Memorandum   Subject: Assignment 2: Writing to Describe and Define

To: Professor Ariadne Rooney

From: Chris Campbell

Date: September 17, 2013

The purpose of this memo is to explain the rotator cuff and how they are properly treated if injured.

The rotator cuff consists of muscles and corresponding tendons that word together to stabilize the shoulder.

Audience:

The audience consists of patients who are about to begin physical therapy that have had problems with their rotator cuff. Most of these patients have a very limited knowledge of what the rotator cuff is and how to overcome their injury. Most likely, the patients only know that their shoulder hurts when doing various movements.

Purpose:

When patients have an injury to their rotator cuff, they should have a foundation of anatomical knowledge of their injured area. This technical definition and description will be used as an educational tool for patients in the waiting room to read before they undergo their first physical therapy session. The writing is designed define term types within the rotator cuff so patients will know all of the components. The explanations will be discussed in basic terms so patients can clearly understand.

Problem:

Patients with pain or discomfort in their shoulders often wish to know more about how the shoulder muscle works and how to ease the pain. It is essential that the patient does not overexert their rotator cuff while rehabilitating the injury. I will utilize purposeful definitions and descriptions to help physical therapy patients fully understand their rotator cuff injury and the therapist’s role in their recovery. Often physical therapists will give their patients exercise homework to do at home and the patient’s adherence is poor. If the patient increases their knowledge about their condition, then their willingness to practice exercises at home will surge.

Placement:

This information will be given to rotary cuff patients in an informational packet that they will read in the waiting room of a physical therapy clinic.

Choices to Extend Definition:

I implemented useful analogies and some cause and effect examples to extend my definition. The main pattern that I used was defining term types that are subdivisions of the rotator cuff. I chose the visual in the extended definition to show the defined muscles of the rotator cuff and where the rotator cuff lies in the relation to the whole body. After patients learn the basics about the rotator cuff in the technical definition, they will learn how to rehabilitate an injured rotator cuff (how does rehabilitation of the injury work?) in the technical description.

Extended Technical Definition

The rotator (musculotendinous) cuff consists of the muscles and tendons that stabilize the shoulder joint by holding the head of the upper arm into the glenoid fossa of the shoulder blade. The muscles that make up the rotator cuff amazingly work together to create the joint with the greatest range of motion in the entire body. Similar to the hip joint, the rotator cuff allows movement in every direction. The rotator cuff is used for many everyday tasks such as brushing teeth and cooking dinner. There are four main muscles that compose the entire rotator cuff:

• Supraspinatus • Infraspinatus • Subscapularis • Teres minor

Supraspinatus

The Supraspinatus muscle is located in the shallow top portion of the shoulder blade (scapula). When this muscle is contracted, it allows arm movement away from the body. When there is a movement of a limb away from the body it is also called “abduction.” Beyond moving the shoulder more than 30 degrees away from the body, the supraspinatus muscle helps stabilize the joint while aiding the deltoid muscle.

Infraspinatus

The Infraspinatus muscle resides below the supraspinatus on the backside of the shoulder blade. In addition to stabilizing this joint, the infraspinatus helps rotate the arm away from the body.

Figure 1: Anatomical view of the rotator cuff muscles (Shoulder Injuries- A Very Common Injury). The picture on the left side is a view of the left backside of the shoulder blade.

Subscapularis

The Subscapularis muscle is connected to the part of the shoulder blade that faces the ribs. It rotates the arm toward the body as well as stabilizes the shoulder joint. This muscle may be utilized to brush teeth or clean dishes. The Subscapularis is the most powerful muscle of the rotator cuff and can have a huge impact on shoulder mobility if it is injured.

Teres Minor

The Teres Minor muscle is the on the lateral border of the infraspinatus and shoulder blade. The tendon attached to the Teres Minor inserts at the head of the bone of the upper arm. This muscle has two actions: rotate the arm away from the body and move the arm back towards the body.

