Rotator Cuff Tendonosis / Impingement

The rotator cuff involves four muscles that surround and support the shoulder joint (subscapularis, supraspinatus, infraspinatus, and teres minor). Together with the deltoid, the rotator cuff muscles place the arm in the overhead position essential in many sports. Sometimes these muscles get strained and irritated. Several different mechanisms of rotator cuff injury are presently recognized. These can be divided into acute traumatic injuries and the more common microtrauma caused by repetitive overuse injuries as seen in overhead activities (swimming, volleyball, etc.)

rotator

The symptoms of rotator cuff injury caused by both mechanisms include pain, weakness, and limitation of motion. Pain tends to be located in the front, top or side portions of the shoulder. Patients with acute inflammation of the rotator cuff have intermittent mild pain with overhead activities.

Patients with chronic inflammation of the rotator cuff have persistent, moderate pain with overhead activities; there may be pain at rest, but much less than with overhead activities. Patients with partial and full-thickness rotator cuff tears have persistent pain at rest that is often referred to the deltoid (shoulder) muscle insertion on the side of the upper arm. The symptoms of weakness and limitation of active motion may be the result of pain or a rotator cuff tear.

Several weight training exercises, including the upright row, military (shoulder) press and lat pull downs behind the neck jeopardize the muscles and tendons of the rotator cuff. Among the rotator cuff tendons, the supraspinatus tendon is the most frequently involved, probably because of its relative lack of blood flow and location in a potentially narrowed space below the shoulder bones. Frequently, the chest and front shoulder muscles development is disproportionate to that of the scapular (postural) stabilizing muscles.

Treatment is largely non-operative. It is aimed at pain control and scar tissue breakdown utilizing Acupuncture Physiotherapy and Targeted Soft Tissue Therapy, increasing pain-free shoulder range of motion, stretching (with emphasis on the posterior capsule of the shoulder), and strengthening of the scapular stabilizers, rear shoulder muscles, and external rotators with Functional Rehabilitation.