rotator cuff tendonitis

[alophysio]

Hi,

The reason i wouldn't do mobilisations is because stiffness doesn't seem to be a problem. Sharileedahl is right in that there might be other reasons to do it but after 6 years, there are bigger fish to fry...

1. Soft calcification - no idea what that means but if the calcification is in the tendon, then perhaps she has sustained repeated small traumas and there is calcification in the tendon INLINE with the tendon as opposed to the hard blobs we can sometimes see. In that case, it might be a stress reaction to tension as opposed to a reaction to a tear/other injury - hope you understand what i mean there!

2. If the pt's internal rotation is deficient, then the inferior band of glenohumeral ligament might be tight. For this, Burkhart recommends lying on the affected side in 90deg ABD with elbow at 90deg then internally rotating to stretch. See attached.

3. How is her serratus anterior function, upper traps function ?? A common mistake in these cases is to train the rhomboids with retraction which is terrible (IMHO) because the orientation and function of rhomboids is to downwardly rotate the scapula. Combine this with an overactive lev scap and suddenly you have a nice recipe for repeated impingement. Upper traps' function is to pull on the distal third of the clavicle and jam it onto the SC joint on the sternum. Then help the scapula upwardly rotate via the CLAVICLE (there is no upper traps attachment on the scapula). The axis of rotation starts from the base of the spine of the scap until EOR where the AoR is at the acromion part of the spine of the scap. Bogduk has a good paper from 1994 about it - see attached too!

Hope that helps. Don't forget to check her neck and her thoracic function. Basically, work on the dysfunctions that are leading to the reason why she is aggravating the pain producing structure. These dysfunctions are often not painful. I haven't mentioned things like lat length (or any other muscle length) or any of the other usual things that physios do.

personally i would get more active so she understands that the answer to her problems lie with her discipline in her exercises...you are there to do the things she can't - diagnose, observe, treat and correct problems she doesn't have the knowledge to do herself.

Good luck