The rotator cuff is a group of tendons and muscles that form a cuff over the humerus to the scapula. This group of muscle includes teres minor, infraspinatus, supraspinatus, and subscapularis. These muscles provide stability to the shoulder and allow the shoulder to rotate and function properly during shoulder movement. The tendons and muscle can be damage by overuse, injury, or gradual aging. This damage may cause significant pain, fluid accumulation within the joint due to inflammation, arthritis, calcium deposits, and decrease range of motion. Rotator cuff tear, rotator cuff tendinitis, rotator cuff impingement, frozen shoulder, subacromial bursitis are conditions or injuries for rotator cuff. (Ma, 2015)
The etiology of rotator cuff injury
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may possible cause by outlet impingement, subacromial spurs, type 2 acromion, type 3 acromion, osteoarthritic spurs of the acromioclavicular joint, thickened coracoacromial ligament, calcified coracoacromial ligament, nonoutlet impingement, loss of rotator cuff causing superior migration of the humerus, secondary impingement from an unstable shoulder, acromial defects, anterior capsular contractures, posterior capsular contractures, and thick subacromial bursa. (University of California, 2011). According to Bilal (2015), annual incidence of shoulder disorders in the Western general population is 7% to 25%. There are 10 causes per 1000 population and increase by ages. In persons aged 42 to 46years, the incidence peaks at 25 cases per 1000 population. In aged 70 years or older, 21% of persons have shoulder symptoms which attribute to the rotator cuff. In magnetic resonance imaging (MRI) studies, tears have been observed in 34% of asymptomatic individuals of any age. After age 60 years, 26% of patients have partial thickness tears, and 28% demonstrate full-thickness tears. According to studies, racial variation associated with rotator cuff disease is not known. There have no gender difference associate with rotator cuff disease. The male-to-female ratio is 1:1. Rotator cuff disease is more common after age 40 years. According to studies, the average age of onset is estimated at 55 years. (Armstrong, 2011; Bilal, 2015;Malanga, 2015) The symptoms associated with rotator cuff conditions are described as a dull ache deep in the shoulder, disturb sleep from lie on the affected shoulder, difficult to comb hair, difficult to reach behind back, difficult to reach objects on shelves, playing an overhead sport, stiffness or loss of motion worsen slowly over time, and arm weakness. (Mayo Clinic Staff, 2015). The prognosis for rotator cuff injury is rest and surgery.
Surgery to repair a torn rotator cuff is usually successful in relieving pain in the shoulder. The procedure may not always return strength to the shoulder. Rotator cuff repair can require a long recovery period. However, some rotator cuff tears may not fully recover. Stiffness, weakness, and chronic pain may still be present after rotator cuff repair. The progression of rotator cuff injury and onset of symptoms are associated with a significant portion of tears progress with time and that the overall size of the tear may be a predictor of future pain development. (Lashgari & Redziniak, 2012, p. …show more content…
11). The medical management for rotator cuff injury is including resting the joint to avoid any movement or activity that hurts via sling, ice shoulder two to three times a day to reduce pain and swelling, perform range-of-motion exercise, exercise to strengthen the joint, use anti-inflammatory painkillers. If the conditions get worse, the surgery may need to be performing to repair rotator cuff injury. The rotator cuff tests will be also provided by doctor such as magnetic resonance imaging (MRI), computed tomography (CT), plain filem (X-rays), physical examination, ultrasound, arthrogram, and painful arc test. (WebMD, 2015) The risk factors for rotator cuff injury or tears are fall down on outstretched arm, lift heavy things with a jerking motion, broken collarbone, dislocated shoulder, repetitive stress such as playing baseball, tennis, rowing, or weightlifting, lack of blood supply such as getting older, and bone spurs as aging.
