Stop Blaming the Rotator Cuff: The Mechanism of Shoulder Injuries

Stop Blaming the Rotator Cuff: The Mechanism of Shoulder Injuries

The rotator cuff is a group of muscles located at the front of your upper arm. These muscles are responsible for extending and retracting your biceps (the long head) and brachialis (the short head). They also attach to other structures such as your tricep, forearm bones, wrist bone, elbow joint and shoulder blade.

Rotator cuffs are most commonly injured during sports such as baseball, football, gymnastics and wrestling. Sports that involve throwing or punching include hockey, boxing and judo. Other common causes of rotator cuff injuries include overuse injuries from lifting weights, repetitive stress fractures of the humeral head and other types of trauma.

When rotators are torn they cause pain in your shoulder. When these muscles are injured, it may take several months before you feel any pain. If the injury occurs during training, it will affect how well you perform your sport.

How do I know if my rotator cuff is injured?

If you have ever been told that “your rotator cuff tears easily” then you probably already know what I am talking about. Your rotator cuff does not tear easily! It is also rarely torn completely during normal activities. But you may miss some of your sport or recreational activities if you have damaged your shoulder.

Pain is a signal from your body that something is wrong. You use pain to guide and protect yourself. Pain from a rotator cuff injury may feel like sharp burning, jabbing or dull ache in the front of your shoulder. It can also extend into your upper arm and even all the way up to your neck and jaw. Pain may be noticed during or after activity and may even awaken you at night.

Other common symptoms of a rotator cuff injury include:

Muscle weakness in your shoulder or arm.

Having limited flexibility in your shoulder joint.

Noises such as popping, grinding and cracking when moving your shoulder.

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Partial to full loss of motion in your shoulder.

Tightness or swelling in your shoulder muscles.

Treating a rotator cuff injury:

You can heal a rotator cuff injury:

Stop doing all activities that cause pain. This may be difficult at first, but you must resist the urge to push through the pain or extend your current limits. Your shoulder needs time to heal.

Apply cold therapy to reduce pain and swelling. You can use an ice pack, bag of frozen vegetables, gel packs or a plastic bag of ice placed inside a shirt. Cold therapy should be applied for 15-20 minutes every 2-4 hours for the first 48-72 hours.

Apply heat to increase blood flow and relax tight muscles. Use a heating pad set on low, hot showers or baths and visits to a professional massage therapist. Do not apply heat immediately after activity as this may cause more swelling.

Do gentle stretching to keep your shoulder flexible. Hold stretches for 30 seconds and repeat 3 times.

Work on your posture and strengthening exercises using good form for at least an hour every day.

Strengthening the muscles around your shoulder blade and back will help support the weight of your arm and prevent additional injury.

Use a sling or arm brace to keep your injured arm stable if you are worried about further injury or if your symptoms persist. You can also use crutches to take pressure off of your legs.

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Get back to your favorite activities when:

You no longer feel pain or have any symptoms.

All of your strength and flexibility has returned. Shoulder pain during an activity is a sign that you need to rest and may mean you need to visit a healthcare provider.

Your shoulder feels strong and flexible.

You have full range of motion in all directions without pain or limitations.

You have no more pain with daily activities.

You can return to activities that place demands on your shoulder once you are pain free for two weeks. Always warm up before activity and do not push yourself too hard or strain yourself.

Carpal tunnel syndrome:

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is one of the most common causes of pain and weakness in the hands and wrists. A CTS diagnosis is often given if you have hand pain that is made worse by activities such as gripping or pinching, and that is better by rest. Other symptoms may include numbness, tingling or weakness of the fingers and sometimes the entire hand. A common misconception is that carpal tunnel syndrome is caused by compression of a nerve in the wrist, known as the carpal tunnel. In reality, there is often no carpal tunnel compression at all in people diagnosed with CTS. CTS is actually caused by a combination of factors such as swelling of the soft tissues in the palm (known as a “taugemer test”), weakness or dysfunction of the muscles that support the joints in the hand, repetitive and forceful use of the hands and wrist, and heredity.

There is no specific treatment for carpal tunnel syndrome. Most cases resolve on their own within 6-12 weeks or so, however there are many things that can be done to help reduce the severity of the symptoms and hasten recovery.

