Rotator Cuff Tears

rotator cuff tear anatomy shoulder

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Rotator cuff is a group of 4 muscles and their tendons that together form a « cuff » around the head of the humerus (upper end of the arm). The 4 muscle, originate from the scapula (shoulder blade), are upraspinatus, infraspinatus, subscapularis and teres minor. Tendons of each muscle fit on the humerus tuberosity.

Rotator cuff’s functions :

  • Lift the arm

  • Turn the arm

  • Stabilize the humerus in the joint

Causes

rotator cuff tear anatomy

The causes of a rotator cuff tear can be an acute injury such as a fall or because of chronic wear with tendon degeneration. For people over 40 years old, the pinching of the tendon on the underside of the scapula may participate in tearing.

Diagnosis

Diagnosis of rotator cuff tears is based on an examination and/or diagnosis study such as a MRI (magnetic resonance imaging) to confirm the diagnosis. Diagnosis early on in the first symptoms and rotator cuff’s treatment can help to boost the treatment’s results.

Treatment

Goals treatment are to relieve pain and restore strength to the injured shoulder. Several tears in rotator cuff can be treated without surgery. Anti-inflammatory drugs, steroid injections and physical therapy can all be beneficial in treating the symptoms of a tear in the cuff.

Even though a full-thickness tear needs to be cured with surgery, it’s possible to use non-surgical treatments to have a satisfactory function in some cases.

Surgery

rotator cuff tear anatomy surgery

Surgery is recommended if there is persistent pain or shoulder weakness that doesn’t improve with non-surgical treatment. Often patients who have surgery indicate nocturnal pain and difficulty using the arm for lifting and reaching. Many will indicate persistent symptoms despite several months of treatment and limited use of the arm.

Surgery is also recommended for active people who use the arm for overhead work or sports.

Surgical options

The type of repair performed is based on the findings at surgery. A partial tear my necessarily only a trimming or smoothing procedure called a debridment. A full-thickness tear with the tendon torn from its insertion on the humerus is repaired directly on the bone.

3 techniques are used for rotator cuff repair :

  • Open repair (through a traditional incision)

  • Mini-open repair (partially assisted by a camera view, with a smaller incision)

  • Arthroscopic (performed with only a small camera inserted through multiple small puncture wounds)

Recovery and rehabilitation process

Whether for the treatment of non-surgical and surgical rotator cuff tear, rehabilitation has a very important role. Usually recovery is at least 6 months or more depending on the extent of the tear.

When there is a tear, there is frequently a loss of shoulder movement. An exercise or physical therapy program is needed to restore strength and improve shoulder function.

Although surgery repairs the defect of the tendon, the muscles around the arm remain weak and an important effort is necessary in the rehabilitation so that the procedure is a success. After surgery, a complete re-education can last several months.

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-Steph

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General Stretching Of The Upper Body

stretching upper body

What’s up ? This is THE stephane ANDRE ! I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Stand with your feet a little wider than your pelvis width and you back is straight :

  • Hold your ams vertically with your hands clasped and your fingers crossed. Your palms directed upwards :

  • Inhale to inflate your lungs to the maximum and stretch your intercostal muscles. Push your palms up keeping your back and head upright.

  • Exhale slowly by relaxing and starts again.

This stretching exercise stretches intercostal, rectus abdominis, latissimus dorsi, teres major, triceps. When you incline your torso laterally, you stretch more your external oblique and internal oblique, quadratus lumborum and the internal and medium part of your erectors spinae.

stretching upper body lateral

Note

This stretch is great for relaxing the body after a training with heavyweights like leg press, squat, deadlift because the ribcage and spine have been compressed.

This movement may occasionally replace or supplement the stretching at the bar  to rebalance the pressure and tensions of the intervertebral joints.

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-Steph

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Stretching At The Bar

stretching bar back

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Suspended at the fixed bar with the hands apart and with a pronated grip (thumb inwards) :

  • Inhale and exhale slowly focusing on the relaxation of your body. This allows you to relax your back and rebalance the pressure inside the intervertebral discs (the discs that connect the vertebrae to each other).

  • When you feel your muscles relaxed, lower you head forward to try to touch your sternum with your chin. This allows you to stretch the middle and the top of your back.

To increase the stretch, you can ask a person to grab your hips and pull you slowly down or you can swing slightly.

This stretching is essential. When you do it regularly at the end of deadlift, squat or other exercise that compresses the spine, this allows you in the long term to limit the deterioration of your intervertebral discs. This means that this stretch reduces the risk of spinal disc herniation.

Variant

With a tight grip, you stretch more the latissimus dorsi and teres major.

Note

When you do this stretch, it’s possible that you hear cracking of the spinal column followed by a pleasant sensation of release and relaxation of the back.

Don’t worry, these crackles have no gravity. It’s because of the relaxation of the paravertebrale muscle that allow the brutal decompression of the small intervertebral and costovertebral joints. This make the same effect as a suction cup that you take off.

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-Steph

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Biceps Tendon Rupture

biceps brachiitTendon rupture

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Rupture or tear of the biceps long head is the serious injury the most frequent in sport

This injury usually appears on a muscle weakened by tendinitis caused by a sudden movement of the arm. Sudden arm movements are usually thrown like baseball, tennis, throwing sports and also Olympic weightlifting during the snatch. At this point, all tension transferred to the biceps long head which breaks most often where the tendon passes into the intertubercular sulcus of the humerus.

