Rotator Cuff Injury Causes and Treatments

The Ultimate Rotator Cuff Training Guide

The Ultimate Rotator Cuff Training Guide provides 100% of the evidence based info you need to resolve rotator cuff symptoms now. You'll discover how to: Avoid risky, costly surgery. Improve strength. Resolve pain. Handle post-rehab shoulder training. Safely continue working out while experiencing rotator cuff problems. Prevent further damage to your painful shoulder Finally, The Complete Step-By-Step Shoulder. Rehabilitation System You Can Use From The Comfort Of. Your Home To Overcome All Your Shoulder Problems. And Keep It In Peak Condition. For Years Of Pain Free Use. Read more...

The Ultimate Rotator Cuff Training Guide Summary

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Rotator Cuff Exercise Program

Here are the Benefits of The Effective Rotator Cuff Exercise Program: A list of rare but effective rotator strengthening exercises will be revealed. Common and uncommon rotator cuff stretching exercises are given. A suggested list of range of motion exercises will be demonstrated. You will discover a ready-to- use 12 week rotator cuff exercise program. Recommended rotator cuff strengthening exercises will be taught. An outline of pulley exercises for the rotator cuff will be explained. An introduction to the 7 structures that make up the shoulder joint. Discover the structures that stabilizes the shoulder joint. The 5 most common causes of rotator cuff injuries will be discussed. Be introduced to the 12 factors that influence the risk of a rotator cuff injury. Learn the 3 most common injuries that occur to the rotator cuff. Have common assessment and diagnostic tools explained to you. Review the 6 treatment options when it comes to rotator cuff injuries. You get my best rotator cuff exercise program that you

Rotator Cuff Exercise Program Summary

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Author: Rick Kaselj
Official Website: effectiverotatorcuffexercises.com
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Rotator Cuff Tears

Tears in the rotator cuff muscles can occur from acute trauma, chronic overuse, or a combination of the two. Acute rotator cuff tears account for approximately 10 percent of all rotator cuff tears and usually occur as a result of significant trauma. Traumatic causes typically involve a fall on an outstretched arm, causing extreme hyperabduction or hyperextension. Lifting a heavy object or catching a heavy object as it falls can also cause acute rotator cuff tears. Chronic rotator cuff tears account for 90 percent of all rotator cuff tears and are usually due to progressive degeneration. Stage 3 impingement is associated with 95 percent of all chronic tears. If a degenerative tear is present, it is prone to extension with acute trauma. Rotator cuff tears can be further classified as full thickness or partial thickness. Full thickness tears, as the name implies, involve the full extent of the tendon. Partial thickness tears, on the other hand, can exist on either the superior or...

Intramedullary Nailing

Much controversy still exists when a choice needs to be made between the two. Many authors originally inserted intramedullary devices antegrade, either through or lateral to the rotator cuff insertion. Although good unions were achieved with this method and few intraoperative complications were seen, many patients' postoperative course was complicated by limitations of shoulder function. In addition, some authors have reported complications secondary to the nail backing out proximally, requiring a second operation for removal of hardware (22,27,33,35,36). Due to the similar rates of union and infections, most authors gauge the success of surgery in humeral shaft fractures on the basis of shoulder function. The intramedullary nail was originally inserted through the rotator cuff, with the cuff then repaired over the insertion site. Stern et al., in 60 humeral shaft fractures stabilized by rush rods, had a 56 incidence of adhesive capsulitis (41). In this series, most...

Inferior Dislocations Luxatio Erecta

Complications include severe soft-tissue injuries and fractures of the proximal humerus. The rotator cuff, which is always detached, requires orthopedic follow-up. Neurovascular compression injuries are usually found but almost always resolve following reduction. When the humeral head is buttonholed through the inferior capsule, the dislocation is irreducible, and operative reduction is required.

Clinical Features

Patients with rotator cuff tendinitis are typically between the ages of 25 and 40 years, but the duration of the symptoms is more useful than age in making this diagnosis. The patient will report prior episodes of shoulder pain or a long duration of pain before seeking treatment. Since the lesion is not reversible, time and activity modification alone will not improve the symptoms. Patient describe the pain as a deep, aching discomfort that interferes with work and normal daily activities. Night pain, especially sleeping on the affected arm or with the arms above the head, will interfere with sleep. On examination, disuse atrophy of the shoulder musculature may be present if symptoms have been chronic. Palpation of the rotator cuff insertion at the lateral aspect of the proximal humerus will usually produce pain and tenderness. During range-of-motion maneuvers, fibrosis and scarring within the tendon can cause crepitus. A sensation of catching also may be present if scar tissue is...

