Off The Cuff

By

George S. Pellegrino and Victoria L. Magown

For most people, a rotator cuff is just that, a cuff. In the shoulder, the term rotator cuff refers to the tendons of four muscles; subscapularis, infraspinatus, teres minor and supraspinatus. (See illustrations below) Together, these muscles are also referred to as the SITS muscles; an anachronism derived from the first letter of each muscle.

When someone has a rotator cuff tear, we picture a torn cuff like that of a shirt sleeve. In actuality, a torn rotator cuff refers to the torn tendon of one of these four muscles. The most common tear is in the tendon of the supraspinatus.

Before any of the muscles of the rotator cuff tear, we are given a warning. Shoulder pain often indicates “something wrong” with one of these muscles. If caught in time, a tear and the resulting surgery can be avoided. For Chris, treatment in a timely manner prevented disaster.

An accountant by profession working for a local department store and weekend warrior doing his own home remodeling project, Chris began to suffer right anterior shoulder pain and stiffness. Recently, after working five days a week pushing a mouse, Chris spent the weekend completing his home project by painting the interior of his house.

Although he ignored minor right shoulder pain throughout the project, following a game of Frisbee, the pain became unbearable. The most intense pain was at the anterior shoulder produced by Myofascial Trigger Points in the infraspinatus which refers pain there. (See illustration B) When Chris raised his arm, he described pain felt inside the shoulder joint.

A Myofascial Trigger Point (MTrP) is a hypersensitive knot in a muscle that produces a taut band. When stimulated, a Trigger Point produces pain referred in a predictable pattern usually away from the Trigger Point. The taut bands produced by Trigger Points are responsible for the stiffness and leave the tendons vulnerable to a tear.

Myofascial Trigger Points are a frequently overlooked and an often misunderstood source of musculoskeletal pain. The results of two studies involving nearly 400 patients seeking medical intervention for pain showed Myofascial Trigger Points were involved as the source of pain as much as 93% of the time.

During the initial evaluation, restriction of shoulder movement gave a strong indication of which rotator cuff muscles were involved. Treatment consists of applying manual pressure at the MTrP within the patient’s tolerance. A slow pumping action elongates the fibers of the taut band while diluting the chemistry of pain.

A Home Exercise Program consisting of specific stretches helps to maintain the release gained during treatment. Although treatment can be uncomfortable, both treatment and exercise are intended to be pain free. The phrase “No Pain, No Gain” does not apply to MTrPs. With MTrPs, exercising to the point of pain will only lead to more pain.

Following successful treatment of his rotator cuff muscles, Chris was released from treatment only to return after four weeks with a minor exacerbation. After reviewing work habits, a perpetuating factor for his shoulder pain was discovered.

A Perpetuating Factor is a posture or behavior that can reestablish or maintain the existent of MTrPs. For Chris, it was the use of a mouse for hours at a time that kept MTrPs reoccurring in his rotator cuff muscles. Changing from a mouse to a trackball operated by thumb eliminated the use of his rotator cuff muscles insuring that the Home Exercise Program was sufficient to keep him pain free.

Are you suffering from pain “Off the Cuff”? Are your rotator cuff tendons too tight causing shoulder stiffness? Your body is trying to tell you something; stop ignoring the message. Give us a call.