Rotator cuff remedial

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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The shoulder consists of four bony "anchors", the scapula (shoulder blade), the clavicle (collarbone), the humerus (upper arm bone), and the upper spine.

Some material provided by the American Physical Therapy Association

The scapula is a large flat bone that lies on the back of the rib cage and is an anchoring point for many of the shoulder muscles. The scapula provides stability and movement. The clavicle has a joint that attaches it to the scapula and also has a joint that attaches it to the breast bone. The humerus is held in position in the socket of the scapula (glenoid) by muscles of the rotator cuff.

With all these bones, there must be joints, right? Here they are: the acromioclavicular (clavicle and scapula); glenohumeral (scapula and humerus), scapulothoracic (scapula and rib cage), sternoclavicular (clavicle and breast bone), and acromiohumeral (top of the shoulder blade and humerus).

15 muscles move and stabilize the scapula, while 9 muscles stabilize the gleno- humeral joint, with 6 muscles supporting the scapula on the rib cage. The muscles attach to the bones via tendons. Stability as well as range of motion is facilitated by this complex arrangement of the muscles, tendons, and bone structure.

The rotator cuff consists of the four muscles and their associated tendons: supraspinatus, infraspinatus, teres minor, subscapularis.

The function of the rotator cuff is to stabilize the glenohumeral joint, provide for rotation, elevation and depression, protraction (humerus moving away from the socket), and retraction (humerus moving towards the socket).

The muscles of the rotator cuff run from their origin on the scapula to their attachment on the humerus via tendons. The rotator cuff lies beneath the deltoid muscles. The deltoids are joined by the latissimus dorsi, the deltoid and pectoralis major as the most powerful abductors (lift the arm away from the body), rotators, and adductors (bring the arm closer to the body).

Other critical muscle groups include the trapezius, levator scapula, rhomboid major and minor for elevation and retraction (bringing the arm backward). The serratus anterior helps with reaching.

Shoulder problems may develop as a result of trauma, improper body mechanics, overuse, inadequate training, nerve compression, and myofascial syndromes. The shoulder as a highly integrated interdependent structure.

Some of the more common problems are tendonitis, bursitis, and muscle imbalances. Tendonitis and bursitis can be treated with Rest, Ice, Compression, and Elevation (R.I.C.E). Stretching to loosen up the tendons should be started. Such stretching should be done regular and daily, and be initiated before an injury, not after the injury. Anti-inflammatory drugs can be used for symptomatic relief.

Non-surgical remedies including ice, anti-inflammatory drugs and rest for bursitis are the more conservative approach.

Surgery is sometimes done to remove portions of the acromium (top part of the scapula that interacts with the humerus) or the bursa beneath the acromion to create space and reduce friction in the subacromial area.

Entrapment (pinching) of the suprascapular nerve (a major branch of the nerves from the neck) can cause weakness and inability to lift and externally rotate the shoulder.

Disorders of the cervical spine can cause pain radiating to the arm or shoulder. A program of anti-inflammatory medicines, rest, and a gradual return to exercise is appropriate if the problems are minor.

Snapping scapula is an infrequent problem. Snapping scapula syndrome presents with pain and a crunching sensation between the scapula and the ribs. The syndrome may be caused by bursitis occurring between the scapula and the rib cage.

Muscle imbalances and weaknesses in the trapezius, rhomboid, and rotator cuff muscles can lead to improper support for the scapula during movement. RICE and a good solid physical therapy program consisting of strengthening of the rotator cuff muscles, the trapezius and rhomboid muscles will help a lot. Rowing exercises can also help by building up the muscles of the mid-back.

Muscle imbalances can cause big problems, because subtle muscle imbalances are difficult to diagnose and take time and commitment to correct.

Stabilizer muscles like the rotator cuff muscles need to be specifically worked with very light weights, three to five pounds, or elastic bands. Heavier weights will merely work the larger deltoids leaving the rotator cuff muscles undeveloped.

Deep tissue massage, together with proper hydration, icing, strengthening and stretching can bring tendonitis under control.

Addition of ultrasound, electrical stimulation, and other techniques are useful.

For patients with persistent problems due to rotator cuff tendinopathy and partial tears, the treatment of choice is ultrasound-guided needle tenotomy with platelet-rich plasma (PRP). This helps tendon tissue to heal by providing more blood flow and growth factors.

For more information about rotator cuff tendonitis, visit our sister site:
Tendonitis provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.

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