Rotator Cuff Injury and Shoulder Tendonitis

What is a Rotator Cuff Injury?

Have you ever been working out at the gym, pushing a heavy weight and heard a popping sound in your shoulder? Or had a unfamiliar pain flare up in your shoulder from the movements involved in your sport? These are all signs of the same thing; a tear, strain or inflammation in the rotator cuff muscles and tendons.

Anatomy of the Shoulder Joint

The shoulder joint is a complex formation of bones, muscles and tendons and provides a great range of motion for your arm. The only downside to this extensive range of motion is a lack of stability, which can make the shoulder joint vulnerable to injury.

The shoulder is made up of three bones, and the tendons of four muscles. (Remember, tendons attach muscle to bone.) The bones are called the “Scapula,” the “Humerus” and the “Clavicle.” Or, in layman’s terms, the shoulder blade, the upper arm bone and the collarbone, respectively.

The four muscles which make up the shoulder joint are called, the “Supraspinatus,” the “Infraspinatus,” the “Teres Minor” and the “Subscapularis.” Or S.I.T.S. for short. It is the tendons of these muscles, which connect to the bones, that help to move your arm.

In the picture to the left, three of the four muscles are visible, the supraspinatus, the infraspinatus and the teres minor. These are the muscles which are viewed from the rear, or posterior. The subscapularis is not visible because it can only be viewed from the front, or anterior and this particular view only shows the muscles from the rear, as if looking at someone’s back.

What Causes Rotator Cuff Injury?

There are two major causes of most shoulder injuries. The first being degeneration, or general wear and tear. Unfortunately, the shoulder is a tendinous area that receives very little blood supply. The tendons of the rotator cuff muscles receive very little oxygen and nutrients from blood supply, and as a result are especially vulnerable to degeneration with aging. This is why shoulder problems in the elderly are common. This lack of blood supply is also the reason why a shoulder injury can take quite a lot of time to heal.

The second cause of most shoulder injuries is due to excessive force, or simply putting too much strain on the tendons of the shoulder muscles. This usually occurs when you try to lift something that is too heavy or when a force is applied to the arm while it’s in an unusual or awkward position.

Symptom of Rotator Cuff Injury

There are two common symptoms of a shoulder injury, pain and weakness. Pain is not always felt when a shoulder injury occurs, however most people who do feel pain, report that it’s a very vague pain which can be hard to pinpoint.

Weakness, on the other hand, seems to be the most reliable symptom of a shoulder injury. Common complaints include an inability to raise your arm above your head or to extend your arm directly to the side or in front. In most cases, the larger the tear or damage to the tendons, the harder it is to move your arm and the injured area.

PREVENTION

Appropriate Progressions of weight

If the shoulders are an over-dominating muscle group during most movements, posture must be corrected. The shoulder must be placed into a position that keeps it as a secondary assist muscle group. Heavy bench press and inappropriate increases in weight will promote shoulder injuries. With proper progressions of strengthening, technique, and body position, shoulders can remain healthy and injury free when restricted from unnecessary movements and loaded properly.

Proper Posture

Limiting the range of motion and dominance of the shoulder will allow more protection and aide in prevention of injuries to the muscles and tendons of the rotator cuff. During the bench press, for example, an athlete should pinch his or her shoulder blades back in order to focus contractions to the pectoral musculature and allow the shoulder to act as a secondary stabilizing muscle group like the triceps muscles. This will promote better shoulder health. When all training is focused around this proper position, the shoulder will become less dominant and the larger muscles around will be recruited correctly, leading to better shoulder health.

Pre-Habilitation

Slowly and properly building up the rotator cuff and deltoid muscles to progress along with the larger muscles is vital to keeping shoulders healthy and free from injury. A set of exercises that build these muscles specifically must be practiced on a routine basis in order to keep the muscles of the shoulder strong and ready to support and transfer forces. Continuous therapeutic work on these muscles will ensure that tendons, ligaments, and joints are more likely to remain healthy under maximal forces.

ACL INJURY

2SP training is dedicated to educating athletes about the warning signs to prevent knee injuries. Anterior Cruciate Ligament (ACL) problems occur due to muscular imbalances and movements that encourage maximal forces at the knee. Preventing these injuries can come from proper training which teaches athletes to limit forces at the knee by using larger surrounding muscles. Building up the surrounding muscles in a balanced manner will help prevent this type of injury from ever occurring.

