heal the injured tissue. If the shoulder is immobilized during this time, the new collagen is laid down in a disorganized fashion, creating scar. The goal of gentle stretching, strengthening and anti-inflammatory medication, is to stimulate the cells to lay down collagen along the lines of stress, forming normal strong tendons. The combination of a good warm up, gentle stretching, strengthening below the limits of pain, icing after working out and anti-inflammatory medication has been consistently shown to speed recovery time in the strongest possible fashion. After you are comfortable with these stretches and have minimal pain and good/fair range of motion in your shoulder, you can move onto resistance exercises. These usually start with what is known as tubing exercises. The ‘tubing’ is also known as a theraband, which is just a big rubber elastic band that you tie, at one end, to something and you hold the other end and pull the band thereby stretching it and providing resistance for your shoulder.
Phase 2 - Tubing exercises
- External rotation: Stand resting the hand of your injured side against your stomach. With that hand grasp tubing that is connected to a doorknob or other object at waist level. Keeping your elbow in at your side, rotate your arm outward and away from your waist. Make sure you keep your elbow bent 90 degrees and your forearm parallel to the floor. Repeat 10 times. Build up to 3 sets of 10.
- Internal rotation: Using tubing connected to a door knob or other object at waist level, keep your elbow in at your side and rotate your arm inward across your body. Make sure you keep your forearm parallel to the floor. Do 3 sets of 10.
- Extension: Same principles as the other two. Keep the arm parallel. 3 sets of 10. As you feel more confident and you find your strength increasing, you can add more resistance - either in terms of shortening the length of the theraband so you need more resistance to stretch it or by increasing hand held weights in small increments.