Name of the Student
19th November, 2015
Case Study: Orthopedics
Rotator Cuff refers to the shoulder joint or more technically the glenohumeral joint. The arrangement of the joint is such that lesser bony stability is associated with. Thus, it does not ball under the category of a true ball and socket joint, which not only provides buffering action during movements and resists stretch. The glenohumeral joint is controlled by the rotator cuff muscles and ligaments. These muscles are called subscapularis, supraspinatus, infraspinatus and teres minor. Improper biomechanics during throwing and repetitive stress can cause injury to these muscles. There can be various forms of tear which can be a partial thickness or full thickness tear. The tendons start to rupture and may or might not progress through the entire length of tendon. Apart from the type of tear, rotator cuff muscle tear is classified according to the size of the tear. Type 1 tears are tears in the tendon which are less than 2 cm and in Type 2 tears the size is greater than 2 cm (Wolf, Dunn & Wright 1007-1116).
The rehabilitation plan for such injuries is very specific. The principle of rehabilitation is to help the athlete regain motion, strength and function of the shoulder on the athletic performance or act. The rehabilitation plan of the athlete in question could be as follows (Burkhart, Morgan & Kibler 125-158):
Rehabilitation objective Exercise to be Intervened
Phase 1 (From surgery till next two weeks of surgery) Reduction in pain
Maintaining active range of motion of elbows, wrist and neck
Relative res for reducing inflammation
Active range of motion of elbows, wrist and neck
Passive range of motion for shoulders, shoulder flexion and abduction (0 degrees to 50 degrees)
Phase 2 (Initiate after two weeks of surgery) Restoration of active assisted range of motion and passive motions like phase 1
Activation of shoulder and scapular stabilizers through shoulder abduction (0 degrees and 30 degrees)
Postural dysfunctions to be reoriented shoulder mobilizations
active assisted the range of motion and passive motions for shoulders in cardinal planes
The initiate active range of shoulder flexion and rotation on the 4th week.
Phase III (5 to 7 weeks post surgery) Full shoulder motion in all planes
Normal strength of shoulder rotators (internal and external) with shoulder at 0-degree abduction Shoulder internal and external rotation with weights at 0-degree abduction.
Kinetic chain shoulder and scapular stabilization drills
Scapular strengthening exercises (Inculcate scapular setting exercise)
Phase 4 ( 12 weeks of surgery) Normal cuff strength and endurance at 0 degrees of shoulder abduction and scaption The multi-plane range of active motions in the shoulder with gradually increasing velocities.
Sleeper stretch should be initiated
Rotator cuff strengthening at 90 degrees of shoulder abduction and overhead 9 beyond 90 degree)
(Inculcate cross over arms stretch exercise)
Scapular strengthening in open and closed kinetic chain
Burkhart SS, Morgan CD, &Kibler WB. Shoulder injuries in overhead athletes. The “dead
arm” revisited. Clin Sports Med, 19.1(2000): pp 125-158
Wolf BR, Dunn WR, & Wright RW. Indications for repair of full-thickness rotator
cuff tears. Am J Sports Med. J, 35.6(2007):pp1007-1016