In anatomy, rotator cuff ) is a group of muscles and their tendons that act to stabilize the shoulder. Of seven scapulohumeral muscles, four form a rotator cuff. The four muscles are the supraspinatus muscle, the infraspinatus muscle, the small muscle teres, and the subscapularis muscle.
Video Rotator cuff
Struktur
Otot yang menyusun rotator cuff
The supraspinatus muscle spreads out in a horizontal band to insert on the superior and intermediate aspects of the larger tubercle. The larger tubercle project as the most lateral structure of the humeral head. The medial for this, in turn, is the lower tuberosity of the humeral head. The origin of the subscapularis muscle is divided from the remaining origin of the rotator cuff as it is far to the scapula.
These four tendons of these muscles converge to form a rotator cuff tendon. These tendon insertions along with the articular capsule, the coracohumeral ligament, and the glenohumeral ligament complex, converge into confluent sheets before they are inserted into the humeral tuberosity. The insertion place of rotator cuff tendons in larger tuberosities is often referred to as a footprint. The infraspinatus and teres are small fuses near their musculotendinous junction, whereas the supraspinatus and subscapular tendons join as a sheath that surrounds the biceps tendon at the entrance of the bicipital groove. Supraspinatus is most often involved in rotator cuff cuffs.
Maps Rotator cuff
Function
Rotator cuff muscles are important in shoulder motion and in maintaining the glenohumeral joint (shoulder joint) stability. These muscles arise from the scapula and connect to the humeral head, forming a cuff in the shoulder joint. They hold the humeral head in the small, shallow glenoid fossa of the scapula. The glenohumeral joint is analogously described as a golf ball (the humeral head) sitting on a golf tee (glenoid fossa).
During the abduction of the arm, moving outward and away from the trunk, the rotator cuff suppresses the glenohumeral joint, an action known as concave compression, to allow the large deltoid muscles to further lift the arm. In other words, without a cuff rotator, the humeral head will rise partly out of the glenoid fossa, reducing the efficiency of the deltoid muscles. The anterior and posterior directions of the glenoid fossa are more susceptible to shear disturbance because the glenoid fossa is not as deep relative to the superior and inferior directions. The contribution of rotator cuff to compression and stability of the basin varies according to the stiffness and direction of the force they apply to the joint.
In addition to stabilizing the glenohumeral joint and controlling the translation of the humeral head, the rotator cuff muscles also perform several functions, including kidnapping, internal rotation, and external rotation of the shoulder. The infraspinatus and subscapularis have a significant role in the abduction of the scapular plane's shoulder (scaption), producing a power that is two to three times greater than the strength produced by the supraspinatus muscle. However, supraspinatus is more effective for general shoulder abduction because of the timed arm. The anterior portion of the supraspinatus tendon is given to a much greater load and stress, and performs its primary role.
Clinical interests
The rotator cuff is torn
The tendon at the end of the rotator cuff muscle can become torn, which causes pain and restricts arm movement. A torn rotator cuff may occur after trauma to the shoulder or may occur through "wear" of the tendon, most often a supraspinatus tendon found beneath the acromion.
Cuff rotator injuries are generally associated with movements that require repetitive overhead movement or strong pulling motion. Such injuries are often supported by athletes whose actions include making repetitive throws, athletes such as baseball pitchers, softball pitchers, American football players (especially quarterbacks), cheerleaders, weightlifting (especially lift lifts due to extreme loads used in the bench press), players rugby, volleyball player (due to swinging motion), water polo player, rodeo team rookie, shot thrower (due to bad technique), swimmer, boxer, kayakers, western martial artist, fast bowler at cricket, tennis player (due to movement their service) and tenpin bowlers due to the repetitive swinging motion of the arms with the load of bowling balls. This type of injury also often affects the conductor of the orchestra, the choir conductor, and the drummer (because, again, for the swinging motion).
Treatment for rotator cuff ruptures may include rest, ice, physical therapy, and/or surgery. A published review of 14 trials involving 829 patients found that there was insufficient evidence to show whether surgery was better than non-surgical options. A manual therapeutic review and exercise treatment found inconclusive evidence as to whether the treatment was better than placebo, but " The high quality evidence from one experiment suggested that manual therapy and exercise function was improved little more than placebo at 22 weeks, little or no different from placebo in terms of other important patient outcomes (eg pain overall), and was associated with more relative side effects often but light. "
Surgery is often recommended for patients with acute traumatic rotary cuff injury resulting in considerable weakness. Surgery can be done openly or arthroscopy, although the arthroscopic approach has become much more popular. If surgical options are selected, rotator cuff rehabilitation is required to regain maximum strength and range of motion in the shoulder joint. Physical therapy takes place through four stages, increasing movement throughout the phase. Tempo and intensity stages depend only on the extent of injury and the needs of patient activity. The first stage requires immobilization of the shoulder joint. Shoulders whose injuries are placed in the flexion of the sleeve and shoulder or arm abduction are avoided for 4 to 6 weeks after surgery (Brewster, 1993). Avoiding the movement of the shoulder joints allows the torn tendon to fully heal. Once the tendons are fully restored, passive exercises can be implemented. A passive shoulder exercise is a movement in which the physical therapist maintains the arm in a certain position, manipulating the rotator cuff without effort by the patient. These exercises are used to improve the stability, strength and range of minor Subscapularis, Supraspinatus, Infraspinatus, and Teres in rotator cuff movements. Passive exercises include internal and external rotation of the shoulder joint, as well as shoulder flexion and extension.