An injury to the rotator cuff can be due to an acute traumatic event or chronic “wear and tear” over the years. For instance, an old pair of jeans will fray over time near the knee region just as the tendons of the rotator cuff can be frayed after many years of use.

Developed Technical Description

Causes of rotator cuff injury

An injury or irritation to the rotator cuff can be caused by tendinitis, bursitis, poor posture, falling, lifting or pulling, and repetitive stress. The suffix “itis” indicates inflammation of the area. Tendinitis forms when there is repetitive stress due to overuse or overload. Often tendinitis will happen to athletes who perform activities where the arm is swung overhead such as tennis or basketball (“Rotator Cuff Injury”). Bursitis is the inflammation of the sac of bursa, which contains synovial fluid between joints in the body. This fluid filled sac works like the oil in a car as it lowers the friction of your joints. Poor posture can also contribute to a rotator cuff injury because it can allow a tendon to be pinched under your shoulder bones. Poor posture is a common issue in today’s society when many jobs involve sitting at a desk most of the time. When trying to protect the rotator cuff, it is important not to lift or pull an object overhead that is too heavy (Rotator Cuff Injury).

Compounding factors

There are a few lifestyle factors that can predispose some individuals to a rotator cuff injury. For instance as one gets older than 40, a rotator cuff injury becomes much more common. Being an athlete may also increase risk of a rotator cuff injury if it involves repetitive swimming or pulling motions. Various jobs can also play a big role in an injury if it causes high stress to the shoulders such as carpentry painting, or construction. Weak shoulder muscles can also cause an injury because there will be less protection if a traumatic event occurs.

Interventions

Once an injury is sustained in the rotator cuff area it is important to treat the area with care. The acronym R.I.C.E. can be used in this situation: rest, ice, compression, and elevation. It is essential to get adequate sleep and try not to overexert the affected shoulder(s). If the shoulder becomes inflamed after an acute injury or becomes overused, then ice may be applied. Ice can be applied with a bag of frozen vegetables, a cold pack or a towel filled with ice cubes. Use ice for 15 to 20 minutes at a time every couple of hours for the first few days after the injury. A hot pack or heating pad should be used to relax the muscles after about three days when the inflammation has improved. If the pain prevents focus on other day-to-day activities or is unbearable then pain relievers may help.

The role of physical therapy in rehabilitation

The two main categories of a rotator cuff tear are acute and chronic. An acute rotator cuff tear is a result of a traumatic event or an “instant tear.” A chronic rotator cuff injury is a result of constant stress to the area. Once it is determined that a serious injury has not occurred with an acute tear, then the physical therapist can begin to implement strategies to strengthen the area.

For chronic patients, physical therapists can teach the patient how to correctly exercise the joint to maintain and improve mobility while decreasing pain.

There are three main exercises that strengthen the rotator cuff and prevent future injury. All three of these exercises can be done with an exercise stretch band anchored in a doorframe and the band should be placed 30 degrees below parallel in the door (Rotator Cuff Exercises). The first exercise begins with the arm at a right angle in front of they body and then rotates at the shoulder away from the body. With this exercise the elbow should be bent at 90 degrees and posture should be straight. The second exercise is scapular retraction, which means that the shoulder blades are pulled together. The patient will face the door and then pull backward on the bands. It can help to imagine that someone’s hand is in the middle of the back and the patient is trying to “grap” the hand with the shoulder blades. The third exercise starts with the arm at a right angle in front of the body and then rotates at the shoulder towards the body. The amount of repetitions will vary depending on the severity of the injury, but usually it will start at 2 sets of 10 repetitions and then work up to 30 repetitions (Rotator Cuff Exercises).

Figure 2: The 3 main exercises to improve rotatory cuff injury strength (“Rotary Cuff Exercises”).

 

Citations:

Shoulder Injuries-A Very Common Injury. Photograph. Iron Impact Fitness. Nd. Web 9/23/13.

Rotary Cuff Exercises. Pilates and Mind Body Mastery. Oct. 30, 2011. Web. 9/23/13.

Rotator Cuff Injury. Mayo Clinic. Nd. Web. 9/23/13.