Rotator Cuff  by Heather Lu

The rotator cuff consists of four different muscles the Supraspinatus, Infraspinatus, Teres minor and the Subscapularis. Secondary muscles that can also be affected by the rotator cuff injury would be Deltoid, Pectoralis Major Rhomboids, and the Trapezius.

Rotator cuff injuries occur in various ways.  Through sports injury (basketball, volleyball, tennis and swimming), occupational hazard (cosmetologist, factory worker, mechanic), a prolonged period of time in the same position (sleeping), a fall on an outstretched arm, or chronic degeneration (40+-year-olds wear and tear usually involving the impingement from bone spur development.

Symptoms can range from weakness, pain both sharp and gradual, loss of range of motion, stiffness, and usually more pain at night when less mobile.

There is three different types of rotator cuff injuries Tendinitis – which is inflammation of one of the four rotator tendons. Bursitis – inflammation or irritation of the bursa (fluid-filled sack in the joint).  Capsulitis – which is the inflammation of the capsule.

Diagnosis is done by a physician during a physical exam and can include medical images such as x-ray, MRI, and ultrasound. Which help to determine if arthritis or bone spurs are involved.

There are three different types of types of tears. Partial thickness tear – wear & tear, degeneration. Full thickness tear – pinpoint, spot tears the whole way through. And Full thickness tear with a detachment which needs surgery.

The treatment consists can consist of non-surgical and/or surgical methods. Non-surgical is usually the first step in treating a tear unless it was acute (stabbing pain, loss of ROM) aka detachment. Non-surgical methods consist of rest and pain relief – massage, limiting overhead movements of the arm, wearing a sling, anti-inflammation meds and practices such as cryotherapy, pain meds, and corticosteroid medicine into the joint. Occupational and physical therapy and medical massage. If results are not seen after a period of time then surgical means would be the next step. Surgical methods are mainly used for tears with detachment from the bone. There are three types of surgical repairs. Open surgical repair-involves detaching the deltoid partially and repairing the rotator cuff. Mini-open repair-includes a small incision 3 to 5 cm where an arthroscope is used, the deltoid is not detached from this surgery. And in All arthroscope repair-fastest recovery, smallest incision 1/4-1/2 inch, lowest infection rate, the sterile saline solution is used to expand a joint area. Recovery from surgery can be anywhere between 4 to 6 weeks depending on what type and which muscle was reattached.

As a medical massage therapist, we would want to assess whether the rotator cuff injury was acute or chronic through the client intake. Then perform Active Tests aka client performs (this gives us general information regarding how recent the injury is), Passive test aka we assist client in moves (allows us to feel the movement of the structure, the articulation, and the end field, and Resistive tests aka client actively resists movement) allows us to  examine muscle-tendon attachment sites.

From there we would work the supporting secondary muscles loosening them up. Then start Myofascial techniques, effleurage, trigger points, myofascial spreading, cross fiber stretching, neuromuscular, isometric, local stretching, eccentric release, soft tissue release, and passive mobilization. Focusing on each of the four primary muscles one at a time. Cryotherapy if needed and inflammation arises during treatment. And finish with some lymphatic drainage for edema. The main point is to bring blood flow with the oxygen and nutrition to the injured site for healing.

At home stretches and stretches that can build strength –

1. scapula compress and depressed which would shorten the rhomboid muscles.

2. pendulum swing – this is where you hang your arm down while bent over and you swing your body to get your arm to move. This decompresses the shoulder joint. (Can also be prone, off the side of the table and you actively move the arm slightly back-and-forth in the ball and socket.)

3.  The resisted wall stretches – medial & lateral rotation and abduction of the arm.

4.  Pushing down on the counter/chair/table and slowly walking backward only to the point where it’s pain-free and then walk forward again to meet your hand.

Cryotherapy, addressing sleeping positions and topical magnesium MSM lotions and Homeopathic Arnica cream/gel could also be of use.

Complete healing depends upon the muscle and what type of tear, clients age, their use of home stretches and strengthening techniques, mindset.

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