ROTATOR CUFF TENDINITIS
Rotator Cuff tendinitis is one of the most common ailments in the human species.
This is because our shoulders are the least stable joints in our bodies. In allowing
for movement in 6 different planes of motion, the shoulder gives up the stability
found in most other joints. In addition, the shoulder is composed of a ball and
socket joint in which the head of the humerus sits in the glenoid labrum which
acts as a socket. This socket is smaller than it should be enabling greater shoulder
flexibility than any other joint as well as greater tendency for subluxations and
dislocations. The head of the humerus sits in the glenoid labrum in a similar way
that a golf ball sits on a tee.
Tendinitis is a condition in which the muscle tendon is inflamed causing pain and
is often accompanied by fluid. Tendinitis pain only occurs when the muscle
tendon that is painful is active. Tendinitis is distinguished from bursitis which is a
condition in which bursa (fluid) is inflamed and can occur whether or not the
muscle is activated. Both tendinitis and bursitis represent common overuse
syndromes.
The Rotator Cuff is composed of four different tendons that serve to stabilize the
shoulder when it is active. The tendons are the supraspinatous, infraspinatous,
teres minor and subscapularis. The supraspinatous, infraspinatous, and teres
minor primarily enable the shoulder to externally rotate which allows us to reach
backwards and assists the motion of reaching overhead.
The subscapularis is the primary internal rotator of the shoulder. Such an action
is prominent when we reach behind our back to put on some article of clothing.
The Rotator Cuff is located in a very crowded region of the body. In the same
region, the long head of the biceps and the deltoid muscles can be found. The
long head of the biceps acts independently of the Rotator Cuff but is often
squeezed or impinged with trauma to the rotator cuff tendons, the acromion, the
humerus, or the scapula. The deltoid acts in concert with the teres minor and
infraspinatous for the motions of external rotation and abduction (moving the
arm away from the body). In addition, the brachial plexus which is where all of
the nerves of the arm muscles originate or pass through is in the same region.
Any action involving moving the arm overhead with force is not a motion that the
shoulder is made for handling. Thus throwing a ball, serving a tennis ball or
passing a lacrosse ball all excessively strain the rotator cuff tendons by placing
more force on these tendons than they are made to handle. The Rotator Cuff
tendons can also be strained by repetitive overhead activity that involves a lower
degree of force. People who work in jobs that require repetitive reaching up to
shelves or reaching away from their bodies can also injure or tear one of the
rotator cuff tendons.
The most commonly ruptured Rotator Cuff tendon is the supraspinatous. This
tendon, as all the Rotator Cuff tendons do, originates on the scapula. While the
muscle belly of the supraspinatous sits on the superior portion of the scapula, its
tendon extends to the anterior portion of the shoulder and attaches to greater
tuberosity of the humerus. This tendon is frequently squeezed, strained or
impinged with overhead activity. The greater the force or the frequency of such
motion, the greater is the likelihood of causing an impingement to the
supraspinatous tendon. An excessive impingement or strain will usually result in
a tear of the tendon. The supraspinatous tendon is also the most commonly
impinged tendon in the rotator cuff region. Impingement usually accompanies
tendinitis.
Any type of Rotator Cuff injury is painful and involves long recovery period.
Rehabilitation following Rotator Cuff surgery for a torn tendon can easily last a
year. Even recovering from a subluxed (displaced humeral head in a downward
direction) can take six months of steady physical therapy. If an injury has
occurred to your Rotator Cuff or other part of your shoulder, it is important to
seek physical therapy in order to prevent a frozen shoulder. A frozen shoulder
prevents you from being able to reach above shoulder height. This is because the
necessary action of shoulder external rotation, which enables shoulder elevation
above 90 degrees, cannot occur with a frozen shoulder. Extensive manual
therapy combined with pain relief modalities and proper exercise instruction are
essential following a Rotator Cuff surgery, strain or impingement to prevent
permanent damage and regain normal function and shoulder mobility.
Proper physical therapy for a Rotator Cuff injury such as an impingement or
tendon tear involves pain relief modalities, manual stretching, myofascial release,
and exercise instruction. Manual therapy needs to be tailored to each individual’s
pain level, condition, and ability to begin exercise.
Initial exercises focus on stretching. As pain subsides and motion is restored, the
focus of therapy shifts to improving strength and scapula stability. Strengthening
the Rotator Cuff tendons effectively improves scapula stability enabling pain free
motion to occur with greater frequency thus restoring normal function.
If you are currently experiencing any pain or discomfort in your shoulder, Newton
Physical Therapy would be happy to evaluate your condition and recommend the
best course of action. The shoulder is a complex and dynamic joint that requires
proper care to function in all positions with varying degrees of force applied for
whatever activity you may need your shoulder to perform.