Injury Management

Rotator Cuff Injuries

What is (RC) Rotator Cuff?

A rotator cuff (RC) is a group of muscles surrounding the shoulder complex and providing it with additional stability and strength to handle the forces generated by movements around the joint. 

The RC group originates from different aspects of the scapula, aka shoulder blade, and inserts on the humerus head, forming a cuff around the glenohumeral joint. The rotator cuff group comprises four muscles, known as SITS, and they include the following:

Supraspinatus 

Origin – Supraspinous fossa of the scapula

Insertion – Greater tubercle of the humerus (superior facet) 

Action – Initiates abduction of the humerus

Infraspinatus 

Origin – Infraspinous fossa of the scapula

Insertion – Greater tubercle of the humerus (middle facet) 

Action – Lateral rotation of the humerus

Teres Minor 

Origin – Lateral portion of the dorsal side of the scapula

Insertion – Greater greater tubercle of the humerus (lower facet)

Action – Lateral rotation of the humerus

Subscapularis 

Origin – Subscapular fossa of the scapula

Insertion – Lesser tubercle of the humerus 

Action – Medial rotation of the humerus

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Functions of the RC group.

The RC group plays an essential role in various upper body movements, including flexion, extension, abduction, adduction, external/lateral rotation, and internal/medial rotation. 

The head of the humerus is more significant concerning the glenoid fossa, which challenges the joint’s stability. The RC group plays a vital role in keeping the humerus head intact within the glenoid fossa and supporting its strength and stability. 

Type of Injuries 

RC Tear refers to micro or macro tearing of the muscles or tendons. A physiotherapist will define the degree of injury depending on the extent of tear, activity, and pain symptoms of the client. 

  • First-degree strain refers to a partial tear with solid and painful activity. 
  • Second-degree strain refers to a partial tear with weak and painful movement.
  • Third-degree strain refers to a complete tear with very weak and painless movement.

RC Tendinitis refers to the acute inflammation of the RC soft tissue. In contrast, RC Tendinopathy refers to inflammation of the tendon resulting from repeated stress. It refers to chronic irritation due to overuse or degeneration of the RC soft tissue.

Impingement syndrome refers to biomechanical dysfunction of the shoulder complex, which causes abnormal wear and tears on the RC tissues.

PT Management

Patient education refers to informing the patient about the problem and educating them on the do’s and don’t to facilitate the recovery process. For example, if some of the exercises are counterproductive, inform the patient about them. Proceed with caution on back squats due to shoulder going into slight external rotation; overhead movements need high stability, conventional deadlifts. 

Cryotherapy 

Cryotherapy, sometimes known as cold therapy, is the local or general use of low temperatures in medical treatment. An individual can use it in several ways, including acute or chronic pain management and acute injury or inflammation. In addition, the therapy can be used pre or post-exercise depending on the type of injury; sometimes, it works best when combined with a rehabilitation program. 

There are four signs of inflammation, including warmth, pain, swelling, and loss of movement/ROM. If the four signs exist, help the patient immediately with an ice pack till they meet a professional for a complete diagnosis. The most common type of cryotherapy is an ice pack. The most effective ice to use in an ice pack is crushed ice because it conforms comfortably to the contours of the injured area.

Active Rest 

The client should continue to exercise safely and sustainably as advised by the physiotherapist. Since this will also help maintain the available range of motion at the joint. Immobilization may be recommended in extreme cases depending on the extent of the injury. Even then, the client should continue lower body workouts on the machines. 

Strengthening 

A strength training routine should be a part of the daily lifestyle to keep up with the daily wear and tear of muscles and bones, an uncontrollable factor of the aging process. Resistance training exercises with progressive overload help maintain the structural strength and stability of the joints. The client should focus on strengthing the muscles using practices that target shoulder flexion, extension, horizontal abduction, and adduction. Vertical abduction only if recommended by the physiotherapist. 

Author: Pankaj Narsain (INFS Faculty)

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