July 30, 2014

Intermittent clouds

The Death of a Rotator Cuff

SoreArmThe rotator cuff is a group of 4 small muscles whose job is to keep the head of the humerus (arm bone) centrally located in the glenoid fossa (socket) while the arm is moving.  Each of the four muscles assists larger muscle groups when the arm moves in different directions. One of the four rotator cuff muscles, supraspinatus, assists with abduction of the humerus or raising the arm overhead from the side.  Two of the four rotator cuff muscles, teres minor and infraspinatus, assist with externally rotating the humerus.  The last of the four rotator cuff muscles, subscapularis, assists with internal rotation of the humerus.

At times a rotator cuff muscle can tear suddenly. This may occur with a fall or a powerful movement such as throwing a ball or swinging a racquet. But the vast majority of times the tear develops over time. The symptoms are typically pain that is worse at night and may affect sleeping. As time goes on there is gradually worsening of pain and eventually having some weakness. Consequently, individuals may notice limitations in movement and activity.

ArmPainOne research paper (Hijioka et al 1993) estimates that by the age of 60, sixty percent of adults have some form of rotator cuff pathology. The question that must be asked is why this condition is so common?  The reason for this is the shoulder complex is comprised of several joints. Two of the largest and most important joints are Glenohumeral (GH) joint and the Scapula Thoracic (ST) joint. The GH joint is where the arm bone goes into the socket of the shoulder blade. The ST joint is where the shoulder blade glides along the rib cage. A rhythmic movement between the joints must exist for proper movement. If the arm is raised overhead to 180 degrees, the GH motion consists of 120 degrees and ST motion accounts for 60 degrees. An exercise to demonstrate this can be done by having someone hold your shoulder blade in a fixed position as you raise your arm and see how this feels. As you may notice this exercise is very difficult to perform and maybe painful.  The reason for this illustration is that we spend much of our day and our lives in a position where our head is forward and mid back is in a forward position (flexed or slouched).  Over the course of time our mobility in our mid back and shoulder blades become less.  This eventually increases pressure on our rotator cuff as we try to move our arm overhead and as we strength train.  As a result over time we develop tendonitis, micro-tears, and then eventually full thickness tears due to our poor posture. In general rotator cuffs don’t die they are murdered. If we started specific rotator cuff strengthening before we restore proper GH or ST movement, we will only make things worse.

Centerpointe Chiropractic and Physical Therapy have successfully treated many people with shoulder problems. They work with individuals ranging from young athletes to baby boomers. They also provide post surgical rehabilitation should that be required.  If you have any questions regarding your condition you can contact Lou Rossi D.C. or Kyle Milligan P.T. at (330) 723-2225 or go to www.medinacenterpointe.com.