Rotator cuff injury or tears most commonly appear along with aging. People are over 40 at greater risk. It does not mean younger people will not get rotator cuff tears or injury. People who do repetitive lifting or overhead activities are also at risk for rotator cuff tears. Athletes, painters, carpenters, and others who do over use rotator cuff may also have greater chance for tears or injury. People who have physical injury such as broken collarbone may also damage rotator cuff. In order to prevent the rotator cuff injury or tears, taking rest breaks to reduce the load on the shoulder, exercises to strengthen the shoulder and encourage range of motions are the way to help. (Nail,
2014). To help patient to adapt environment, patient may need to rearrange their common use daily stuffs from higher level shelves to the lower level shelves to prevent over stretch or over use the rotator cuff. Energy conservation will be another good way to teach patients to safe their energy and avoid causing any pain during daily activities such as lifting heavy objects, washing hair or comb hair. The adaptive equipment may also be provide such as reahcer, dressing stick, and long handle shoulder sponge to reach back during the shower. After recover from surgery or inflammation reduce, patient may need to do the exercises to strength their muscle to prevent repetitive injury.
Many factors like patients age, symptoms, size of the tear, and nature of onset (traumatic or degenerative) are responsible for determining the prognosis of the physical therapy treatment 9. Since it’s a partial thickness tear of the rotator cuff, the non-operative treatment is reasonable unlike, a full thickness tear where surgery will be required to treat the patient 9. The patient shows symptoms of moderate irritability without significant functional deficit which makes him a good candidate for conservative treatment 10. The pain reported by the patient is 6/10 so the patient participates well in physical therapy exercise to increase shoulder strength, and flexibility. There was a study done from Finland which asserted that physical therapy alone can produce results which are equal to those produced by arthroscopic surgery and open surgical repair in cases of rotator cuff tears 11. In this case, with three weeks of physical therapy the patient has showed a decrease in pain and reported it as 4/10 on pain rating scale and showed improvements in abduction (140̊) and external rotation (65̊). The MMT for shoulder abduction was 4-/5 and external rotation is still same as
... It is not completely clear how it is that a tendon becomes a ligament, although Dr. Akizuki thinks that range of motion exercises help the tendon learn that it is being used as a ligament now and that it needs to adopt. Surgeons don't go back in to biopsy the repaired elbow to see how the tissue has changed, but follow-up MRIs show that the new tissue is acting as a ligament should.
Patient returned the next day still complaining of pain. The PT applied heat, then initiated the exercise program, but the patient could not perform theem to same extent as previously, secondary to pain. Therefore, the PT told the patient to schedule an appointment with his physician. The patient was seen by the MD the next day and an arthrogram performed that revealed a reinjure to the repaired site. And a second surgery repaired the rotator cuff.
The ability to flex the finger consists of a serial of flexor muscles in the forearm and their tendons are inserted to the bones of finger. The injury of flexor tendon might cause the loss of bending of the fingers or thumb. The flexor digitorum profundus tendon (FDP) attaching to the distal phalanx and the flexor digitorum superficialis tendon banding to middle phalanx well demonstrated the specific type of tendon-to-bone insertion site characterized by the four-zone enthesis.[1] The retinacula (sheath) structures serve as strong fibrous bands wrap around the flexor tendons in order to keep the flexor tendons in place while flexion.
Rotator cuff tears are generally categorized as a chronic injury because it takes repetitive wear and tear on the muscles for it to finally inflict pain on the body. Chronic injuries are simply when the pain gradually continues over a long period of time. On the contrary, acute pain is when something happens suddenly and the pain is much more sharp than compared to the dull and long lasting pain of a chronic injury. (Source 3) In sports the biggest reason why an athlete would tear or injure his/her rotator cuff is not because something major happened instantly like a broken bone or a pulled muscle, but because they continued to put stress on these muscles over a certain period in time. The pain signals will stay active in the nervous system for several months. (Source3) Usually this will occur when the certain activity they are doing is perfomed incorrecty or in a harmful way. An example of this would be lifting too heavy of weights or not using proper technique.
