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Shoulder Series Part 1 Rotator Cuff Tendinopathy - By Robert White

Posted by: Emma on: 27/01/2018

Category: pilates

Shoulder Series

PART 1

Rotator Cuff Tendinopathy

What is Rotator Cuff Tendinopathy?

Rotator Cuff Tendinopathy (RCT) refers to deterioration of the rotator cuff tendons in the shoulder.

The Rotator cuff is a made up of 4 tendons namely;
• Infraspinatus
• Supraspinatus
• Teres minor
• Subscapularis

Together they act to ‘rotate’ the humerus within the glenoid fossa of the scapula.

Tendinopathy refers to pathology within the tendons leading to deterioration. This can be anything from inflammation to a small tear, resulting in the accumulation of scar tissue around the tendon. In some cases this leads onto a partial thickness tear or even a full thickness tear (rupture) of the tendon.

The Rotator Cuff Muscles

Muscle Origin on Scapula Insertion on humerus Action
Subscapularis Subscapular fossa Lesser tuberosity of humerus Internal / Medial rotation
Teres Minor Middle half of lateral border Inferior aspect of greater tuberosity External / Lateral rotation
Infraspinatus Infraspinous fossa Posterior aspect of greater tuberosity External / Lateral rotation
Supraspinatus Supraspinous fossa Superior aspect of greater tuberosity External / Lateral rotation

 

What are the symptoms?

The most common symptoms of RCT are:

• In the acute phase, pain is experienced during overhead activities like reaching high or playing sport.
• Pain is usually at the front of the shoulder and can refer as far as the elbow.
• Chronic RCT can be painful throughout the day, at rest and disturbing sleep, especially when pressure is applied to it.
• Loss of power and weakness into the range of motions listed in the table above is usually present.

And for clients with a Rotator Cuff tear:

• Intense pain immediately
• Possible snapping feeling at time of injury
• Pain is worse at night
• Progressive loss of power and movement.

Diagnosis of RCT

A full examination of the shoulder / neck / arm is required to make a definitive diagnosis of RCT. This is best carried out by a manual therapist (Physiotherapist, Chiropractor, Osteopath, etc) and will involve assessment of active, passive and resistive movements of the arm that require the use of the rotator cuff tendons as outlined above.

In some case where the diagnosis is still uncertain, an Ultrasound Scan and X-ray can be requested.

What are the causes?

RCT can be caused by several factors but the majority are of mechanical origin:

• Playing sports with an excessive amount of shoulder rotation &/or overhead activity (swimming, throwing, racket sports, etc)
• Working with the arm overhead for long periods (decorators, welders, electricians, etc)
• Poor control and coordination of the scapula and glenohumeral joint
• Poor posture – keeping the shoulder in the same position for a prolonged period – most commonly – protracted and medially rotated.

Rotator Cuff tears can obviously be brought about by a sudden strain to the shoulder, possibly from lifting a heavy weight in a bad posture, falling directly onto it or having the arm pulled ferociously. Tears that occur from chronic RCT tend to be the result of prolonged accumulation of inflammation and its effects on the integrity of the tendon tissue.

Treatment of RCT & Pilates

Acute treatment of RCT and tears to the Rotator Cuff involves the same process as any other injury in that it is best to initially immobilise the arm and shoulder (maybe using a sling), apply ice with compression and rest it from harmful activities. At this stage, analgesics (Paracetamol) and anti-inflammatories (Ibuprofen) can also help reduce the discomfort.

After approximately 72 hours the shoulder is ready to be mobilised. This type of treatment is best conducted by a manual therapist and will involve a combination of passive movement therapy, soft tissue work, possibly electrotherapy and most importantly – prescriptive exercises.

Prescriptive exercises are crucial in RCT treatment in order to address the cause of the problem and not just the symptoms. The exercises will need to correct any poor movement patterns and reduced stability of the scapula.

At this stage, Pilates is perfect!!
Pilates is ideal for the treatment and recovery of RCT as it can educate the client on better shoulder alignment, specific rotator cuff strengthening and overall trunk stability. It can be used to address any of the contributing factors such as poor posture, bad body awareness and the effects of repetitive activity.

A good all round Pilates programme can introduce the client to a better understanding of how the shoulder and arm function in relation to the rest of the body and how subtle corrections of poor movement and/or posture will aide in the reduction of symptoms but also significantly reduce symptoms. Incorporating Pilates equipment, particularly the Reformer and Cadillac, alongside the prescription of exercises using resistive bands, can help your client achieve their goals even quicker.

 

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