Emergency Department Care

It may be clinically impossible to differentiate an acute rotator cuff strain from a partial-thickness or full-thickness rotator cuff tear. The immediate goal of emergency care for suspected rotator cuff injuries is to provide support, protection, pain relief, and most important, to help prevent further dysfunction and disability. An arm sling can be provided for support and comfort until acute symptoms subside. However, the perils of prolonged immobilization stiffness, weakness, and loss of motion should be emphasized to the patient. Appropriate analgesia should be provided, as should instruction in the proper use of ice two to three times per day to reduce pain and inflammation. When symptoms allow, gentle range-of-motion exercises such as pendulum swings and walking the fingers up the wall should be started.

Intramedullary IM Nailing Technique

The antegrade approach involves accessing the intramedullary canal through the shoulder, along the lateral junction of the articular cartilage and the lateral third of the humeral head, approximately 1 cm medial to the greater tuberosity. To achieve this access, a 4-cm incision is made anterolateral to the acromion, overlying the deltoid. The deltoid is then split and the subdeltoid bursa identified and removed to expose the supraspinatus tendon. Some authors have recommended a formal exposure to the rotator cuff so as to make sure that its fibers are split along the more vascular portion (just lateral to the articular surface) rather than in the proximal portion 1 cm from its insertion on the greater tuberos-ity, where the vascularity is poor. The tendon is then split along it fibers and the previously mentioned insertion site exposed. The retrograde approach has been advocated as a potential alternative to violating the rotator cuff, with less resulting limitation of shoulder...

Biomechanics

Ral insertion will have the proximal fragment pulled into abduction by the rotator cuff musculature, mainly the supraspinatus. A fracture below the pectoralis inser- 5 Figure 4 Fracture patterns of the humeral shaft. The pattern of the fracture can be predicted based on the location of the fracture and the pull of the deltoid, pectoralis major and rotator cuff muscles. A. Proximal fractures will have the proximal fragment pulled into abduction due to the pull of the rotator cuff muscles. B. Fractures below the pectoralis major insertion will have the proximal fragment pulled into adduction by the pectoralis, while the distal fragment is pulled into abduction by the deltoid. C. Fractures below the deltoid insertion will have a proximal fragment pulled into abduction by the deltoid. D. X-ray of a 2-year-old girl following a fall with a humeral shaft fracture pattern similar to that seen in Fig. 4B due to the location of the fracture. (Drawn by James T. Suchy.)

Renal Bone Disease

B2-MICROGLOBULIN AMYLOIDOSIS Dialysis-related amyloidosis, or b2-microglobulin amyloidosis, is seen commonly in dialysis patients over 50 years of age and on dialysis for more than 10 years. Amyloid deposits have been found in the GI tract, bones, and joints. Complications include GI perforations, bone cysts with pathologic fractures, and arthropathies, including carpal tunnel syndrome and rotator cuff tears. Patients with amyloidosis have significantly higher mortality rates than those without this disorder. The etiology of b2-microglobulin amyloidosis may be related to both decreased clearance and increased synthesis from immunologic reaction to hemodialyzer filters. Switching to more biocompatible filters that have higher clearance of b 2 microglobulin has markedly reduced the incidence of amyloidosis.

Specific joints

This is one of the commonest joints affected by dislocation ofwhich the vast majority are anterior dislocations (Fig. 22.18). Posterior dislocations are associated with electrocution and epileptic seizures. Anterior dislocation is particularly associated with violent contact sports injuries (e.g. rugby). It is not uncommon to sustain injuries to the axillary nerve or brachial plexus, although the former may spontaneously recover. In the older age group, glenohumeral joint dislocations are associated with rotator cuff tears and fractures of the greater tuberosity. The pathological lesion in younger age groups is the Bankart lesion and predisposes the shoulder to recurrent dislocation. It is an avulsion or tear of the anterior labrum off the glenoid articular margin with capsular striping off the anterior neck of the glenoid. It may be associated with a small fracture off the anterior rim of the glenoid ('bony Bankart lesion'). Dislocation is associated with early degenerative changes...

Bones and Joints

The humerus, clavicle, and scapula make up the bony structures of the shoulder complex. The scapula has two bony extensions, the coracoid and the acromion, which help protect the rotator cuff and play important roles in shoulder function. reinforcing the joint capsule. Finally, four specialized muscles known as the rotator cuff encompass the glenohumeral joint and provide stability during motion.

Muscles

The rotator cuff consists of four muscles the supraspinatus, the infraspinatus, the teres minor, and the subscapularis. All originate on the scapula, traverse the glenohumeral joint, and insert on the proximal humerus. The rotator cuff functions primarily as a dynamic stabilizer of the glenohumeral joint. The rotator cuff muscles also contribute significantly to the power of the upper extremity, providing 30 to 50 percent of the power in abduction and 90 percent in external rotation ( Fig. 275-1, Fig 275-2). FIG. 275-1. Posterior view of shoulder illustrating rotator cuff muscles. FIG. 275-1. Posterior view of shoulder illustrating rotator cuff muscles. The subscapularis is the only rotator cuff muscle that arises from the anterior aspect of the scapula. It attaches to the lesser tuberosity of the humerus and provides internal rotation of the arm (Fig 2.75-2). The long head of the biceps tendon, although not formally considered part of the rotator cuff, assists in rotator cuff...

