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The rotator cuff (SITS muscles) is a group of and their that act to stabilize the human shoulder and allow for its extensive range of motion. Of the seven scapulohumeral muscles, four make up the rotator cuff. The four muscles are:
| Suprascapular nerve (C5) | |
| Suprascapular nerve (C5–C6) | |
| [[Axillary nerve]] (C5) | |
| Upper and Lower subscapular nerve (C5–C6) |
The supraspinatus muscle spreads out in a horizontal band to insert on the superior facet of the greater tubercle of the humerus. The greater tubercle projects as the most lateral structure of the humeral head. Medial to this, in turn, is the lesser tubercle of the humeral head. The subscapularis muscle origin is divided from the remainder of the rotator cuff origins as it is deep to the scapula.
The four of these muscles converge to form the rotator cuff tendon. These tendinous insertions along with the articular capsule, the coracohumeral ligament, and the glenohumeral ligament complex, blend into a confluent sheet before insertion into the humeral tuberosities (i.e. greater and lesser tubercle). The infraspinatus and teres minor fuse near their musculotendinous junctions, while the supraspinatus and subscapularis tendons join as a sheath that surrounds the biceps tendon at the entrance of the bicipital groove. The supraspinatus is most commonly involved in a rotator cuff tear.
The rotator cuff compresses the glenohumeral joint during abduction of the arm, an action known as concavity compression, in order to allow the large deltoid muscle to further elevate the arm. In other words, without the rotator cuff, the humeral head would ride up partially out of the glenoid fossa, lessening the efficiency of the deltoid muscle. The anterior and posterior directions of the glenoid fossa are more susceptible to shear force perturbations, as the glenoid fossa is not as deep relative to the superior and inferior directions. The rotator cuff's contributions to concavity compression and stability vary according to their stiffness and the direction of the force they apply upon the joint.
In addition to stabilizing the glenohumeral joint and controlling humeral head translation, the rotator cuff muscles also perform multiple functions, including abduction, internal rotation, and external rotation of the shoulder. The infraspinatus and subscapularis have significant roles in scapular plane shoulder abduction (scaption), generating forces that are two to three times greater than the force produced by the supraspinatus muscle. However, the supraspinatus is more effective for general shoulder abduction because of its moment arm. ShoulderUS.com] The anterior portion of the supraspinatus tendon is submitted to a significantly greater load and stress, and performs its main functional role.
Rotator cuff injuries are commonly associated with motions that require repeated overhead motions or forceful pulling motions. Such injuries are frequently sustained by athletes whose actions include making repetitive throws, athletes such as Handball, baseball , softball pitchers, American football players (especially ), , cheerleaders, weightlifters (especially powerlifters due to extreme weights used in the bench press), Rugby football players, volleyball players (due to their swinging motions), water polo players, rodeo team roping, shot put throwers, swimmers, boxers, , martial arts, Fast bowling in cricket, tennis players (due to their service motion) and Tenpin Bowling due to the repetitive swinging motion of the arm with the weight of a bowling ball. This type of injury also commonly affects orchestra conductors, , and (due, again, to swinging motions).
As progression increases after 4–6 weeks, active exercises are now implemented into the rehabilitation process. Active exercises allow an increase in strength and further range of motion by permitting the movement of the shoulder joint without the support of a physical therapist. Active exercises include the Pendulum exercise, which is used to strengthen the Supraspinatus, Infraspinatus, and Subscapularis. External rotation of the shoulder with the arm at a 90-degree angle is an additional exercise done to increase control and range of motion of the Infraspinatus and Teres minor muscles. Various active exercises are done for an additional 3–6 weeks as progress is based on an individual case-by-case basis. At 8–12 weeks, strength training intensity will increase as free-weights and resistance bands will be implemented within the exercise prescription.
A common cause of shoulder pain in rotator cuff impingement syndrome is tendinosis, which is an age-related and most often self-limiting condition.
Studies show that there is moderate evidence that hypothermia (cold therapy) and exercise therapy used together are more effective than simply waiting for surgery and they suggest the best outcome for non-surgical treatment of subacromial impingement syndrome. The group of patients who participated in the exercise group were found to use significantly lower amounts of non-steroidal anti-inflammatory drugs (NSAIDS) and analgesics than the control group with no intervention.
The rotator cuff includes muscles such as the supraspinatus muscle, the infraspinatus muscle, the teres minor muscle and the subscapularis muscle. The upper arm consists of the deltoids, biceps, as well as the triceps. Steps must be taken and precautions need to be made in order for the rotator cuffs to heal properly following surgery while still maintaining function to prevent any deteriorating effects on the muscles. In the immediate postoperative period (within one week following surgery), pain can be treated with a standard ice wrap. There are also commercial devices available which not only cool the shoulder but also exert pressure on the shoulder ("compressive cryotherapy"). However, one study has shown no significant difference in postoperative pain when comparing these devices to a standard ice wrap.
Surgery may be recommended for patients with an acute, traumatic rotator cuff tear resulting in substantial weakness. Surgery can be performed open or arthroscopically, although the arthroscopic approach has become much more popular. If a surgical option is selected, the rehabilitation of the rotator cuff is necessary in order to regain maximum strength and range of motion within the shoulder joint. Physical therapy progresses through four stages, increasing movement throughout each phase. The tempo and intensity of the stages are solely reliant on the extent of the injury and the patient's activity necessities. The first stage requires immobilization of the shoulder joint. The shoulder that is injured is placed in a sling and shoulder flexion or abduction of the arm is avoided for 4 to 6 weeks after surgery (Brewster, 1993). Avoiding movement of the shoulder joint allows the torn tendon to fully heal. Once the tendon is entirely recovered, passive exercises can be implemented. Passive exercises of the shoulder are movements in which a physical therapist maintains the arm in a particular position, manipulating the rotator cuff without any effort by the patient. These exercises are used to increase stability, strength and range of motion of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles within the rotator cuff. Passive exercises include internal and external rotation of the shoulder joint, as well as flexion and extension of the shoulder.
A 2019 Cochrane Systematic Review found with a high degree of certainty that subacromial decompression surgery does not improve pain, function, or quality of life compared with a placebo surgery.
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