An ACL injury is caused by the over-stretching or tearing of the ligament. Ligaments attach bones to other bones. A tear may be partial or complete.

Considerations

The knee is similar to a hinge joint, located where the end of the thigh bone (femur) meets the top of the shin bone (tibia). Four main ligaments connect these two bones:

Medial collateral ligament (MCL) — runs along the inner part (side) of the knee and prevents the knee from bending inward.
Lateral collateral ligament (LCL) — runs along the outer part (side) of the knee and prevents the knee from bending outward.
Anterior cruciate ligament (ACL) — lies in the middle of the knee. It prevents the tibia from sliding out in front of the femur, and provides rotational stability to the knee.
Posterior cruciate ligament (PCL) — works with the ACL. It prevents the tibia from sliding backwards under the femur.
The ACL and PCL cross each other inside the knee, forming an “X.” This is why they are called the “cruciate” (cross-like) ligaments.

ACL injuries often occur with other injuries. The classic example is when the ACL is torn at the same time as both the MCL and medial meniscus (one of the shock-absorbing cartilages in the knee). This type of injury often occurs in football players and skiers.

Women are more likely to have an ACL tear than men. The cause for this is not completely understood, but it may be due to differences in anatomy and muscle function.

Adults usually tear their ACL in the middle of the ligament or pull the ligament off the femur bone. These injuries do not heal by themselves. Children are more likely to pull off their ACL with a piece of bone still attached. These injuries may heal on their own, or they may require an operation to fix the bone.

When your doctor suspects an ACL tear, an MRI may help confirm the diagnosis. This test may also help evaluate other knee injuries, such as to the other ligaments or cartilage.

Some people are able to live and function normally with a torn ACL. However, most people complain that their knee is unstable and may “give out” with physical activity. Unrepaired ACL tears may also lead to early arthritis in the affected knee.

Causes

ACL tears may be due to contact or non-contact injuries. A blow to the side of the knee may result in an ACL tear.

Coming to a quick stop, combined with a direction change while running, pivoting, landing from a jump, or overextending the knee joint (called hyperextended knee), also can cause injury to the ACL. These cases happen more frequently in volleyball or basketball for women.

Basketball, volleyball, football, soccer, and skiing are common causes of ACL tears.

Symptoms

Early symptoms:

A “popping” sound at the time of injury
Knee swelling within 6 hours of injury
Pain, especially when you try to put weight on the injured leg
Those who have only a mild injury may notice that the knee feels unstable or seems to “give way” when using it.

First Aid

An ACL injury should be treated with:

Elevating the joint (above the level of the heart)
Ice
Pain relievers such as nonsteroidal anti-inflammatory drugs (like ibuprofen)
Do not play again until you have been evaluated and treated.

Some people may need crutches to walk until the swelling and pain have improved. For mild injuries, your doctor may suggest physical therapy to help you regain joint motion and leg strength.

Your doctor may recommend surgery to rebuild the ACL. The old ligament cannot be fixed, so a new one needs to be constructed.

DO NOT

In the case of a serious knee injury, do not try to move the joint. Use a splint to keep the knee straight until a trained medical professional has evaluated it.
Do not return to play until you have been evaluated and treated.

When to Contact a Medical Professional

Anyone with a serious knee injury should seek medical attention for x-rays and evaluation.

If the foot is cool and blue after a knee injury, the knee may be dislocated and blood vessels to the foot may be injured. This is a true medical emergency that requires immediate professional help.

Prevention

Use proper techniques when playing sports or exercising. Several women’s college sports programs have reduced ACL tears through a training program that teaches athletes how to minimize the stress they place on their ACL.

Although the issue is controversial, the use of knee braces during aggressive athletic activity (such as football) has not been shown to decrease the incidence of knee injuries and may give the player a false sense of security.

References

Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, et al. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med. 2008;42:394-412.

Birmingham TB, Bryant DM, Giffin JR, Litchfield RB, Kramer JF, Donner A, Fowler PJ. A randomized controlled trial comparing the effectiveness of functional knee brace and neoprene sleeve use after anterior cruciate ligament reconstruction. Am J Sports Med. 2008;36:648-655.