Rotator Cuff Muscles

Rotator Cuff Muscles• Four muscles, that form a “cuff”

surrounding the head of the humerus and compress (hold down) the head of the humerus into the glenoid fossa during movement

• The “SITS” muscles

–Supraspinatus

–Infraspinatus

–Teres Minor

–Subscapularis

Rotator Cuff Muscles• Not very large• Must possess strength and muscular

endurance• Performing repetitious overhead activities

(throwing, swimming, and pitching) with poor technique, muscle fatigue, or inadequate warm-up and conditioning leads to failure of rotator cuff muscle group in dynamically stabilizing humeral head in glenoid cavity

• Leads to further rotator cuff problems such as tendonitis and rotator cuff impingement within subacromial space

Functions• Maintain and stabilize the

humeral head in the glenoid fossa of the scapula–Prevent subluxation or dislocation of the humerus

• Assists to abduct, medially and laterally rotate the shoulder

SupraspinatusO: Supraspinous fossa

of scapula (above the spine of the scapula)

I: Superior surface of the Greater Tubercle of Humerus

Actions:• Abduction • Superior support of

glenohumeral joint

Integrated Functions of Supraspinatus

• Assists in eccentric deceleration of humeral adduction

• Works with the other rotator cuff musculature to dynamically stabilize the humeral head in the glenoid fossa

InfraspinatusO: Infraspinous fossa

of scapula (below the spine of the scapula)

I: Greater Tubercle of Humerus

Actions: • Lateral (external)

rotation of humerus • Posterior support of

GH joint

Integrated Functions of Infraspinatus

• Assists in eccentric deceleration of medial rotation of the humerus

• Works with the other rotator cuff musculature to dynamically stabilize the humeral head in the glenoid fossa

Teres MinorO: Upper two thirds and

dorsal surface of lateral border of the scapula

I: Greater tubercle of humerus inferior to infraspinatus insertion

Actions: • Lateral (external)

rotation of humerus• Stabilizes humeral

head

Integrated Functions of Teres Minor

• Assists in eccentric deceleration of medial rotation of the humerus

• Works with the other rotator cuff musculature to dynamically stabilize the humeral head in the glenoid fossa

SubscapularisO: Subscapular Fossa

of ScapulaI: Lesser Tubercle of

HumerusActions:• Medial rotation

(internal) of humerus• Anterior support of Glenohumeral Joint

Integrated Functions of Subscapularis

• Assists in eccentric deceleration of lateral rotation of the humerus

• Works with the other rotator cuff musculature to dynamically stabilize the humeral head in the glenoid fossa

Rotator Cuff Disease• Rotator cuff injuries are common

among certain populations

• The most commonly injured muscle is the supraspinatus due to its poor blood supply

• Common conditions–Rotator Cuff Tears

–Tendonitis, Bursitis

–Impingement Syndrome

Rotator Cuff Tears• Tears and/or injury are typically related to

degeneration, instability, bone spurs, trauma, overuse and diminished strength/flexibility related to the aging process.

• Supraspinatus most commonly torn at insertion and Infraspinatus is second

• People that are involved in repetitive overhead sports including swimming, volleyball, baseball, softball, tennis, gymnastics, etc. are also at risk

Tendonitis• Symptoms:

– Pain is often described as a dull ache or sharp pain along the top of the shoulder or upper lateral arm

– Pain with overhead use of the arm– Night pain, especially when sleeping on the affected

arm– Pain when trying to reach behind the back– Shoulder weakness and stiffness

• Symptoms associated with tendonitis normally respond to rest, ice, anti-inflammatory medication and therapeutic exercise.

• Recovery time varies from two-four weeks or several months

Shoulder Impingement Syndrome• The space between the undersurface of the

acromion and the superior aspect of the humerus is normally narrow and is maximally narrow when the arm is abducted

• Any condition that further narrows this space can cause impingement.

Shoulder Impingement Syndrome

• Pinching of the supraspinatus, long head of the biceps brachii, or subacromial bursa under the acromial arch.

