Rotator Cuff

For diagrams see pages 62 and 63 of your lab notebook.

Shoulder impingement syndrome-

Occurs with abduction or forward flexion and medial rotation.
Usually impingement of the supraspinatus tendon or the long head of the biceps.
Supraspinatus tendon passes over the head of the humerus and under the anterior acromion process and coraco-acromion ligament.

Elevation of the humerus occurs. You get superior migration of the humeral head due to weakness of the rotator cuff.

Rotator cuff stabilizes and depresses the humeral head during movement.
Specific Muscles:
c)teres minor

What other muscles might you rehab for helping the rotator cuff action- specifically abduction?

Muscles that help to depress the scapula- Why?
Specific muscles:
anterior: subclavius
pectoralis minor
posterior: lower trapizius
serratus anterior

Muscles that help to downwardly rotate the scapula- Why?
Specific muscles:
anterior: subclavius
pectoralis minor
posterior: rhomboid major and minor
levator scapulae

movement of the humerus to the scapula is
2 : 1

scapula doesn't rotate upwards until about 30 degrees of abduction

If the muscles depress and downwardly rotate the scapula and the muscles of the rotator cuff pull down the head of the humerus, the the supraspinatus and the deltoid muscle will have a better line of pull
(more rotary component and less stabilizing or compression of the joint and perhaps less impingement due to abduction)

Lastly, and one of the things that also seems to help most people:

When your arm is in the adducted position, you get compression of the supraspinatus tendon and it leads to decreased blood flow. If the tendon is already impinged from the exercise (swimming in your case) you can see how this would be a problem.

When you are resting- taking notes in class, sleeping, make sure your arm is abducted (with support obviously and ice would help) to allow blood flow and faster recovery. Don't sleep with your arms at your sides.

Introduce idea of musclar strength imbalances. Strong muscles anteriorly, but weak muscles posteriorly don't help this particular problem.

Would also want to stop exercise which are anteriorly rotating and abducting since this just aggravates the problem in the first place.


Lateral epicontylitis:

What potentially makes this occur?

The extensors of the wrist are attached at the lateral epicondyle of the humerus

position of wrist

position of elbow

timing of impact

bi-articular muscles

carpal tunnel syndrome:

primarily due to repetitive use

median nerve:
proprioceptive nerves

Can migrate upward through the rest of the body due to co-contraction and an attempt to stabilize from the rest of the muscles. Can also traslate all the way up to the shoulder joints. Depends on what initial body position is causing is-

Typing versus, farm or field work.

Carpal tunnel- flexor retinaculum & carpal bones

Median nerve- comes through the spinal cord at c8-t1- OVERHEAD

Median nerve damage-
1)numbness and tingling and pain in the palm and fingers-
2)weak thumb and
3)inability to pronate
4)difficulty flexing the wrist

Ulnar nerve- c5-c8- T1
1) distributes to flexors of the forearm