There is evidence that injury to the median nerve, which is located in the carpal tunnel, can cause temporary or even permanent changes in the way some people process sensations such as touch, temperature and pain. In other words, even after the original cause of carpal tunnel syndrome is gone, some people continue to experience numbness and pain in the hand. The good news is that these changes can almost always be “fixed” with certain types of physical therapy.

This guide will teach you about the most effective ways to decrease swelling of the soft tissues in the palm (a condition known as “taugemer” or “tau-mu-mer” in the medical world), strengthen the muscles that support the joints in your hand, and improve how these muscles function.

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The sooner you start, the sooner you will get back to 100%!

How do I know if I have carpal tunnel syndrome?

The most common symptom of CTS is pain that is made worse by activities that involve gripping, pinching and pushing or pulling.

How do I prevent carpal tunnel syndrome?

Preventing CTS is actually very easy. All it takes is a little awareness of how you are using your hands and wrists and then adjusting your activities as necessary.

For example, most people do not give their hands and wrists a rest when doing repetitive activities such as driving or using a computer keyboard. If you anticipate that you will be engaging in a repetitive activity, take frequent “micro-breaks” by changing your grip or shifting your wrists.

The most common activities that people do which put them at risk for CTS are activities that involve gripping or using small muscles in the hands and wrists. This includes activities such as holding the steering wheel while driving, using a pen or pencil, typing, doing hand work such as building something or working on a computer keyboard.

If you think you may be at risk, there are a few simple tests that your physician can perform to see if you do, in fact, have CTS.

The first test involves having your fingers curled into a fist and the thumb tucked in with the other fingers stretched out as far as possible. The doctor will then gently push on the palm of your hand to see if it causes pain. This is called the Tourna Portio Test.

If you are male and over 40, the next test is to have you bend your wrist back and forth. This is because males over 40 have an increased risk of having problems in that area as well.

If these tests are positive, your doctor can run further tests to rule out other conditions that might cause similar symptoms including rheumatoid arthritis, osteoarthritis, gout, and several others.

Another common test involves having your arm hanging next to your side and then using the other hand to push the knuckles of your fingers upward (ulnar deviated). This causes stretching and increased pressure on the nerve. If you feel a tingling or painful sensation in the fingers it is considered positive test.

If these tests are positive, it means that you have some mild nerve irritation in the wrist area and are at risk for developing CTS.

If CTS is confirmed, the next step is to start physical therapy and learn how to prevent or delay worsening of the condition. It is very important that you follow these procedures because if left untreated, CTS can cause permanent damage. Please read this guide thoroughly as it can help you avoid further injury and pain.

What are the symptoms of Carpal Tunnel Syndrome?

Symptoms of CTS include pain, tingling and numbness in the hand and fingers. At this point, it is very important to start a prevention program to ensure that you do not develop CTS.

The main reason carpal tunnel syndrome is so common is that most people do not take adequate steps to treat it before it becomes severe enough to require surgery. If you start treatment in its earliest stages, you may be able to avoid surgery altogether. The symptoms of CTS can come on suddenly or develop slowly over time. The following is a list of common CTS symptoms:

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Hand, wrist and forearm pain that is usually worse at night

Numbness and tingling in the hand

Weak grip

Painful Scarring

Muscle weakness

Slow motor skills deterioration

Muscle atrophy (wasting away)

Severe cases can cause loss of fine finger movement

How is Carpal Tunnel Syndrome Diagnosed?

It is common for CTS to occur in people who do a lot of work that requires them to use their hands repetitively such as typing. When you engage in a lot of repetitive hand activity, you are more likely to develop CTS especially if you do not give your hands and wrists rest periodically.

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Another common cause of CTS is having an injury or illness that causes swelling in the area. Normally our body has very small passageways in the tissues around the median nerve and if swelling occurs, it gets in the way of the nerve causing a pinching effect. This is what causes the pain and tingling sensations that are typical with CTS.

Diagnosing Carpal Tunnel Syndrome typically involves a physical examination by your physician. Your physician will check your hand for weakness and also test for any numbness or tingling in your fingers. If CTS is suspected, your physician will most likely refer you to a hand specialist called a Orthopedist or a Neurologist.

The Orthopedist or Neurologist will perform more tests, and if they confirm that you have CTS, they will determine whether you need surgery or not. Your physician will probably order an MRI to get a better idea of the extent of the damage in your median nerve. Your physician may also order other tests such as an electrodiagnostic testing to determine how severe the condition is.

How can Carpal Tunnel Syndrome be treated and what are my options?