Shoulder Impingement Syndrome

• Overuse or repetitive microtrauma sustained in the overhead position may contribute to shoulder impingement

• Shoulder pain and rotator cuff disease are common in athletes involved in sports requiring repetitive overhead arm motion (e.g., swimming, baseball, volleyball, tennis), overhead workers, and sedentary people

Causes of Shoulder Impingement Syndrome

• Bony abnormalities (hooked acromion)

• Muscle imbalances:–Weak lateral rotators (infraspinatus

and teres minor) and shortened medial rotators of the shoulder (subscapularis, pectoralis major, anterior deltoid, latissimus dorsi, and teres major) results in inadequate stabilization of the humeral head in the glenoid fossa

Causes of Shoulder Impingement Syndrome

• Poor posture

• Repetitive overhead motions

• Overuse of the shoulder (baseball pitchers, swimmers, tennis players…)

• Poor exercise form

Signs and Symptoms of Shoulder Impingement Syndrome

• Pain usually in the anterior deltoid

• Weakness and decreased range of motion

• Pain is exacerbated by overhead or above-the-shoulder activities

• Night pain

• Difficulty sleeping, particularly when the person lies on the affected shoulder

Exercise Guidelines • Strengthen the shoulder lateral rotators

and abductors

• Stretch the shoulder medial rotators and adductors

• Strengthen the rotator cuff muscles

• Strengthen the shoulder girdle muscles (levator scapula, trapezius, rhomboids, pectoralis minor, and serratus anterior)

Exercise Guidelines • Contraindicated Exercises:

–Full range bench press, triceps dips, full range push-ups, behind-the-neck exercises (e.g., lat-pull, military press, pull-up) upright rows, supine triceps pullovers, DB pullovers

• Be careful of: –Anything overhead (if painful)–Most “pressing” exercises–Anything heavy–“Pulling” exercises

Upright Rows

• Avoid! • This exercise places the shoulder in medial

rotation as the shoulder is abducted, a position that does not allow sufficient space for the greater tubercle to clear the acromion process

• Onset of pain from Upright Rows often is not immediate, although it may be

• Accelerates rotator cuff degeneration. If you do them, you risk developing chronic tendonitis or bursitis

Isometric Exercises• Not generally used with a healthy

shoulder population

• Used primarily when range of motion is limited due to injury or surgery

• Contraindicated for people with hypertension or any form of cardiovascular disease. Isometrics increase blood pressure and heart rate, so they should be avoided.

Rotator Cuff Isometric Exercises• 10 to 15 repetitions

• Hold for 10 seconds

• Isometric Shoulder Lateral Rotation Against Wall (push outward)

• Isometric Shoulder Medial Rotation Against Wall (push inward)

Exercise Guidelines• Sets: 1-3

• Repetitions: 10-15

• Weight (DB’s, Tubing, Bands):

–Light

–0-5 pounds

• Rest Intervals: 60 seconds

• Hold each stretch for 20 seconds and repeat for 2-3 repetitions

Rotator Cuff Active Range of Motion Exercises

• Active Range of Motion: movement of a joint provided entirely by the individual performing the exercise, there is no outside force aiding in the movement

– Scapula: retraction, protraction, elevation, depression, upward rotation, and downward rotation (necessary for rotator cuff stability)

– Glenohumeral Joint: flexion, extension, abduction, adduction, horizontal abduction and adduction, lateral and medial rotation, and circumduction

Rotator Cuff Strengthening Exercises• Shoulder Shrugs with Body Weight, Tubing, or DB’s• Standing Shoulder Extension with

Band/Tubing• Scaption:

– Between Flexion and Abduction– Laterally rotate shoulders and perform DB

raises (0-5 pounds) at 45 degrees with thumbs up (scapular plane)

Rotator Cuff Strengthening Exercises• Standing Bilateral Shoulder Lateral Rotation with

Tubing• Standing Unilateral Shoulder Lateral Rotation with

Tubing/Band• Standing Unilateral Shoulder Medial Rotation with

Tubing/Band• Supine Bilateral Shoulder Lateral Rotation with Tubing

(lying supine, hip flexed, tube around bottom of foot)

Rotator Cuff Strengthening Exercises• Prone Scapular Exercises:

– Shoulder Extension to Plane of Body – Horizontal Shoulder Abduction with Thumbs Up– Shoulder Lateral Rotation

• Side-lying/Standing Lateral and Medial Shoulder Rotation with Towel Rolled in Armpit

• Push-Up Plus Against Wall (scapular protraction)

Rotator Cuff Stretching Exercises• Standing Pulling Towel or Golf Club Behind the Back

(medial and lateral shoulder rotation) (do not bring head forward

• Pectoral Stretch Against Door/Wall (laterally rotate shoulders to 90 degrees)

• Standing Rolled Towel, Golf Club, or Broomstick Behind the Back (shoulder extension) (do not bring the head forward)

• Seated Shoulder Lateral Rotation Against Wall• Posterior Deltoid Stretch• Seated with Hands Clasped Bilateral Shoulder Flexion

with Scapular Protraction Against Table