Here is some of the information I recently shared in my June newsletter. Each newsletter has a specific focus.  This month is focused on shoulder and rotator cuff injury and rehabilitation information. If you would be interested in receiving my newsletter, please head over to my contact page and sign up.

TIDBITS and UPDATES

1. Booksreadr.org has several pdf's from leading treatment facilities, including Vanderbilt University and St. Luke's Elks Rehab, as well as other practitioners, focused on Shoulder Impingement Syndrome Treatment Protocols.

2. Shoulder Impingement Syndrome is also known as Painful Arc

3.  A study conducted by Gillooly, Chidambaram, and Mok and published in The Bone and Joint Journal indicates the Lateral Jobe Test may be a very reliable method of diagnosing rotator cuff tears.

4.  For a nice demonstration of the basic rotator cuff orthopedic tests, watch this vimeo from Geoffrey Gray.

5. For a brief article and video demonstration of Rotator Cuff Manual Centering.

STUDIES, ARTICLES, and RESOURCES

I receive a weekly update on anything published anywhere on the internet that includes information about rotator cuffs and shoulders.  Much of it is personal blogs, stories about athletes that are injured, etc., but some of the information can be helpful to practitioners.  I try to glean the best of the information to provide a brief synopsis of the information and a link to find the full item yourself.  If you have any problems with the links, please let me know, or if you come across any information that you think would be good to share, please also feel free to pass that information along to: info@dev.holistichealingarts.net

• 1. An article published by OA Sports Medicine by B. Haviv, titled Rotator Cuff Tears, Evaluation and Treatment: A Critical Review (Haviv B. Rotator cuff tears, evaluation, and treatment: a critical review. OA Sports Medicine 2013 Oct 01;1(2):20. ) geared to understanding the Epidemiology of sports injuries with a focus on the shoulder.  A summary of findings noted in the article:
  Studies report about 1/3 of the population suffers from shoulder symptoms during their lifetime
• One of the main causes of shoulder pain in the older population is rotator cuff tears
• The prevalence of rotator cuff tears in the general population is 20%.
• The Rotator Cuff moves and stabilizes the humeral head in the center of the glenoid by the principle of coupling forces.
• Imaging studies have shown that the prevalence of asymptomatic Rotator Cuff Tears is 30% and 65% in people older than 60 and 70, respectively.
• The source of pain in rotator cuff abnormalities is still unclear. It is known that a ruptured rotator cuff does not cause pain directly since there are many asymptomatic full-thickness tears.  It is generally believed that the subacromial bursa is a major source of pain and discomfort as it undergoes some friction during shoulder movement and has sensory nerve endings.
• The bursa is innervated anteriorly by the suprascapular nerve and posteriorly by the lateral pectoral nerve. It contains nociceptors and proprioceptors.  These receptors imply a reflex system that coordinates the rotator cuff maintenance of the humeral head position.
• Massive tears may cause shoulder instability, and when trying to elevate the arm, the humeral head sublimates anteriorly, preventing the deltoid muscle from efficiently abducting the arm. This is called pseudo-paralysis.

2. A report of a study out of Tufts Medical Center (Bannuru, Reveendhara) shows shock wave therapy could be beneficial for some types of shoulder injuries.  Shock wave therapy involves using sound wave pulses on the outside of the body.  The technique has been used to break up kidney stones.  It is being used in Europe to treat rotator cuff tendonitis with calcifications. Studies should a high percentage of patients with chronic pain do form calcium deposits in their joints and the shock wave therapy produces a decrease in pain and an increase in function. The treatment is not yet approved by the FDA. A few patients involved in a study in the US reported minor soreness or redness but few other side effects.  The therapy is also being considered for treating tennis elbow and plantar fasciitis.

3. Negative shoulder movements and stretching were shown to be effective for long-term treatment for chronic subacromial shoulder pain in a study performed at Linkoping University in Linkoping, Sweden by Hanna Hallgren and published in British Journal of Sports Medicine 2014. The study is only a starting point however since the sample size was small and only one therapist provided treatment.
The program consisted of six different exercises: two eccentric exercises for the rotator cuff (supraspinatus, infraspinatus, and teres minor), three concentric/eccentric exercises for the scapula stabilizers (middle and lower trapezius, rhomboids, and serratus anterior), and a posterior shoulder stretch. Each strengthening exercise was repeated 15 times in three sets twice daily for eight weeks. The posterior shoulder stretch was performed for 30-60 seconds and repeated three times twice daily. From week eight to week 12, the exercises were repeated once a day. The exercises were individually adjusted and progressed with increased external load by using weights and elastic rubber bands at the physiotherapist visits once every other week during the whole rehabilitation period.

4. A poly-l-lactic acid bioabsorbable patch has been designed to specifically reinforce surgical repair of tendons with large to massive rotator cuff tears. Preliminary study results show successful repair with functional improvement at 12 months and 42 months post-surgery.
5. A systematic literature review was conducted by the University of Alberta Evidence-based Practice Center in 2010 to examine the effectiveness of treatment for rotator cuff tears.  The review concluded that more research of higher quality is needed to determine the relative effectiveness of current treatments.  (Nonoperative and Operative Treatments for Rotator Cuff Tears: Future Research Needs).

6.  Ben Benjamin, PhD, wrote a very thorough article published in Massage Today (The Forgotten Rotator Cuff, Part 2, Massage Today, April 2014) with a focus on the Teres Minor muscle-tendon unit.  The article includes some very clear descriptions of orthopedic tests that can determine teres minor injury and defining some activities that can lead to teres minor injury.
He also has a follow-up article (The Forgotten Rotator Cuff Muscle, Part 4) detailing exercises for the Teres Minor and infraspinatus.
7.  Rotation Medical Inc. has received FDA approval for a new technology for repairing small rotator-cuff tears. The technology involves a collagen scaffold that is attached to shoulder tendons using a set of disposable instruments. This scaffold can spark new tendon tissue grown. A brief article and video showing the procedure can be found on bizjournal.
8.  A study, published in the Journal of Orthopaedic Science in September 2014, found night pain in patients with rotator cuff tears correlates with increased blood flow in the anterior humeral circumflex artery.
9.  And, for some news on the Complementary medicine front, a study published in the Journal of Bone and Joint Surgery in July 2014, found melatonin may help mediate nocturnal pain in shoulder disorders such as rotator cuff tears or frozen shoulder. The summary and links to the article can be found doctorslounge.