The main goal in treating CTS is to prevent the condition from worsening and ensure that you do not develop any symptoms of tingling, numbness or pain in your fingers. The following tests may be performed:

Nerve conduction test – This procedure measures how fast electrical signals travel along nerve fibers.

Nerve biopsy – A sample of tissue is taken from the area to be examined under a microscope.

Where is Carpal Tunnel Located?

The carpal tunnel is a narrow canal in the wrist that contains tendons, blood vessels and the median nerve. The eight carpal bones in your wrist form the four walls of this tunnel.

At this point, it is very important that you start a Carpal Tunnel Prevention Program to ensure that you do not develop any symptoms and to prevent any further damage from occurring.

Carpal Tunnel Prevention Program

The best way to reduce your risk of developing CTS is to start a prevention program as soon as possible. Enrolling in your companies workers compensation insurance is an added bonus because they should provide you with a wrist splint that you can start wearing immediately. The skin over the roof of the tunnel forms the floor and acts as a sliding cover. This allows the tunnel to be narrow so that the median nerve can travel to the hand to control fine motor skills such as finger movement.

When do I need treatment?

If you experience any symptoms of CTS, it is important to see your physician immediately. Early treatment is very important in preventing this condition from worsening and ensuring that you do not develop any long term complications. You may be required to provide a note from your physician in which case, you should see your physician as soon as possible. Your physician will determine whether or not you need surgery and if you do, he will refer you to a hand specialist called an Orthopedist or a Neurologist who can perform the surgery. If the cause of your CTS is from repetitive trauma, your physician may want you to start wearing a wrist splint at all times to keep your wrist in a neutral position. He may also tape your thumb, to stop it from bending as far.

How is Carpal Tunnel Syndrome treated?

The treatment for CTS will vary depending on your situation and the severity of your condition. Most people with this condition will require surgery to cut the scar tissue that is causing the nerve to become compressed. Your physician may also prescribe pain medication to help ease any discomfort you may experience during the healing process.

If you are a smoker and have been experiencing any symptoms of numbness, tingling or pain in your fingers, it is very important that you see your physician immediately since smoking has been linked to an increased risk of CTS.

What can I expect from treatment?

The main goals of treatment are to relieve any symptoms that you are experiencing and to prevent any further damage to the median nerve. Your physician will determine the best course of action depending on your situation. Here are some treatments that may be performed:

Surgery – In some cases, surgery is necessary to alleviate the pressure on the median nerve. The surgeon will make a small incision in your wrist and cut a hole in the transverse carpal ligament to enlarge the carpal tunnel.

Most people who have CTS surgery experience relief of their symptoms almost immediately after the procedure. Your physician will probably provide you with a wrist brace after your surgery and recommend that you wear it for at least three months. You may also be required to perform physical therapy to strengthen the muscles in your hand and fingers since some of the nerves that control these muscles were also cut during the surgery. This will relieve the pressure on the median nerve. The surgeon will also examine the bones and surrounding tissue to make sure there is nothing else that needs to be treated.

Once the surgeon has determined that the surgery has alleviated your symptoms, the incision will be closed and you should experience an almost immediate relief of your symptoms.

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Your physician may also choose to inject the area around the nerve to help reduce any swelling in the region. This is called a trigger release. During this procedure, the surgeon will numb the area around your wrist and forearm and then insert a very small needle into the carpal tunnel. He will then inject the area around the median nerve to alleviate any pressure on it. This procedure can be repeated several times if necessary and most people only require one injection in order to relieve their symptoms.

Other treatments – If your CTS is not very severe, your physician may recommend that you take some time off to rest the nerve. Some people have found relief from their symptoms with this method. Your physician may also suggest that you start wearing a wrist brace at night to keep the wrist in a neutral position while you sleep. This will relieve any stress or weight that may be putting pressure on the median nerve.

Wearing a wrist splint on your hand and arm during the day may also take some stress off of your median nerve since it will keep your hand in a slightly bent position.

If these treatments do not alleviate your symptoms, medication may be recommended to help relieve the pressure on the nerve. Your physician may also suggest that you start performing regular exercise or physical therapy to try to restore strength to the muscles in your hands.

