1. Rotator Cuff Muscles

2. 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

3. 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

4. Prevent subluxation or dislocation of the humerus
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

6. Supraspinatus
O: 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

7. 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

8. Infraspinatus
O: 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

9. 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

10. Teres Minor
O: 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

11. 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

12. Subscapularis O: Subscapular Fossa of Scapula
I: Lesser Tubercle of Humerus
Actions:
Medial rotation (internal) of humerus
Anterior support of
Glenohumeral Joint

13. 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

14. 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

15. 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

16. 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

17. 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.

18. Shoulder Impingement Syndrome
Pinching of the supraspinatus, long head of the biceps brachii, or subacromial bursa under the acromial arch.

19. 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

20. 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

21. Causes of Shoulder Impingement Syndrome
Poor posture
Repetitive overhead motions
Overuse of the shoulder (baseball pitchers, swimmers, tennis players…)
Poor exercise form

22. 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

23. 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)

24. Exercise Guidelines Contraindicated Exercises: Be careful of:
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

25. 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

26. 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.

27. 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)

28. 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

29. 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

30. 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)

31. 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)

32. 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)

34. 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