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Rotator Cuff Injuries


Rotator cuff injuries (RCIs) are extremely common amongst athletic population sand non-athletic populations. RCIs include rotator cuff tendonitis, supraspinatus tendonitis, biceps tendonitis and rotator cuff tears. Incident rates indicate that 10-30% of individuals will sustain a rotator cuff tear in a lifetime.  The majority of these tears are degenerative meaning repetitive micro trauma occurs overtime leading to erosion of the tissue.  Individuals with these injuries wake up with shoulder pain for no apparent reason, not having experienced a specific traumatic event.



Why are RCIs so common?

The rotator cuff is flawed by design. Anatomically, the rotator cuff is vulnerable, having only a one centimetre space to avoid compression at the front of the shoulder. The space is referred to as the Rotator Cuff Interval (RCI). Several factors can obliterate the RCI, causing compression of the tendon and ultimately cellular damage that may even progress to a tear.

What is the solution?

The majority of injuries, 90% in fact, are managed conservatively with physical therapy, meaning a minority of cases proceed to surgery.  Physical therapy consists of 2 phases.

 

Phase 1: Managing pain and inflammation

Repetitive micro trauma to muscle or tendon invokes an inflammatory response, or an outpouring of chemicals into the tissue.  The function of these chemicals is first to signal pain  and second to attract chemical mediators and building blocks to restore damaged tissue. The negative effects of inflammation however, are pain and muscle spasm.

Clinical trials have proven that acupuncture is an effective solution for mitigating pain and muscle spasm due to inflammation. Individuals receiving acupuncture are better able to perform rehabilitative exercise and report less pain and greater function given the same injury.

 For some individuals a cortisone injection is also beneficial.

 

Phase 2:Restoring RCI

A biomechanical assessment must be performed to determine which factors are compromising the RCI for each particular case. Based on this assessment, appropriate treatment is implemented which may consist of manual therapy/muscle release techniques to unwind tight muscles that are feeding into a muscular imbalance as well as strengthening exercises.

 

References

Hanratty CE, McVeigh JG, Kerr DP, Basford JR, Finch MB, Pendleton A, Sim J.

The Effectiveness of Physiotherapy Exercises in Subacromial Impingement Syndrome:

A Systematic Review and Meta-Analysis. Semin Arthritis Rheum. 2012 May 17.

 

 Timmons MK, Thigpen CA, Seitz AL, Karduna AR, Arnold BL, Michener LA. Scapular

Kinematics and Subacromial Impingement Syndrome: A Meta-Analysis. J Sport

Rehabil. 2012 Mar 2.

 

 

Holmgren T, Björnsson Hallgren H, Öberg B, Adolfsson L, Johansson K. Effect of

specific exercise strategy on need for surgery in patients with subacromial

impingement syndrome: randomised controlled study. BMJ. 2012 Feb 20;344:e787.

 

Johansson K, Bergström A, Schröder K, Foldevi M. Subacromial corticosteroid

injection or acupuncture with home exercises when treating patients with

subacromial impingement in primary care--a randomized clinical trial. Fam Pract.

2011 Aug;28(4):355-65.

 

Molsberger AF, Schneider T, Gotthardt H, Drabik A. German Randomized

Acupuncture Trial for chronic shoulder pain (GRASP) - a pragmatic, controlled,

patient-blinded, multi-centre trial in an outpatient care environment. Pain. 2010

Oct;151(1):146-54.

 

Crawshaw DP, Helliwell PS, Hensor EM, Hay EM, Aldous SJ, Conaghan PG. Exercise

therapy after corticosteroid injection for moderate to severe shoulder pain:

large pragmatic randomised trial. BMJ. 2010 Jun 28;340:c3037.

 

Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement syndrome and

rotator cuff injuries: an evidence-based review. Br J Sports Med. 2010

Apr;44(5):319-27. Review.

 

Kelly SM, Wrightson PA, Meads CA. Clinical outcomes of exercise in the

management of subacromial impingement syndrome: a systematic review. Clin

Rehabil. 2010 Feb;24(2):99-109. Review.