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Evaluation and Treatment of Rotator Cuff Impairments: Summary
Infraspinatus and Teres Minor The infraspinatus and teres minor both control external rotation of the shoulder. These muscles arise from the back of the scapula and insert into the humerus, playing a role in movements like throwing and reaching behind the body. They also help stabilize the shoulder joint, preventing the humeral head from shifting too far during rotation. Subscapularis The subscapularis is the largest rotator cuff muscle and is responsible for internal rotation of the shoulder. Located on the front of the scapula, it stabilizes the anterior part of the shoulder. Tightness in this muscle can limit shoulder flexion and lead to postural issues such as a forward shoulder posture or internally rotated shoulders. Common Injuries and Dysfunction Rotator cuff injuries are typically caused by repetitive strain, trauma, or degenerative changes. These injuries can lead to pain, reduced range of motion, and muscle weakness. Some examples include the following: Impingement Impingement is a general term for disruption of tissue that can occur against multiple structures in numerous planes. Athletes and manual laborers who perform repetitive overhead movements are particularly at risk for impingement. Rotator Cuff Tears Rotator cuff tears can vary from partial to fullthickness, with the supraspinatus tendon being the most commonly affected. Tears often result from overuse or degenerative changes but can also be caused by trauma. Large tears can severely limit shoulder movement and make everyday tasks painful and difficult.
Tendinopathy
Tendinopathy chronic degeneration of rotator cuff tendons, often caused by overuse. As this degeneration progresses, it can lead to pain, weakness, and a reduction in shoulder function. involves the A key concept in understanding how the behavior of muscles, tendons, and tissues over time can lead to tendinopathy is plasticity. While muscles are primarily elastic, meaning they return to their original shape after being stretched, they can also exhibit plasticity—a property where tissues maintain a new shape after being stretched or deformed for long periods. For example, when muscles are kept in shortened positions for prolonged periods, like when sitting for long hours, they might not fully return to their original length. This is why muscle imbalances can develop, and why corrective exercises, particularly stretching, are effective in gradually restoring muscle length. Latissimus Dorsi Tightness The latissimus dorsi is a large, powerful muscle that extends from the lower back to the humerus. Its main functions include shoulder adduction, extension, and internal rotation. Tightness in the latissimus dorsi can limit shoulder flexion, which becomes especially problematic when raising the arms overhead, and cause excessive internally rotated shoulders. This can also contribute to a hyperlordotic lumbar curve, as tightness in the latissimus causes compensatory extension of the spine when trying to achieve shoulder flexion. Prevention and Management Preventing and managing rotator cuff injuries revolves around maintaining proper shoulder mechanics and muscle balance. Muscle imbalances such as hypertonic levator scapula and hypotonic lower trapezius can lead to chronic scapular elevation, which can increase the likelihood of injury.
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