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Bernardo Gialanella, Francesco Grossetti, Marina Mazza, Laura Danna and Laura Comini

Rotator cuff tear is a common cause of disability of the shoulder and, among several diseases of the upper limbs, is considered to be the one with higher costs, whether from a medical, surgical, or insurance point of view. Surgical treatment and repair of chronic condition is indicated when

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Aaron Turner

Key Points ▸ Scapular dyskinesis is often present in patients with an existing shoulder injury. ▸ The best conservative treatment for rotator cuff tears remains unclear. ▸ Treatment of scapular dyskinesis improves dysfunction associated with rotator cuff tears. Scapular dyskinesis affects the

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Michael E. Powers

This paper reviews the role of the rotator cuff during two key phases of the pitching sequence and presents a training program for these muscles. The program uses a periodization design consisting of three stages, beginning with a high-resistance/low-repetition eccentric strengthening stage. This is followed by a low-resistance/high-repetition stage for training muscular endurance. The core exercises for these two stages are prone external rotation in the 90/90 position, prone horizontal abduction, side-lying D2 flexion pattern, supine internal rotation in the 90/90 position, prone elevation with 100° of shoulder abduction and external rotation, and standing scapular plane elevation. The final stage of the program uses high-speed functional exercises: 90/90 external rotation, 90/90 internal rotation, D2 PNF flexion pattern, D2 PNF extension pattern, supine plyometric 90/90 internal rotation with a medicine ball, and the “arm whip” through the D2 PNF flexion pattern. The goal of this program is to prepare the muscles for the stresses of pitching and prevent shoulder injuries.

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Anthony C. Santago II, Meghan E. Vidt, Xiaotong Li, Christopher J. Tuohy, Gary G. Poehling, Michael T. Freehill and Katherine R. Saul

function due to age-related declines in strength. 2 , 3 Further, older adults employ compensatory kinematic strategies, such as decreasing their thoracohumeral elevation angle 4 when performing upper limb tasks. 4 – 7 These age-related declines can be exacerbated by a rotator cuff tear

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James J. Irrgang, Susan L. Whitney and Christopher D. Harner

Shoulder pain in throwing athletes is reviewed. The anatomy and function of the rotator cuff and the biomechanics of the throwing mechanism are described. Physical examination for rotator cuff injuries, treatment considerations, and a protocol are presented. Failure to recognize glenohumeral instability may limit the success of nonoperative management of rotator cuff injuries in throwing athletes. This article provides a comprehensive review of some of the underlying causes of rotator cuff pathology in throwing athletes. Rotator cuff injuries in throwing athletes are closely associated with glenohumeral instability. The role of glenohumeral instability in the pathogenesis of rotator cuff injuries is described.

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Rodney Y. L. Wong, Patrick S. H. Yung and H. T. Leong

Softball is one of the most popular sports in recent decades. Rotator cuff tendinopathy is one of the most frequently reported overuse injuries in softball players, accounting for approximately 10% of all injuries recorded during softball competitions and practices. 1 Rotator cuff tendinopathy is

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Kathleen A. Swanik, Kellie Huxel Bliven and Charles Buz Swanik

Context:

There are contradictory data on optimal muscle-activation strategies for restoring shoulder stability. Further investigation of neuromuscular-control strategies for glenohumeral-joint stability will guide clinicians in decisions regarding appropriate rehabilitation exercises.

Objectives:

To determine whether subscapularis, infraspinatus, and teres minor (anteroposterior force couple) muscle activation differ between 4 shoulder exercises and describe coactivation ratios and individual muscle-recruitment characteristics of rotator-cuff muscles throughout each shoulder exercise.

Design:

Crossover.

Setting:

Laboratory.

Participants:

healthy, physically active men, age 20.55 ± 2.0 y.

Interventions:

4 rehabilitation exercises: pitchback, PNF D2 pattern with tubing, push-up plus, and slide board.

Main Outcomes Measures:

Mean coactivation level, coactivation-ratio patterns, and level (area) of muscle-activation patterns of the subscapularis, infraspinatus, and teres minor throughout each exercise.

Results:

Coactivation levels varied throughout each exercise. Subscapularis activity was consistently higher than that of the infraspinatus and teres minor combined at the start of each exercise and in end ranges of motion. Individual muscle-recruitment levels in the subscapularis were also different between exercises.

Conclusion:

Results provide descriptive data for determining normative coactivation-ratio values for muscle recruitment for the functional exercises studied. Differences in subscapularis activation suggest a reliance to resist anteriorly directed forces.

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Hio Teng Leong and Siu Ngor Fu

Rotator cuff (RC) tendinopathy is considered to be the principal cause of shoulder pain in orthopedics and sports medicine, 1 , 2 particularly in athletes with repetitive overhead activities. 3 It is an umbrella term that includes a spectrum of pathological changes ranging from tendinopathy to

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Rachele E. Vogelpohl and Roger O. Kollock

Context:

Shoulder injury in baseball pitchers is a very common problem and has been linked to an imbalance in rotator cuff strength. Recently, the use of functional shoulder strength ratios has become more popular because they more closely resemble the actions of the shoulder during the throwing motion.

Objective:

To investigate the link between preseason shoulder rotator cuff functional strength ratios and the development of shoulder pain and injury.

Design:

Prospective research design.

Setting:

University human performance laboratory.

Patients:

Fifteen collegiate baseball pitchers participated in this study. At the end of the baseball season, six (19.5 ± 1.8 years, 73.6 ± 2.8 inches, 198.7 ± 19.1 lbs) developed shoulder injury and were placed in the injured group, and nine (21.0 ± 1.7 years, 73.1 ± 2.3 inches, 207.9 ± 28.1 lbs) did not develop injury and were placed in the noninjured group.

Interventions:

Isokinetic peak torque was collected concentrically and eccentrically for both shoulder internal rotation (IR) and external rotation (ER) at 60°-s−1, 180°-s−1, and 300°-s−1.

Main Outcome Measure:

The following functional ratios were calculated from the peak torque measures: concentric ER: concentric IR; eccentric ER: eccentric IR; concentric ER: eccentric IR (cocking phase); and eccentric ER: concentric IR (acceleration phase). Analysis was conducted using an analysis of variance comparing the injured and noninjured groups. A secondary analysis was conducted using an analyses of variance on the concentric and eccentric peak torque for shoulder IR and ER between groups.

Results:

The acceleration phase functional shoulder ratio was significantly higher (p = .019) in the injured group and a concentric IR peak torque (p = .003) was significantly lower in the injured group compared with the noninjured group.

conclusion:

Increased acceleration phase ratios and decreased concentric IR peak torque may be linked to the development of shoulder injury during a baseball season.

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Birinder Singh B. Cheema, Marissa Lassere, Ronald Shnier and Maria A. Fiatarone Singh

The purpose of this article is to document a rotator cuff tear sustained by an elderly woman performing progressive resistance training (PRT) in a recent randomized controlled clinical trial. The patient was a sedentary 73-y-old Caucasian woman. Investigation revealed an acute, full-thickness tear of the right supraspinatus secondary to performing a shoulder press exercise. Further investigation via MRI revealed degenerative disease of the acromioclavicular joint including lateral downsloping of the acromion and an anteroinferior acromial spur, which would presdispose to impingement. Conservative management was implemented in this case for over 6 months with minimal success. The patient remained functionally limited in virtually all activities of daily living. Given the medical history, health status, physical condition, and age of our patient, it is probable that degenerative changes predisposed the patient to the injury. To our knowledge this is the first published report of an older adult sustaining a rotator cuff tear during PRT.