Followup

Timely referral for all stages of impingement is crucial to help preserve function and mobility in the shoulder. Clinical follow-up is usually recommended after 7 to 14 days for stage 1 and 2 lesions. For stage 3 lesions, associated with chronic disability or other concern for rotator cuff tears, more acute follow-up is recommended. If symptoms have diminished at the time of follow-up, a supervised course of therapy with emphasis on rotator cuff stretching and strengthening may be prescribed. If the symptoms persist or have worsened, the clinical physician may attempt a subacromial injection of glucocorticoid to help arrest the inflammatory response. If symptoms persist despite full conservative measures after 6 to 12 weeks of treatment, further workup with arthrography, magnetic resonance imaging (MRI), or arthroscopy to rule out rotator cuff tearing may be carried out at the discretion of the primary clinical provider.

Coracoacromial Arch

Coracoacromial Arch

The coracoacromial arch is an important anatomic concept in understanding shoulder pathology. The arch is formed by the coracoid posteriorly, by the acromion anteriorly, and by the coracoacromial ligament, which forms the anterior roof of the arch (Fig . 27.5 3). The humeral head provides the floor of the arch. This arch defines the space within which the muscles of the rotator cuff, the tendon of the long head of the biceps, and the subacromial bursa must fit and function. The coracoacromial ligament is considered vestigial however, by virtue of its position it can contribute to compression or impingement of the rotator cuff. FIG. 275-3. Lateral view of shoulder illustrating coracoacromial arch with rotator cuff and subacromial bursa. Repetitive use of the arm overhead or above the horizontal compresses the rotator cuff and related structures between the humeral head and coracoacromial arch (Fig. 275 4). The impingement syndrome refers to the pathologic changes that occur in the...

Proximal Humerus

Direct Force Humerus Shaft

The proximal humerus is composed of the articular segment, the greater and lesser tuberosities, and the proximal humeral shaft. Muscles of the rotator cuff insert on the humeral tuberosities, and the biceps tendon travels between them. The humeral circumflex arteries enter in the area of the bicipital groove and the tuberosities to supply blood flow to the articular segment. Two-part fractures account for 10 percent of proximal humerus fractures, with the remaining 10 percent evenly split between three-part and four-part fractures. Such displaced fractures are more frequently associated with complications and are often difficult to manage. Treatment considerations include integrity of the blood supply, integrity of the rotator cuff, likelihood of union, associated dislocations and neurovascular injuries, and the functionality of the patient. Closed reduction, intraoperative treatment, or a combination of the two may be necessary. Emergent orthopedic consultation for multipart...

The Neck

The neck is the most common source of pain referred to the shoulder. Degenerative disease of the cervical spine, degenerative disc disease, and herniated nucleus pulposus can all refer pain to the shoulder. These symptoms may occur acutely or gradually. The pain is usually worse during daytime activities and better at night when activities cease. The patient with a C5-C6 herniated disk may present with pain very similar to that due to rotator cuff disease. Careful and thorough examination of the cervical spine and a complete neurovascular examination should be included in the evaluation of any patient with shoulder pain. On examination, range of motion in the neck may be restricted and may reproduce symptoms in the shoulder. Axial loading may especially cause referred pain. If a cervical condition is considered to be the source of pain, cervical radiographs including oblique views should be obtained. In the absence of neurologic findings, conservative measures may be inititiated. In...

Adhesive Capsulitis

Adhesive capsulitis, commonly referred to as the frozen shoulder syndrome, causes significant discomfort and dysfunction. It is characterized by markedly restricted joint motion and pain. This condition usually occurs in middle-aged patients and is uncommon in patients younger than 40 years of age and in those older than 70 years. It is more common in women, particularly postmenopausal women. The incidence in the general population is 2 to 5 percent this increases to 10 to 20 percent in patients with diabetes. An increased incidence is also associated with patients with a history of trauma, cervical disc disease, thyroid disease, intracranial lesions, and personality disorders. It is rarely associated with the presence of rotator cuff tears.

Bursae

The bursae facilitate motion between the components of the shoulder. There are eight identifiable bursae in the shoulder complex. However, only one, the large subacromial bursa, also known as the subdeltoid bursa, is clinically significant. The subacromial bursa is extraarticular its roof adheres to the undersurface of the deltoid, and its floor to the underlying rotator cuff. A thick layer of synovial fluid between the roof and the floor normally allows smooth frictionless motion between the rotator cuff and adjacent structures.

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