Mississauga Chiropractic Presents: Rotator Cuff Strain

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Here’s another blog from a Mississauga Chiropractor…

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A rotator cuff strain is a trauma or activity induced injury to the supraspinatus, infraspinatus, teres minor, and/or subscapularis muscles or tendons.  It is often caused by or is the result of a chronic impingement syndrome.  A rotator cuff strain can also be caused by a single event or rapid onset (this helps to differentiate from a shoulder impingement)

 

3 Grades of Rotator Cuff Strain Severity:

 

Grade

Clinical Findings

Healing Time

1

(Mild)

  •   Minimal disruption of adjacent findings
  •   1%-10% fibres damaged
  •   Slight loss of strength
  •   Minimal pain
  •   Trigger points & loss of range of motion

7 days to 4 weeks

2

(Moderate)

  •   Partial tearing of the ligaments or muscle   hemorrhage & marked pain
  •   11%-50% fibres damaged
  •   Marked loss of strength (3/5)
  •   Athletic injury, lifting, trauma

2 weeks to 1 year

3

(Severe)

  •   51-100% fibres damaged
  •   Almost complete or complete loss of strength   (0/5)
  •   Ecchymosis; Drop arm sign
  •   Surgical evaluation is recommended
2 months to >1 yr

 

Mechanism of Injury:

a)      Prolonged or repetitive overuse of muscle tendon units over a short period of time, especially due to shovelling, overhand throwing or lifting activities like weight lifting, baseball, football, racket sports

 

b)      Due to a single violent blow or force applied to the shoulder – especially abduction/external rotation/extension or adduction/internal rotation/flexion injuries common to contact sports like football, wrestling, rugby, soccer & hockey

 

c)      Lifting or pulling

 

d)      Falling on an outstretched hand (FOOSH)

 

e)      Pre-existing impingement syndrome

 

Risk Increases with:

a)      Contact, throwing, overhead activities, fatigue and/or poor conditioning

b)      Poor nutrition, obesity & reduced strength or flexibility

c)      Previous shoulder injury

d)      Aging; geriatric population is a high risk group

e)      Muscle imbalances – especially a weak or fatigued rotator cuff

 

Prevention:

a)      Having normal joint range of motion and flexibility.  Shoulder and neck mobilization and adjustments.

b)      Proper strengthening & flexibility exercises prior to/and during a sport season or work

c)      Having adequate warm-ups prior to a sport practice, competition or work (pendulum arm swings)

d)      Wearing proper fitting & appropriate protective equipment during contact sports (e.g. pads & tape)

e)      Improved technique, avoid aggravating activities & avoid overuse

f)        Strengthening, stretching, warm-up and rehabilitation should focus on glenohumeral rotation as well as scapular retraction & rotation.

 

History:

a)      Immediate pain at the time of injury; sometimes the pain may subside with continued activity only to return when the activity is over.  Pain often refers to the superior lateral shoulder, posterolateral arm & elbow.

 

b)      Popping or tearing sensation at the moment of injury, followed by pain & weakness

 

c)      Shoulder pain that increases with active shoulder movement, resisted muscle contraction, passive stretching & pressure over the involved muscle

 

d)      Muscle spasms of the shoulder & shoulder girdle

 

e)      Loss of strength – especially rotation & abduction (empty can test) – the deficit will increase with the severity of the injury.  There is a marked strength loss with the elderly in rotator cuff tears

 

Management:

1.  Acute Stage First 2-7 days depending on severity

a)      Rest & Ice; immobilize – sling if grade 2 or 3 (swelling often peaks in 5-7 days)

b)      Electrotherapy (IFC or microcurrent)

c)      Ice every hour on first day for 15-20 minutes each time; then 5 times/day for 5 more days

 

2.  Subacute Stage 2-8 weeks depending on severity

a)      Ice if swelling persists, otherwise use alternating hot packs (first) & ice packs (last)

b)      Electrotherpy (IFC or microcurrent alternating with ultrasound)

c)      Non-resistive pendulum exercises gradually progressing into active resistive isometric, isotonic & isokinetic exercises after most range of motion is regained – ice after doing the exercises if pain or swelling results

d)      Massage therapy at 2 days to 2 weeks after injury depending on severity & pain tolerance

e)      Start stretching exercise at 1-2 weeks after injury (Grade 1) depending on severity (wait if more severe) & patient tolerance

 

  1. Recovery:

a)      Aggressive muscle strengthening & stretching program, with the emphasis on:

  1. Glenohumeral Rotation
  2. Scapular Protraction
  3. Retraction & Rotation
  4. Proprioceptive Exercises (gym ball)
  5. Aim for 2:3 strength of external rotators to internal rotators

 

b)      Massage Therapy:  Active Release Technique (ART), Trigger Point Therapy, Graston Technique

c)      Electrotherapy

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