for Rotator Cuff Syndrome
Rotator Cuff Syndrome
usually refers to pathology involving the supraspinatus tendon but
may involve the infraspinatus, teres minor or subscapularis tendons.
These tendons are particularly vulnerable to overload and
degenerative changes due to their small muscle tendon cross
sectional complex, high level activation, relatively poor
vascularity and high stress location.
Physiotherapists have the clinical skills to
assess and treat posture and muscle imbalances, and overuse injuries
of the rotator cuff muscles. The physiotherapist will develop a
strengthening program to restore normal function of the shoulder and
prevent recurrence of Rotator Cuff Syndrome.
instability may lead to internal impingement of the
posterio-superior corner of the supraspinatus tendon against the
humeral head and labrum. Physiotherapists can accurately assess the
underlying instability and design and implement a specific
Benefits of physiotherapy
The usual pathology for young athletes presenting with
rotator cuff pain is supraspinatus tendonitis where there is an
inflammatory overload reaction in the tendon structure. The older
patient usually presents with supraspinatus tendonitis where there
is degenerative structural breakdown in the tendon and a secondary
inflammatory reaction in the surrounding tissues (predominantly the
sub-acromial bursa or the glenohumeral joint capsule itself). Both
scenarios result in the patient presenting with supraspinatus
impingement pain where physiotherapy intervention can provide
In the young athlete, the impingement pain is
usually caused by muscle imbalance around the shoulder girdle or by
an underlying anterior instability.
function/positioning influences rotator cuff function and its
vulnerability to developing sub-acromial impingement. In turn,
scapula function is affected by:
The usual pattern of muscle imbalance is a protracted
scapula, weak and lengthened lower trapezius, weak external rotator,
and tight and overactive internal rotators and levator scapulae.
||Spinal dysfunction e.g. postural changes.
Physiotherapists use mobilisation, postural education and
exercise programs to treat spinal dysfunction. |
||Muscle tightness e.g. pectoralis minor leading to
scapula protraction. Physiotherapists use massage and
stretching techniques to treat muscle tightness. |
||Scapula stabiliser weakness e.g. poor lower
trapezius control. Physiotherapists can help to retrain and
strengthen this area by prescribing specific exercises. |
This will result in an anteriorly placed humeral head and
propagate sub-coracoid or subacromial impingement (Kibler 1991).
Because of the alteration in humeral head position, local muscle
imbalances and aberrant firing of the rotator cuff will occur.
In the older patient it is well documented that local forms
of capsulitis can result in response to the degenerative changes
seen in the supraspinatus tendon.
Capsulitis responds very
well to a combination of appropriate anti-inflammatory treatment and
specific local physiotherapy techniques such as massage,
mobilisation and capsular stretches.
Recent work by Burkhart
(1994) and Warner (1990) has also pointed to the importance of
developing adequate external rotation strength in rotator cuff
pathology as it is the strength present in the inferior force couple
of the rotator cuff that enables the supraspinatus to function
Wuelker (1992) has demonstrated that while
subacromial decompression may decrease the pressure in the
subacromial space by 5%, adequate strength in the inferior force
couple may decrease the pressure by 61%. This demonstrates the
significant role physiotherapists play in the management of rotator
cuff syndrome and the development of muscle strength.
Kibler BW (1991): The
role of the scapula in the overload throwing motion. Contemporary
Orthopaedics. 22 (5): 525-532.
Burkhart S. (1994):
Reconciling the paradox or rotator cuff repair versus debridement: a
unified biomechanical rationale for the treatment of rotator cuff
tears. Arthroscopy 10 (1): 4-19.
Burkhead WZ and
Rockwood CA 1992: Treatment of instability of the shoulder with an
exercise program. The Journal of Bone and Joint surgery 74A
Warner J, Michaeli L, Arslanian L, Kennedy J
and Kennedy R (1990): Patterns of flexibility, laxity and strength
in normal shoulders and shoulders with instability and impingement.
The American Journal of Sports Medicine, 18 (4): 366-375.
Wuelker N, Roetman B and Roessig S (1995): Coracoacromial
pressure recordings in a cadaveric model. The Journal of Shoulder
and Elbow Surgery, Vol. 4, (6): 462-467.
Would you like the names of physiotherapists
who have a special interest in Muscle Re-education for Rotator Cuff
Syndrome? This falls under the category of musculolskeletal. Call us on (03) 9527 7532 or contact us here.
|By courtesy of the Australian Physiotherapy Association