Return to play time frame depends on a few factors, such as the severity of the tear, where the tear occurred, and how good the repair was. The more severe the tear the longer the time frame becomes. If surgery is needed the time frame is normally ten to twelve weeks to re strength the shoulder.
Lindsay Simpson Betsy Schlosser PTST 20003 15 April 2014. Research Paper: Rotator Cuff Tear and Repair. Shoulder injuries are very common amongst people of all ages. If you think about it, we use our shoulders for numerous daily activities like driving, reaching up in cupboards, washing and brushing our hair, picking up items off the floor, reaching in our pockets whether it be in the front or the back, putting a belt on, and many others. A common injury that occurs in the shoulder, though, is the rotator cuff.
It can mean losing the chance to get that scholarship for young athletes, and it can also mean the end of those million dollar paychecks for those who have gone professional. A torn ACL can result in numerous surgeries, months of vigorous exercise and rehabilitation, and a sufficient amount of pain. It requires complete patience, as pushing too hard can result in further, more painful injuries. Even after all that, an athlete is not guaranteed he or she will ever be able to play sports again. The anterior cruciate ligament is the reason that the knee only has one pattern of movement.
... This patient, after treatment, had completed ROM and was able to get back to daily activities (Papa 2012). GISTM has been shown to work on all types of injuries, whether the patient had surgery or not. GISTM is becoming a well-known tool in the clinical world and is a reason for faster recovery periods (Black 2010). Works Cited Black D. Treatment of knee arthrofibrosis and quadriceps insufficiency after patellar tendon repair: a case report including use of the graston technique.
In the CNN article “Shazier injury, dirty hits cast dark shadow over steelers MNF win vs Bengals” Sean Tomlinson explains how Ryan Shazier’s injury and JuJu Smith-Schuster’s hit impacted the monday night football game between the Bengals and the Steelers. Shazier was injured on a pass play he was carted off by the medical team and did not play the rest of the game. Late into the game JuJu Smith-Schuster made a crackback block on Vontaze Burfict which some sports analysts viewed as a dirty hit.
The patient is on antibiotics to prevent infection. For a full result and return, the patient will have to take several months to a year for strength and range of motion to return. As some pitchers and other main players might have to take up to two years off to make sure they are the way they were before they had Tommy John surgery. Physical Therapy is a must after surgery. After returning home, most of the patients will have an exercise program for gentle range-of-motion. There are three different stages of rehabilitation. The first stage for a pitcher is gentle motion exercises while wearing an elbow brace; after 6-8 weeks, the second stage is elbow strengthening exercises; and the third stage is to start tossing a ball and gradually working from the mound. Professional pitchers will take up to nine months to a year to play again while position players will take six to nine months
Ben Roethlisberger, commonly known as Big Ben is a quarterback player of Pittsburgh Steelers who suffered a Lisfranc injury in a game. He was carted off because of his serious foot injury that will compromise his mobility and scramble ability.
... rehab could not do what a team of surgeons could, they physically go in and repair the ACL (Davis 18). Even with physical therapy, rehabilitation and bracing the knee you cannot get the immediate same results.
There are many ways you can prevent injuries from happening before they do occur. Make sure you lift the right amount of weight to ensure that your body won’t wear down or you won’t injure yourself. Lifting more than you need to will only make your body worse. Using poor form can get you hurt quicker and easier than any other way. Make sure that you are using the correct form even if that means hiring a trainer or having a spotter. Workouts that you know can help because you will know the correct position. Workouts without machinery and weights have a lesser risk of hurting you. Cassidy says, “Years of intense workouts take a toll on your body..... Cartilage wears down and muscles, tendons, and ligaments can become less limber” (1).
Rotator cuff tear – The muscles adjoining the shoulder joint are required for rotating the shoulder, amid other movements. The tendons of these muscles furthermore influence the structural strength of the shoulder joint. Harsh, rapid actions, for example in tennis and baseball, can result in tearing of one of these tendons. This then causes pain as well as a decline in range of motion. Surgery possibly will be necessary to repair a torn