Rotator Cuff and Shoulder Injuries
• Shoulder complaints are common in sports and work due to either trauma or repetitive activities
Rotator Cuff Comprised of…
• “SITS” muscular group
• Supraspinatus (abductor of the shoulder)
• Infraspinatus (external rotator of the shoulder)
• Teres Minor (external rotator of the shoulder
• Subscapularis (internal rotator of the shoulder)
(4) Shoulder Girdle Joints
• Glenohumeral (GH)
• Acromio-Clavicular (AC)
• Sterno-Clavicular (SC)
• Scapulo-Thoracic
Impingement
• Occurs under subacromial space where the bursa, long head biceps, supraspinatus are most commonly “impinged”
• Common in sports injuries and overhead activities.
• Supraspinatus weakness indicates glenohumeral joint dysfunction
• Limited range of motion (pain 90-120 degrees of abduction)
• Pain on palpation/orthopedics
• Orthopedic testing to compress the subacromial space are often positive (Hawkin's and Kennedy Tests)
Acromio-Clavicular Joint
• Commonly injured by fall on the shoulder or on an outstretched arm
• >5mm between acromion and clavicle (called a separation)
• Weakness of coracobrachialis muscle indicates AC joint dysfunction
• Pain on palpation to AC joint
• Orthopedic testing often positive (Adduction Test, Horizon Sign)
Neurology of a joint
• Hilton's Law: Innervation of adjacent muscles and joint capsules related.
• Pre: Pre-test the joint with muscle testing. If weak or painful, and adjustment is warranted.
• Post: Post-test the joint, improvement of strength by 50% or >, and reduction in pain by 50%.
Rehabilitation
• Use Theraband or light weight for mild resistance
- Internal Rotation (90 degree flexed elbow at side, )
- External Rotation (infraspinatus, teres minor)
- Supraspinatus
- Flexion
- Abduction
• “Rule of Threes”: 3 minutes, 3 times/day
Research
• Chiropractors use gentle, safe adjustments, combined with specific exercises and physiotherapy that prove effective in alleviating shoulder pain.
(JMPT 1994; 17:43-53)
• Surgery is not always effective; many patients suffer severe postoperative pain and may never recover full range of motion.
(Canadian Journal of Anesthesiology 2003; 50:265-9)
CCEP
• Certified Chiropractic Extremity Practitioner (post-graduate training in extremities)
Dr. Tim McRoberts carries his CCEP and specializes in extremity adjusting and sport related injuries.