Exercises for strengthening your hand and fingers

Looking after your sleep pattern – If your job requires you to use a keyboard or perform some other activity that requires repetitive hand and finger movement, you may need to start paying more attention to your sleep cycle. Most people are used to spending 8 hours in bed each night, but some research has shown that people actually need more time than this in order to achieve the highest level of productivity while they are awake. Most people do not reach their peak level of productivity until after they have been awake for at least 10 hours. If your job consists of doing a lot of typing or any other activity that requires a lot of hand and finger movement, you may want to try getting as much sleep as possible. You will probably notice that your ability to concentrate and your level of productivity will increase if you make an effort to get more sleep.

You should also try to create a comfortable sleeping environment. Most people are used to sleeping in a bed, but unless you regularly get more than 8 hours of sleep a night, you may want to consider sleeping on the floor. Sleeping on a mattress is not ideal if you spend most of your day sitting down because it will cause your back to bend into an unnatural position while you are sleeping. Sleeping on the floor will help to prevent this from occurring. It will also put less stress on your muscles.

If you are used to sleeping in a bed, try taking the mattress out of your bed and putting it on the floor. If this is not an option you can buy a futon mattress or a thick foam pad to put on the floor instead.

You may also want to sleep in the buff. Sleeping in clothing can put some strain on your back while you are sleeping.

It may sound a little weird to go to sleep naked, but you will probably find that it actually feels quite comfortable and it will help you to sleep better. If being naked in front of others is going to be a problem for you, you can always buy a body pillow and wrap it around yourself while you sleep.

The length of your sleep cycle can also affect your productivity. Most people who engage in manual labor are most productive in the morning. This is usually the time when they have the most energy and are able to perform their job the best. For people who work office jobs or do desk work, the opposite is usually true. These types of people are usually more productive in the afternoon and early evenings.Some people are naturally night owls while others are morning people.

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If you are a night owl you may not feel tired until late at night. If this is the case, you may want to avoid watching TV or doing anything else that will cause you to become sleepy until you have to go to bed. If you are a morning person you may need to force yourself to stay awake until late at night in order to get your sleep cycle shifted so you feel tired when it’s bedtime.

One final tip that can help ensure that you get your eight hours of sleep is taking a nap during the day. Most people do not function as well after only getting four hours of sleep, so it is important to take a nap if you did not get enough sleep the night before. The best way to take a nap is to set a timer for 30 minutes. When you wake up from your nap, you should try to immediately go back to sleep for at least an hour because your body will now be ready for another three or four hour cycle of sleep.

The first week is the hardest when you are trying to establish a routine. Most people find it difficult to adjust to going to bed at a certain time every night and also getting up at the same time every morning.

The most important thing to remember during the first week is that you should never break your sleep schedule. If you go to sleep at 2:00 AM every night for the first three nights, you should ALWAYS go to bed at that time. Never do you want to mess up your sleep schedule.

Most people find that after the first week is over, they have adjusted to a sleeping pattern and can now wake up without an alarm clock. Unfortunately, most people also find that their bodies begin to desire sleep later and later. This is why it’s important to keep to a strict sleep routine.

Killing time before bed can be difficult. If there are any tasks that you need to do, such as paying bills, etc, you should try to do them in the morning so you don’t have to worry about them later.

The Evening Routine

It is important to not only have a consistent sleep schedule, but also a consistent evening routine. Everyone is different, so the exact tasks you do may be different, however there are some common things that most good routines contain:

A shower or bath. This helps you to both get clean and also can help you to relax before bed which is very important. Take this time to think about your day and any stressful situations that happened that day.

Sources & references used in this article:

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Load on the shoulder in low intensity wheelchair propulsion by HEJ Veeger, LA Rozendaal, FCT Van der Helm – Clinical biomechanics, 2002 – Elsevier

Screening the athlete’s shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology by AM Cools, D Cambier, EE Witvrouw – British journal of sports …, 2008 – bjsm.bmj.com

Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair by Y Tuoheti, E Itoi, N Yamamoto, N Seki… – … American journal of …, 2005 – journals.sagepub.com

Techniques for managing poor quality tissue and bone during arthroscopic rotator cuff repair by PJ Denard, SS Burkhart – Arthroscopy: The Journal of Arthroscopic & …, 2011 – Elsevier

Preventing musculoskeletal disorders in clinical dentistry: strategies to address the mechanisms leading to musculoskeletal disorders by B Valachi, K Valachi – The Journal of the American Dental Association, 2003 – Elsevier

Biomechanics of overhand throwing with implications for injuries by GS Fleisig, SW Barrentine, RF Escamilla, JR Andrews – Sports Medicine, 1996 – Springer