As development progresses after 4-6 weeks, active training is now being implemented into the rehabilitation process. Active exercises allow for increased strength and range of motion further by allowing the movement of the shoulder joint without the support of a physical therapist. Active exercises include the Pendulum workout (as shown in Figure 2), which is used to strengthen Supraspinatus, Infraspinatus, and Subscapularis. The external rotation of the shoulders with the arms at an angle of 90 degrees is an additional exercise performed to improve control and range of small muscle movements of Infraspinatus and Teres. Various active exercises were performed for an additional 3-6 weeks as progress was based on individual cases per case. At 8-12 weeks, the intensity of strength training will increase as free-weight and resistance bands will be implemented in the exercise recipe.
cuff rotator cuff
A systematic review of relevant research finds that the accuracy of physical examination is low. The Hawkins-Kennedy test has a sensitivity of about 80% to 90% for detecting collisions. The tests of infraspinatus and supraspinatus have specificity of 80% to 90%.
A common cause of shoulder pain in rotator cuff impingement syndrome is Tendinosis, which is age-related and most often limited.
Inflammation of rotator and fibrosis intervals
The rotator interval is a triangular space in the shoulder that is functionally reinforced externally by the coracohumeral ligament and internally by the superior glenohumeral ligament, and traversed by the intra-articular biceps tendon. In imaging, it is defined by the coracoid process at its base, superior supraspinatus tendon and inferior subscapular tendon. Adhesive capsulitis changes can be seen at this interval as edema and fibrosis. Pathology at intervals is also associated with glenohumeral instability and biceps.
Pain management
The rotator cuff includes muscles such as supraspinatus muscle, infraspinatus muscle, small muscle teres and subscapularis muscle. The upper arm consists of deltoids, biceps, and triceps. Steps should be taken and precautions should be taken so that the rotator cuff to heal properly after surgery while still maintaining the function to prevent a deteriorating effect on the muscle. In the immediate postoperative period (within one week after surgery), pain can be treated with standard ice packs. There are also commercially available devices that not only cool the shoulder but also push the shoulder ("cryotherapy compression"). However, one study showed no significant difference in postoperative pain when comparing this device with a standard ice pack.
Continuous passive movement
Physiotherapy can help manage the pain, but utilizing programs that involve continuous passive movement will reduce the pain even further. A low-intensity assisted passive movement allows the network to be stretched slightly without destroying it. A continuous passive movement increases the shoulder range and allows the subject to extend the range of motion without experiencing additional pain. Reduced movement will allow people to continue working the muscles to keep them from undergoing atrophy, while also still maintaining the minimum level of function in which daily functioning is allowed. Doing this exercise will also prevent tears in the muscles that will impair the daily functioning further. Because rotator cuff injuries often tend to impede movement without experiencing discomfort and pain, other methods can be done to help accommodate it.
Capsular release
An operating procedure is where the injured area joint will be released to achieve full range of motion without too much pain and discomfort, speeding up recovery time and allowing people to better perform optimally. A study conducted by Jin-Young Park investigated the benefits of using capsular release to help relieve the shoulder stiffness that usually comes whenever there is an injury to the rotator cuff. Some subjects have diabetes mellitus, which can also cause shoulder stiffness, inhibiting external rotation of the shoulder. Of the 49 subjects recruited for this trial, 21 only manipulated to relieve stiffness, while 28 others underwent capsular release surgery along with manipulation to treat shoulder stiffness. Although, overall, no improvement in outcomes were seen with respect to external rotation between control and treatment groups, subjects with diabetes mellitus benefited from treatment that included capsular release surgery. Their rotator cuff function improved significantly in both external flexion and external rotation compared to subjects not diagnosed with diabetes mellitus.
Orthotherapy Exercise
Patients suffering from pain in the rotator cuff may consider using orthotherapy into their daily lives. Orthotherapy is an exercise program aimed at restoring the movement and strength of shoulder muscles. Patients can go through three phases of orthotherapy to help manage pain and also recover their full range of motion in the rotator cuff. The first phase involves gentle and passive stretching throughout the movement, and people are advised not to go above 70 degree elevation to prevent any kind of further pain. The second phase of this regimen requires patients to apply the exercises to strengthen the muscles surrounding the rotator cuff muscles, combined with passive exercises done in the first phase to maintain tissue stretching without forcing it. Exercises include pushup and shoulders shrug, and after a few weeks, daily activities are gradually added to the patient's routine. This program does not require any medication or surgery and can serve as a good alternative. The rotator cuff and upper muscle are responsible for many of the daily tasks people do in their lives. Appropriate recovery needs to be maintained and achieved to prevent restricted movement, and can be done through simple movements.
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