Infraspinatus Tear Information
Rotator Cuff Injuries
The muscles of the rotator cuff provide the greatest range of motion of any joint in the body. Shoulder pain is more common in people with a forward head and shoulder posture. As the shoulders move forward it places more stress on the muscle when it stabilizes shoulder movements. Eventually the muscle becomes shortened, which reduces your ability to stabilize the scapula, pull your arm backwards, and move your shoulder. This infraspinatus limitation makes it more likely for people to develop either infraspinatus tendonitis or supraspinatus tendonosis. Sprains are common where the muscle begins to turn into tendon. The tendons insert on the side of the humerus. These locations tend to be tender to palpitation.
The infraspinatus muscle starts on the back of the scapula under the bony ridge and runs to the top of the humerus. It is triangular in shape, with it becoming more of a point near the humerus insertion. The muscle can become damaged anywhere but is more common closer to the shoulder. This muscle has two important jobs:
- Lateral rotation of the arm: contraction of this muscle rotates the arm to the outside at the shoulder. The simple act of raising your hand to wave hello to someone is a good example of the infraspinatus muscle at work (among others).
- Stabilize the shoulder joint: As one of the rotator cuff muscles, the infraspinatus contracts to stabilize the shoulder joint and keep the head of the humerus from slipping out of its socket during shoulder movement.
The infraspinatus gets some help with its job from some of the other muscles in the shoulder. The teres minor and deltoid muscles assist with lateral rotation of the arm, and the other rotator cuff muscles team up to assist with stabilizing the shoulder joint during various arm movements.
When it is injured it can be painful to pull the arm backwards, reach straight out in front of your body, or grab your seatbelt. Most people are surprised by how much the infraspinatus muscle is involved in their daily activities until they strain the muscle, and feel the pain with use. When the muscle is hurt the pain can radiate from the shoulder blade to the side of the shoulder. The muscle can be tender at the injury site, or radiate down the arm. A dull ache that becomes sharp with movement is common. A bad trigger point will radiate down to the elbow. A trigger point is an area of muscle that has been injured to the degree that it radiates pain to other areas. Mild muscle injuries hurt at the location of the injury only. Worse injuries radiate pain a couple inches. Bigger muscle injuries radiate pain to other areas of the body.
What are the four muscles of the rotator cuff?
The rotator cuff is a group of four muscles that combine at the shoulder. The four individual muscles keep the shoulder joint stable. These muscles control the elevating and rotating motion of the arm. The names of the four muscles are the supraspinatus, infraspinatus, teres minor and subcapularis.
The supraspinatus elevates the shoulder joint and works with the other muscles to keep the head of the humerus bone stable within the shoulder joint. The supraspinatus muscle resists the gravitational pull on the shoulder created by the weight of the arm. This muscle is the most commonly injured of the four rotator cuff muscles.
The infraspinatus along with the teres minor controls external rotation of the shoulder. It carries the arm backward. The infraspinatus also helps keep the humerus bone stabilized in the shoulder joint. This muscle is the second most frequently injured of the four rotator cuff muscles.
The subcapularis controls in the internal rotation of the head of the humerus. It brings the humerus forward and down when the arm is raised. The subcapularis provides strong protection to the front of the shoudler joint and prevents displacement.
The teres minor, along with the infraspinatus, acts to rotate the arm in an outward manner. It works with the other rotator cuff muscles to keep the shoulder joints stable. The term "teres" means smooth in Latin. It is easily fatigued and can sometimes cause pain in the third and fourth fingers.
Because it has a poor mechanical advantage, the infraspinatus is a relatively weak muscle in most people. If it is called upon to suddenly perform heavy exertion, it can easily strain or tear. Some people have a minor strain of the infraspinatus tendon that continues almost unnoticed for years. They may experience slight discomfort when reaching for something on a high shelf or into the back seat of the car. However, when this minor lesion does not heal properly, it can set the stage for a more severe injury later.
When a strain of the infraspinatus tendon occurs, the person frequently feels nothing at the moment because the tendon is warmed-up or because the person is focused in the heat of the moment during an athletic activity. Later that day or the next morning, difficulty putting on a shirt or coat may occur, as the arm is lifted up and out to the side.
With infraspinatus tendonitis, pain is felt in the upper-arm region, sometimes slightly toward the back of the arm, but not always. When the injury is severe, pain can travel to the wrist. During the verification tests for this injury, pain will often be felt down the back, front, or outside of the upper arm and occasionaly over the scapula. Severe infraspinatus tendonitis may complain of pain down the arm as far as the wrist, but this pain pattern occurs only in extreme cases of this injury.
Two to three months of rest will sometimes allow infraspinatus tendonitis to heal, but more often it will remain for years, especially in an active person. Tendon injury exercise, along with rest may improve the condition. Treatment is usually recommended if rest and exercise don't elimate the pain in the course of a month. Hitting backhand in raquet sports is not a good idea while in treatment, nor are any exercises that cause pain such as push-ups and chin-ups.
The infraspinatus tendon is not one that is damaged easily. Most damage that will be done to the infraspinatus tendon will not cause any physical pain and subsequently won't be noticed unless another muscle in the rotator cuff is also damaged. Therefore surgery on this muscle is extremely rare.
Most cases of infraspinatus tendon surgery were accompanied with the primary concern of the supraspinatus tendon being injured. The supraspinatus tendon commonly is injured due to a fall. When one falls and extends their arms out, they are at risk of injuring the rotator cuff muscles. Following the injury if by completing physical therapy the rotator cuff does not show any sign of improvement, surgery will be completed.
