Rotator Cuff and Frozen shoulder
While the term rotator cuff is familiar to many, the meaning of the term is not clear and the description is vague. While many clients have reported a diagnosis of rotator cuff tears, most do not know which of the 4 muscles that make up this structure has been injured or what they do. What is the rotator cuff anyway?
The rotator cuff is formed by four muscles arising from the shoulder blade and attaching to the head of the long upper arm bone called the humerus. Since the shoulder joint is very shallow by design to allow for maximum movement, the four tendons of the rotator cuff muscles form a tendinous cuff to provide stability to the joint.
The four muscles contributing to the cuff are the infraspinatus, supraspinatus and teres minor on the back of the shoulder blade and the subscapularis on the front (underside) of the shoulder blade. The rotator cuff lies underneath the deltoid muscle which covers the shoulder joint and lifts the arm out to the side. To access the attachment sites of the rotator cuff you have to work through the deltoid or try to pry your fingers under the deltoid muscle.
Since we use these muscles a lot to move our shoulder joint around while performing routine tasks such as bathing, grooming our hair or getting dressed we often take them for granted. In athletics we use these muscles in throwing motions. When we sleep on our sides we are putting a lot of weight on the shoulder which can result in loss of range over time.
As massage therapists we have often seen clients with shoulder pain. Many of the rotator cuff injuries reported were the result of falls (or trying to “break” a fall), automobile and bicycle mishaps, the occasional fall off a horse, and of course the throwing motion. A lot of shoulder pain is the result of trigger point activity in overused muscles that move the shoulder joint which respond beautifully to massage work.
Rotator cuff tears commonly involve a strain or tear at the junction between the muscle tissue and the tendon, in the belly of one of the muscles or at the junction of the tendon and the bone around the top of the humerus. Under normal circumstances tears are repaired by the formation of scar tissue to bind the damaged muscle and/or tendon fibers together. Unfortunately, the scar tissue often will bind any adjacent structures together which will limit the range of motion of the joint and may result in pain when movement of the shoulder pulls on the scar tissue and glued structures. It is only natural to keep a painful joint still when any movement causes pain. When the joint is immobilized the gluing is more common. Some rotator cuff injuries require surgery to repair the damage. Often surgery is not performed if the activities of daily life are minimally impacted by the tear.
Frozen shoulder occurs when adhesions occur between the tendons of the rotator cuff muscles and the connective tissue forming the joint capsule that encloses the bones of a joint.
There is a lot you can do for yourself to address muscular tension that contributes to your shoulder pain.
If your mobility allows, you can easily massage the muscle bellies on the top of the shoulder blade using your finger tips or thumbs. The supraspinatus is just deep to the trapezius muscle on the top of the shoulder blade. The infraspinatus and teres minor are superficial muscles found on the broad flat surface just below the bone ridge called the “spine” of the shoulder blade. If you can not reach around back of your shoulder with your fingers, lay on a tennis ball positioned on the shoulder blade and move around pressing the muscles against the tennis ball to massage the tender areas. Foam rollers can also work here but they tend to be too broad with the pressure contact. Tennis balls work much better and a golf ball, although much less forgiving, can apply more specific pressure than a tennis ball. The best idea is to have someone else press into those muscles for you.
The muscle belly under the shoulder blade (subscapularis) requires you to curl your fingertips under the outer edge of the shoulder blade.
To address the tendon attachments to the top of the humerus where the “cuff” is formed you will have to position the arm to the side in order to relax and soften the deltoid muscle. This allows you to press through the muscle toward the top of the arm bone. Then you can move your fingertips across fiber direction to spread the connective tissue apart and restore circulation and flexibility to the tissues.
While you are pressing into the tendon attachment it is a good idea to move the humerus around. Combine pressure with your fingers or thumb with the movement. By orchestrating the pressure and movement you can tease the tissues apart and restore motion. It may be a little painful depending upon the length of time that has passed. If there is no inflammation in the area at the beginning, using moist heat to the tissue to loosen it up before you start the massage work is a good idea. After you apply the fingertip massage it is a good idea to follow up with ice application.
Of course, you can always make an appointment with a professional massage therapist who has experience and training in addressing these muscles. Be certain to ask the therapist about their qualifications prior to scheduling an appointment. Click here for guidelines for choosing a professional therapist.
|Above: a) Suoraspinatus muscle; b) infraspinatus muscle; c) teres minor muscle; d) tendonous attachment site (cuff);|