Tendon Compression (Rotator Cuff)


 

Lucky last in our Tendon Compression series is the poor Rotator Cuff - have we missed any? Please write in, if you think there is another one I should write about that gets compressed around a bony prominence… 

Supraspinatus / Subscapularis

Having a look at these two critical stabilisers of the Head of Humerus ("HH”), it becomes clear that they ride over various bony prominences of the Head of Humerus to attach onto it. Namely the Supraspinatus rides over and attaches to the Greater Tubercle / Tuberosity of the Humerus, and the Subscapularis rides over the Lesser Tubercle to attach onto it. In this first image the Supraspinatus is shown with a small tear in its tendon - such a common degenerative change that may also be associated with compression and shearing from the bony tuberosity underneath.

   

So - why might this happen biomechanically?

We extensively teach on this in Rehab Express and Rehab Essentials (now also known as The Rehab Trainer Injury Prevention System in Australia) - the classic problem with impingement in the shoulder is excessive elevation of the Head of Humerus, and / or excessive anterior shear. In this second image we see what should be happening with Supraspinatus when it functioning well (it keeps the Head of Humerus down in the centre of the socket):

 
 
Supraspinatus as Head Depressor
1. Supraspinatus muscle contracts.
2. Tendon effectively "pulls down" the HH.
3. Clearance space below the acromion increased.
 
 

Now, while these excessive movements are likely to create impingement pain of the soft tissues under the accordion process, they may each also create pain from tendon compression as the bony tuberosity / tubercle pushes out from underneath into the tendon during these excessive movements.

Unfortunately, this compression effect will inhibit these two powerful stabiliser muscles, and the result is worse movement, and more of the same!

One big practical thing to teach your clients not to do is:

DON’T lean on your elbow, sagging into your shoulder!!

 
 

Oh nearly forgot, if you are interested to have a look at our incredible Rehab Vault and what it can do for you, check it out:



Cheerio!

Ulrik
 

 
       

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