Rotator Cuff Tendinitis

ROTATOR CUFF
TENDINITIS
The rotator cuff is a group of muscles and their tendons that act to stabilize the shoulder.
Origin on Scapula Insertion on Humerus Primary Function
Supraspinatus Supraspinous Fossa Superior Facet of Greater Tuberosity Abduction
Infraspinatus Infraspinous Fossa Middle Facet of Greater Tuberosity External Rotation
Teres Minor Lateral Border of Scapula Inferior Facet of Greater Tuberosity External Rotation
Subscapularis Subscapular Fossa Lesser Tuberosity of Humeral Neck Internal Rotation

 The rotator cuff muscles are important in shoulder movements and in
maintaining glenohumeral joint (shoulder joint) stability.
 These muscles arise from the scapula and connect to the head of
the humerus, forming a cuff at the shoulder joint. They hold the head of
the humerus in the small and shallow glenoid fossa of the scapula.
 Cranial to the rotator cuff, there is a bursa that covers and protects the
muscle tendons as they are in close contact to the surrounding bones.
ROTATOR CUFF TENDINITIS
Rotator cuff tendinitis refers to irritation of the tendons and inflammation of the
bursa lining the tendons.
CAUSES
Poor posture, such as rounded shoulders caused by leaning over a computer for long
periods of time.
Repetitive arm movements, such as those performed by a hair stylist or painter.
Overhead shoulder motions, such as those performed by baseball pitchers or swimmers.
Tight muscles and tissues around the shoulder joint.
Weakness and muscle imbalances in the shoulder blade and shoulder muscles.
Bony abnormalities of the shoulder region that cause the tendons to become pinched
(shoulder impingement syndrome).
SIGNS AND SYMPTOMS
Local swelling and tenderness in front of the shoulder.
Loss of strength and motion.
Pain and stiffness on lifting arm.
Difficulty in overhead activities.
Sudden pain with lifting and reaching movements.
Pain in shoulder on rest, on doing certain activities and at night.
Crepitus heard during movement.
RISK FACTORS
OCCUPATIONAL RISK FACTORS
Awkward Postures
Static Postures
Heavy Work
Direct Load Bearing
Repetitive Arm Movements
Working with hands above shoulder height
Lack of Rest
RISK FACTORS
Muscle Imbalance
Decreased Flexibility
Overweight
Aging
Certain Sports (Repetitive Arm Motion)
Two clinical test can be performed to assess Rotator Cuff tendinopathy.
The first is called the “Empty Can test”. The patient stands up with his shoulders in
90°abduction, 30° horizontal adduction and in complete end of rotation. The
therapist fixates his hands on the upper arm of the patient and gives downward
pressure while the patient tries to maintain his position.
In the “Hawkin’s-Kennedy Test”, the patient is standing up with the shoulders

