Rotator Cuff

Chances are, if you are experiencing shoulder pain, the rotator cuff is involved. The rotator cuff is composed of four muscles - the suprasinatus, the infraspinatus, the teres minor and the subscapularis - that provide a stable base for shoulder movement.

The stability of the shoulder is provided through these four muscles rather than by bony structure. These muscles are responsible for positioning and holding the head of the humerus (the long bone of the upper arm) into the shoulder joint. If the head of the humerus is not positioned correctly, it hits the overlying bone, the acromion, pinching the tendons and the bursa (a sack-like, fluid-filled cushion in the joint) causing pain and inflammation. When the head of the humerus is correctly positioned, the larger muscles that move and position the arm can work efficiently and properly.

Because the stability of the shoulder is provided by soft tissues such as the ligaments and muscles, the shoulder has great ability to position the arm and hand in a wide arc of motion for activity. However, the shoulder is also at greater risk for muscular sprains and strains than a joint that derives its stability from bone (such as the elbow).

Even though the muscles of a healthy shoulder work in well-balanced synergy, the muscles that rotate the shoulder inward (internal rotators) are naturally stronger than those that rotate the shoulder outward (external rotators). However, it is the external rotators that are essential for proper positioning of the humeral head into the shoulder joint.
When the muscles of the rotator cuff are in balance, shoulder movement is pain-free. When the muscles are out of balance, the risk for injury, pain and inflammation increases. The rounded shoulder posture that often develops from computer and desk work can lead to muscular imbalance. A large percentage of those who experience hand and elbow pain also have shoulder pain.

To prevent rotator cuff injuries, it is important to do the following:

• Stretch the Internal Rotators
  
  • Lie on your right side with your right arm at shoulder height, elbow bent 90 degrees. Using your other arm, gently rotate your shoulder inward bringing your hand towards the mat by your hip. Hold for 20 seconds. Repeat 2-3 times. Switch sides and stretch the left side.
  • Picture of a Posterior Capsule Stretch from The Journal of the American Academy of Orthopaedic Surgeons
    
  • Picture A – Use a pillow to support the neck in a neutral position and stretch the shoulder gently, not aggressively.
  
  
• Stretch the Chest
  • Standing by a door, rest your right forearm along the door frame with the elbow at shoulder height or slightly below. Keeping the forearm on the door frame, slowly turn your body away from your arm until you feel a gentle stretch across the chest and into the front of the shoulder. If you feel a pinch in the back, take a small step forward until you feel the stretch in the chest instead. Hold for 20 seconds. Repeat 2-3 times. Switch sides and stretch the left side.
  • Picture of Doorway Stretch for the Chest (Pectoralis) from PhysioTherapyExercises.com
  
  Strengthen the External Rotators
  • Lie on your right side with your left elbow tucked into your side and bent at a 90 degree angle, hand towards the mat. Rotate your shoulder outward bringing the hand up towards the ceiling. Keep the elbow bent at the 90 degree angle and the elbow tucked in at the side. Hold at the end range for 3-5 seconds then relax the shoulder rotation and bring the hand back towards the mat. Repeat 8-12 times. Switch sides and strengthen the right side.
  • Picture of External Rotator Strengthening Exercise from PhysioTherapyExercises.com
  
  Focus on Posture
  • Avoiding the rounded shoulder posture will help keep the head of the humerus in proper position.
  • See these related articles for more information.
    • Perfect Posture - The Basics
    • Rounded Shoulders
    • Rounded Shoulders and Forward Head Posture
    
    
  Follow Ergonomic Guidelines for Improving Positioning
  • Being aware of correct ergonomic positioning while working at your desk or on your computer will help avoid the rounded shoulder posture.
  • See these related articles for more information.
    • How to Develop Healthier Ergonomic Habits
    • Ergonomics & Common Sense - Improving Posture
    • Ergonomic ABCs
    
    
  
  

If you are experiencing shoulder pain that is interrupting sleep or work and leisure activity, it is important to seek medical consultation.

Information for this article was taken from The Seven Minute Rotator Cuff Solution: A Complete Program to Prevent and Rehabilitate Rotator Cuff Injuries by Joseph Horrigan, D.C. & Jerry Robinson.

Also available from Amazon.com

The Frozen Shoulder Workbook by Claire Davies & Treat Your Own Rotator Cuff by Jim Johnson, P.T.

Additional Products Helpful for Relieving Shoulder Pain



Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

Epicondylitis

Epicondylitis is pain at either side of the elbow where the finger and wrist muscles originate at the bony bumps of the humerus (upper arm bone). 

Although frequently mistakenly thought of as a tendinitis, epicondylitis is caused by the accumulation of microscopic tearing and damage.   The gradual accumulation of tearing and scarring that can be caused by repetitive trauma initially causes inflammation;  However, eventually, as the body is unable to heal the build-up of daily injury, the condition changes from one of inflammation to one of degeneration.  A physical change in the cellular structure of the tendons occurs including disorganization of the collagen fibers, calcifications, and loss of blood flow to the area. 