Rotator cuff repair surgery for a tear from a sudden injury works best if it is done within a few weeks of the injury. With that being said, the repairs to very large tears are not commonly commonly successful. Rotator cuff repair surgery to repair frayed or thinned tendon tissue is less likely to work than surgery to repair an injury to a healthy tendon.
Very large tears (greater than 5cm) or if they are involving more than one rotator cuff tendon often cannot be repaired, with the exception of grafting. Grafting and patching procedures are possible, but they are not much better than restoring strength than debridement and smoothing, which are less risky and require less rehabilitation.
Infraspinatus tears can be caused by an acute injury or from wear and tear of the tissue over time. Causes of acute infraspinatus tears include:
Causes of degenerative infraspinatus tears include:
Symptoms of an infraspinatus tear are often not noted until another muscle in the rotator cuff is injured as well. The infraspinatus tendon is not an easy tendon to injury, and due to the limited use of this tendon the symptoms of injure are not often noted.
General injuries to the rotator cuff, which includes the infraspinatus tendon present the following symptoms:
Front of shoulder pain: This is the hallmark symptom for the infraspinatus trigger points. The pain often feels like it is deep within the shoulder joint, causing many people to believe that the shoulder itself is damaged.
Inability to reach behind the back: Some people report that they are unable to reach behind their back to fasten a bra or get their wallet out of a back pocket. These movements require significant internal rotation of the shoulder, which stretches the tense muscle and aggravates the trigger points within it.
Inability to raise arm up to head: Reports that people are unable to raise their arms to wash their hair, brush their teeth, or even bring food to their mouth while eating.
Inability to push with arms: Complaints of shoulder pain are reported when using their arms to push up out of a chair or when pushing up out of bed in the morning. Weight lifting exercises like the bench press, inclined bench press, and military press are nearly impossible with active infraspinatus trigger points.
Shoulder pain at night: Infraspinatus trigger points can be a double-edged sword when trying to sleep on your side. If you lay on the affected shoulder, the weight of the upper body can compress the trigger points and produce referred pain. If you lay on the unaffected shoulder, the upper arm may hang down in front of the body and place the affected infraspinatus in a prolonged stretched state, aggravating the trigger points again. In severe cases, you may be forced to sleep in a sitting position to prevent the pain from disturbing your sleep.
Bicepital Tendonitis: The role that infraspinatus trigger points play in many cases of bicepital tendonitis deserves special mention. This condition is characterized by tenderness and pain in the biceps brachii (front) region of the upper arm, and is prevalent in baseball pitchers, football quarterbacks, and tennis players. There haven't been many cases of bicepital tendonitis, but every case was easily resolved by deactivating infraspinatus trigger points.
Shoulder pain that is short-lived may be evaluated by a family doctor. See your doctor right away if you have a sudden loss of motion after an injury - you could have a substantial rotator cuff tear. If you have pain lasting longer than a few weeks or you've been formally diagnosed with a rotator cuff tear, you need to be seen by a shoulder specialist, because some of the surgical procedures are time sensitive.
Taping your infraspinatus can help provide your damaged tissues with bonus support and protection. This works to help prevent re-injury. Sports tape can be worn during all of your daily activities but is particularly effective when worn during exercise.
While we found the taping application below effective for infraspinatus injuries, please feel free to try out various infrapsinatus taping applications in order to find the one that works best for you. There are plenty of tutorials and instructions online. Just remember to pay attention to your pain. If you're feeling pain in a specific area of your shoulder, apply the tape there.
Since the tape needs to be applied to the back of your shoulder, you will likely need someone to help you. Before taping your shoulder, make sure the area is dry and free of any lotions, oils or dirt.
1. Take a full length piece of tape (about 10 inches) and tear the backing off one end.
2. Using no stretch, anchor the tape just below the bone that protrudes from the side of your shoulder.
3. Remove the rest of the backing from the tape, and using 25% stretch, pull the tape towards the back of your shoulder, going just below where the top of the shoulder blade protrudes. Lay down the end of the tape with no stretch.
4. Take another 10 inch piece of tape and cut it in half, rounding the corners, so you have two 5 inch strips of tape.
5. Take one of the 5 inch strips and tear the backing in the middle, peeling it away so you are holding onto the two anchor ends.
6. Using 80% stretch in the middle and no stretch at the ends, apply the tape vertically along the side of your shoulder.
7. Take the other 5 inch strip of tape and tear the backing in the middle, peeling it away so you are holding onto the two anchor ends.
8. Using 80% stretch in the middle and no stretch at the ends, apply the tape vertically right beside the one you just applied, but closer to your shoulder blade.
9. Rub the tape into your skin to make sure it sticks.
Rest: Following an injury, the first thing that should be done is to rest the affected area. Immobilising the affected area will allow your body to begin the healing process for the infraspinatus tendon. Just like a cut that scabs over, internally your body does the same thing.
Cold Compression: Cold alongside compression will help reduce the inflammation making room for the next steps. Cold is essential for relieving pain, reducing inflammation, and with that reduced inflammation, the blood will be able to travel more freely to the injury site.
Increased Blood Flow: Devices are available, and are much better options, that are specifically designed to generate optimal blood flow to the affected area. Increased blood flow will bring nutrient rich blood to the affected area helping to decrease healing times.
Pain Killers: Pain killers should only be used if daily activities are completed. Using pain killers to 'get through the day' is not good. Masking pain will cause more damage that won't be felt until the anti-inflammatories wear off, and increase healing times.
Stretching: Stretching is important to all forms of treatment. Stretching will ensure that the muscles stay strong and that they don't start deteriorating. The most common cause of a secondary injury is due to the fact that the muscles haven't been maintained properly.
Forum Content from the Health Care Company King Brand®
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Re: Shoulder pain
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