abducted in 90° and internally rotate the forearm. The presence of pain with
movement is an indicator of a possible pathology.
MANAGEMENT
Phase 1 - Early Injury Protection: Pain Relief & Anti-inflammatory Tips
As with most soft tissue injuries the initial treatment is Rest, Ice, and Support.
In the early phase, you’ll most likely be unable to fully lift your arm or sleep
comfortably. This means that you should stop doing the movement or activity that
provoked the shoulder pain in the first place and avoid doing anything that causes
shoulder pain.
Ice is a simple and effective modality to reduce your pain and swelling.Apply for 20-30
minutes each 2 to 4 hours during the initial phase or when you notice that your injury
is warm or hot.
MANAGEMENT
Patient education:
Posture
Awareness
Correction techniques
Mirrors for positional feedback
Tactile cues
Repetition and reminders
Address environmental or habitual patterns that evoke symptoms
Educate concerning body mechanics and pathology
Educate about recovery and need to work toward common goals
Safety
Avoid overheard activities such as reaching and lifting
1. Protection Phase (Acute Phase)
Control Inflammation, Reduce Pain, and Promote Healing
Ice – compress or ice massage
NSAIDs
Active Rest of involved limb from repetitive and/or aggravating motions
Retain Mobility
PROM, AAROM, ROM in pain free range
Joint Mobilization Techniques
Inferior glides in scapular plane
Anterior glides in scapular plane
Posterior glides in scapular plane
Codman’s pendulums – promote pain-inhibiting grade II joint distraction and oscillations
For abduction the patient moves the cane as far The affected arm is lifted slowly upwards and downwards
as possible away from the body without (Elevation and depression) for flexion.
compensation.
You can make this exercise more difficult when you ask the patient to lie on a 45° support or to perform the
exercise in a standing position.
The frequency of every exercise is 2-3 times a day, every day.
Retain Muscle Strength
Multi-angle, submaximal isometrics of all involved and surrounding musculature
• Modalities
Cryotherapy - Ice
TENS
High Voltage Galvanic Stimulation
US
Phonophoresis
Iontophoresis
Taping
Guidelines for Progression to Recovery Phase
Decreased pain and/or symptoms
Increased ROM
Painful arc in abduction only
Improved muscular function
2. Controlled Motion Phase (Recovery Phase)
Continue Patient Education
Mobilization
Promote Muscle Strength and Balance of Shoulder Girdle Muscles
Stretch shortened musculature – manual stretching
Pectoralis major and minor
Latissimus dorsi
Teres major
Subscapularis
Levator scaplulae
Strengthen scapular stabilizers
Serratus anterior
Lower trapezius
Rhomboids
Strengthen rotator cuff muscles
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Develop muscular stabilization and endurance
Open chain exercises
PNF techniques
Isotonic exercise – low weight, high repetition using dumbbells
Side lying
External rotation
Internal rotation
Prone
Shoulder extension
Rows
Chin tucks for postural training
Standing
Forward flexion to 90
Abduction to 90
Scaption to 900
Rowing
Wall or table push-ups
Lat pull-downs
Closed chain exercises
PNF techniques Prone prop on elbows
Modified push-up positions
Hands on wall
Hands on high table, low table, or mat
Observe closely for scapular winging
Endurance training
Upper body ergometer
Guidelines for Progression to Maintenance Phase

Full ROM with 0/10 pain on VAS
Involved arm MMT test strength of 70% of contralateral arm strength
Improved muscular strength, power, and control
Improved muscular endurance
3. Return to Function Phase (Maintenance Phase)
Increase muscular endurance
Progress functional training
Emphasis on timing and sequence
Eccentric training progressed to maximum load
Specifically target desired functional activity
Prevent injury
Home Exercise Program (HEP)
Submaximal isometrics as per above
Self-massage
Ice massage
Posture
Chin tucks
Scapular alignment (shoulder rolls)
Early motion exercises
Supine wand exercise (AAROM): External rotation, elbow at side or slightly abducted,
forearm supinated to a thumb-up position
Seated external rotation AARM with cane anchored on floor: “gear shift” patterns
Closed chain weight bearing through hands on high table: bear weight through
hands while shifting side to side
Progress Home Exercise Program
based on safe and effective execution of exercise
adapt therapeutic exercises above to equipment at home
wall push-ups
wall walking
reverse corner push-out with horizontally abducted shoulders – push through elbows
to apply resistance to scapular stabilizer muscles
ER/IR with weight (soup can, cuff weight, etc…)
Self-stretching
Shoulder and Capsular stretches to enhance
Posterior shoulder adduction
External rotation
Internal rotation, standing and side lying
Abduction and elevation
Extension
ERGONOMIC ADVICE:
Using good posture while sitting.
Avoiding lifting your arms repetitively over your head.
Taking breaks from repetitive activities.
Avoiding sleeping on the same side every night.
Avoiding carrying a bag on only one shoulder.
Carrying things close to your body.
Positioning the items on higher shelf on a lower level.

Rotator Cuff Tendinitis

Uploaded by

Copyright:

Available Formats

Rotator Cuff Tendinitis

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Rotator Cuff Tendinitis

Uploaded by

Copyright:

Available Formats

ROTATOR CUFF

Origin on Scapula Insertion on Humerus Primary Function

Supraspinatus Supraspinous Fossa Superior Facet of Greater Tuberosity Abduction

Infraspinatus Infraspinous Fossa Middle Facet of Greater Tuberosity External Rotation

Subscapularis Subscapular Fossa Lesser Tuberosity of Humeral Neck Internal Rotation

In the “Hawkin’s-Kennedy Test”, the patient is standing up with the shoulders

Guidelines for Progression to Maintenance Phase

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.