The proper classification of this injury is a tendinosis, a failed healing of microscopic tissue tears.  This can become an important distinction in prevention and healing of these injuries.  In the early stages, treatments for inflammation such as the use of cold packs and the use of anti-inflammatory medications may be helpful.  In the later stages, however, the goal may be to improve circulation to promote healing in addition to specific conditioning exercises to help organize the tissues around the elbow.

Tennis Elbow

• Lateral epicondylitis, commonly described as tennis elbow, is caused by injury to the outside edge of the elbow. 
  
• The damage is specific to the tendons of the muscles that straighten the fingers, pull the wrist back, and turn the palm up. 
  
• Only 20% of lateral epicondylitis is caused by actually playing tennis.

Golfer's Elbow

• Medial epicondylitis, or golfer's elbow, is caused by injury to the inside edge of the elbow.
  
• The damage is specific to the tendons of the muscles that close the fingers, bend the wrist forward, and turn the palm down.
  
• Golfer's elbow occurs only 10-20% as frequently as tennis elbow.

SYMPTOMS

Classic Symptoms

• Tenderness at the sides of the elbow over the bony protuberances. 
  
• Localized swelling at the point of tenderness.
  
• Pain may radiate from the elbow down the forearm and into the upper arm in more severe cases. 
  
• Activity increases pain. 
  
  • Tennis elbow is aggravated by gripping objects with the wrist bent backwards. 
    
  • Golfer's elbow is aggravated by gripping objects with the wrist bent forward.

Other Possible Symptoms

• A loss of full elbow and wrist motion because of pain.
  
• A feeling of weakness in the arm muscles because of pain.
  
• Generalized swelling of the elbow.

COMPUTER-RELATED CAUSES OF EPICONDYLITIS

One of the most common causes of tennis or golfer’s elbow for computer users can be positioning of the mouse.  

• Reaching forward for the mouse onto a desk that is higher than the keyboard.
  
• Reaching for the mouse placed to the far side of the keyboard.
  
• Gripping the mouse tightly while using wrist motion to activate.
  
• Planting the wrist down and swiveling the mouse using wrist motion.

OTHER OFFICE-RELATED CAUSES OF EPICONDYLITIS

• Reaching frequently for the phone or to take heavy manuals or binders down from high shelves.  
  
• Pulling thick files out of densely packed cabinets or drawers.

CAUSES OF EPICONDYLITIS RELATED TO TRAVEL

Those using laptops or traveling frequently on business are also at high risk.

• Carrying heavy objects such as a suitcase, briefcase or back pack.
  
• Lifting these objects onto surfaces with the palm down and the elbow straight (such as swinging them onto the security table at an airport).

PREVENTION FOR COMPUTER, OFFICE & TRAVEL RELATED CAUSES OF EPICONDYLITIS

Mouse use

• Activate the mouse by using the shoulder muscles. 
  
• The mouse should be at about the same level of the keyboard and positioned as closely to the keyboard as possible. 
  
• Don’t reach forward or out to the side. 
  
• The shoulder should be directly positioned over the elbow.  Keep the shoulders relaxed.
  
• Hold the mouse lightly.
  
• See Ergonomic ABCs for additional information.

Mouse Positioning 

• Use an attachable mouse holder. 
  
• Or use a keyboard bridge over the numerical keys if you do not use the 10-key portion of the keyboard.  
  
• Or use a keyboard station such as the Contour Roller Pro which has a rollerbar mouse that is positioned immediately below the space bar.

Mouse Style

• Use an ergonomic mouse.
  
• Vertical mice are good choices as the “hand shake” position with the forearm neutral rather than palm down can relieve stress on the tissues . 

Office & Travel Tips

• Avoid repetitive and strong gripping, especially with the elbow straight.  (for example, move the heavy manuals and binders down off the high shelves of the computer desk).
  
• Place frequently used objects within easy reach (between eye and hip level and within an easy arm’s reach to prevent excessive stretch).
  
• Use a wheeled suitcase, laptop or backpack.
  
• When using a backpack, place both arms through the straps to distribute the weight evenly across the back.  This takes the stress off the arm.
  
• Pack lightly.  Take only the needed laptop accessories to lighten the load.

General Tips

• Use both hands when lifting to share the load between the arms. 
  
• Keep objects in close to the body. 
  
• Use the strong leg muscles to help with the lift, not the back.
  
• Try to lift heavier objects with the palms up (as if you are scooping up the object).
  
• Take micro-breaks and rest the arms during repetitive or stressful activity.  
  
• Stretch often.
  
• Use heat for comfort, to improve flexibility and to increase blood flow.
  
• Use cold for inflammation or acute injury.

Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

Samples of Products Mentioned in this Article

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