In bodybuilding, this injury is a little different, especially with the deadlift.

There is a technique in deadlift which consists of having a hand with a pronated grip and the other with a supinated grip to lift heavier weights and to avoid that the barbell rolls in the hands.

This simple technique is at the origin of the rupture or the disinsertion of the lower of the biceps (where the muscle is inserted on the humerus). Fortunately, this injury rarely happens.

During the positive phase of the deadlift, the muscles that work are legs, glutes, back and abs. Arms relaxed but they stretched as cranes cables.

Unfortunately, when a hand is with a supinated grip this shortens the biceps (the biceps is extremely powerful with a supinated grip). The result is that there is tremendous tension due to the heavy weights which cause the tearing or total rupture of the tendon of the radius. The biceps with a supinated grip works more than the biceps with a pronated grip.

In the deadlift, the injury is exclusively on the distal tendon of the muscle. The arms hang along the body, which causes the tension to be distributed at the top of the muscle between the tendons of the short head and the long head. For other exercises when the tension is at the bottom of the muscle, the tension is supported on a single tendon insertion.

biceps brachiitTendon rupture

The rupture of the biceps tendon causes a pain relatively moderate compared to the severity of the injury. If we compare the rupture of the biceps tendon with the major pectoralis or the adductors of the thighs, the pain is different. With a rupture of the major pectoralis tendon or adductors of the thighs, the suffering is so strong that the athlete must stop the effort.

It often happens that during a powerlifting competition, athletes who have a rupture of the biceps tendon during the deadlift, continue until the end of the movement.

When this injury occurs, there is swelling in the forearm because of hemorrhaging. But the most surprising thing is the retraction of the biceps which forms a ball at the top of the arm near to the pectoralis major and deltoid. This biceps retraction causes the brachial muscle in the lower arm to be more exposed.

biceps brachiitTendon rupture

It’s always possible to make a flexion of the arm with the rupture of the muscle, which less powerful than before, thanks to the brachial muscle, brachioradialis, long and short radial extensor of the carpus and the pronator teres muscle. On the other hand to make a movement with a supinated grip is a problem because the end of the movement is only carried out by a single muscle, the supinator muscle.

You have to be careful because this injury should be treated quickly by surgery to restore the brachial biceps tendon to the radius. If this surgical operation is not performed in time, the ball will have a fibrous transformation and retraction will be final. The arm’s mobility will always be possible but the loss of strength in flexion and supination is inevitable.

There is a solution to avoid this type of injury with deadlift with a bicep work to have a tendinous reinforcement. This exercise is to do a flexion only with forearms with a straight barbell. This exercise reinforces the biceps distal tendon but be careful by controlling the movement.

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-Steph

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How To Do T-Bar Rows

t bar rows

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Podcast:

Lying on the belly on the inclined bench and take the handles with a pronated grip :

  • Inhale and brings the bar to your chest

  • Exhale at the end of movement

This exercise is similar to the barbell bent rows but it allows a better work of the back muscles because there is less need to focus on the body’s positioning.

This exercise works latissimus dorsi, teres major, posterior deltoid, arm’s flexor (biceps, brachialis, and brachioradialis), rhomboids and trapezius.

The machines with a belly support allow to focus less on the positioning, abs and spinal erectors don’t work. When there are very heavy weights, the rib cage can be compressed on the ventral support and this hinders breathing. When it’s difficult to breathe, doing the exercise is unpleasant.

Note

With a supinated grip, this exercise especially works the brachialis and the upper part of the trapezius at the end to the pull.

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-Steph

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How To Do T-Bar Rows On Feet

t bar rows feet

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Podcast

Knees slightly bent with the bar between your legs. Your take the handles with a pronated grip. Your back is straight and you incline your torso at about 45° :

  • Inspires and brings the bar to your chest

  • Exhale at the end of the movement

This exercise is similar to the barbell bent rows but it allows a better work of the back muscles because there is less need to focus on the body’s positioning.

This exercise works latissimus dorsi, teres major, infraspinatus, rhomboids, the middle part of trapezius and arm’s flexors (biceps, brachialis, and brachioradialis).

Incline your torso works your abs and spinal erectors isometrically.

With a supinated grip, this exercise especially works the brachialis and the upper part of trapezius at the end of the pull.

There are some machines that allow you to have a semi-pronation grip. With a semi-pronation grip, you intensely work the forearms muscles, especially the brachioradialis.

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-Steph

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How To Do Barbell Bent Rows

barbell bent rows

I read a Frederic Delavier’s book « Strength Training Anatomy » and I learned good stuff.

Podcast :

Standing with your knees slightly bent. Your have your back straight and incline your torso around at 45°. You take the barbell with a pronated grip and your hands are wider than your shoulder’s width. Your arms relaxed :

  • Inhale, block your breath and squeeze your abs. Pull the barbell to your torso.

  • Returns to the starting position and exhale.

This exercise work latissimus dorsi, teres major, posterior deltoid, arm’s flexor (biceps, brachialis, and brachioradialis).

When your shoulder blades get closer, your rhomboids and trapezius also work.

Incline your torso works your spinal erectors isometrically.

This exercise has several variants like the hand width, pronated or supinated grip or torso inclination allow you to work your back in different angles.

Attention

It’s important to keep your back straight because if you rounded your back during the movement, you risk having injuries.

Share this article if you think it can help someone you know Thank you.

-Steph

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