Tendon rotation shoulder
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 rotator cuff consists of four muscles--the subscapularis, the supraspinatus, the infraspinatus and the teres minor--and their musculotendinous attachments.
The subscapularis muscle gets its nerve supply from the subscapular nerve and originates on the scapula. It inserts on the lesser tuberosity of the humerus.
The supraspinatus and infraspinatus both get their nerve supply from the suprascapular nerve, originate in the scapula and insert on the greater tuberosity.
The teres minor gets its nerve supply from the axillary nerve, originates on the scapula and inserts on the greater tuberosity.
Between the head of the humerus (upper arm bone) and the acromion (upper part)of the scapula is an area called the subacromial space. A bursa in the subacromial space provides cushioning for the rotator cuff.
The rotator cuff is the stabilizer of the glenohumeral joint which is formed by the humerus and glenoid cup of the scapula.
Although the rotator cuff muscles generate torque, they also depress the humeral head. The deltoid muscle abducts the shoulder (lifts the arm away from the body). Without an intact rotator cuff, particularly during the first 60 degrees of humeral elevation, the unopposed deltoid would cause migration of the humeral head up against the acromion, with resulting subacromial impingement (pinching) of the rotator cuff. In patients with large rotator cuff tears, the humeral head is poorly depressed and can migrate upward during active elevation of the arm.
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