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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.
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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.
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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.
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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.
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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.
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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”).
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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.