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Unraveling the Mystery of Shoulder Pain #3: Infraspinatus

Muscle-Tendon Injuries

Instructor: Ben Benjamin, Ph.D.

Instructor: Ben Benjamin, Ph.D.

ben@benbenjamin.com

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Webinar Goal

Explore the assessment and treatment of infraspinatus muscle-tendon unit injury.

Logistics •  Time: 1 hour

•  Schedule: •  Presentation 30–40 min •  Questions 15–20 min

•  Ongoing questions: Use Question box. If I don’t get to your question, ask me on my Dr Ben Benjamin Facebook page after the webinar.

•  Get a pen and paper please

Pretest 1. The infraspinatus muscle tendon unit is the primary mover when

a. serving in tennis b. hitting backhand c. hitting forehand d. none of the above

2. The infraspinatus muscle tendon unit is usually as strong as strong as the biceps.

True or False? 3. When the infraspinatus muscle tendon unit is injured lying on

either side is often painful. True or False?

4. The antagonist to the infraspinatus is the: a. supraspinatus b. subscapularis c. teres major and minor d. pectoralis and subscapularis

5. The infraspinatus muscle works with the teres major to laterally rotate the shoulder.

True or False?

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Anatomy

Infraspinatus Muscle-Tendon Unit

•  Extends from the infraspinous fossa of the scapula to the greater tubercle

Infraspinatus muscle

Infraspinatus tendon

Teres minor

Infraspinatus Muscle

•  Attached to and covered by the infraspinatus fascia

•  Infraspinatus fascia separates it from teres major and minor

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Infraspinatus Tendon

•  Glides over the lateral border of the spine of the scapula

•  Passes over the posterior of the shoulder-joint capsule

•  Inserts into the greater tubercle

•  Sometimes separated from shoulder-joint capsule by a bursa

Infraspinatus Function

•  Works as external rotator of the glenohumeral joint

•  Abducts the arm

The Rotator Cuff: Infraspinatus and Teres Minor

•  Rotate the head of the humerus outward into external rotation

•  Work together to allow the arm to reach backward

•  Compared to the teres minor, the infraspinatus is the major external rotator

•  Infraspinatus is the second most often injured rotator cuff muscle

Infraspinatus muscle

Infraspinatus tendon

Teres minor

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Assessment

Assessment Tests

•  Resisted lateral rotation •  Resisted lateral rotation (30 degrees) •  Passive Elevation •  Painful Arc •  Horizontal Adduction

Resisted Lateral Rotation

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Resisted Lateral Rotation from 30 Degrees

Passive Elevation

Painful Arc

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Horizontal Adduction

Theory

•  Pain on resisted lateral rotation: infraspinatus is injured

•  Other tests tell you injury location

•  Other tests are only necessary to do specific scar tissue work

Assessment Test Results for the Infraspinatus

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Clinical Reasoning Questions

What muscles do you use when: •  Taking off a sweater overhead? •  Hitting a ball with a bat? •  Reaching to the side (abducting) with your

thumb facing down? •  Reaching behind you to get something in the

back seat of your car? •  Grabbing your bag in the backseat and lifting

it to the front seat next to you? •  Lying on your side in bed?

Opportunity to Test AIS

These were the symptoms I had:

•  When I reached into the back seat of my car to get something, it was painful.

•  When I was lying on my side, after a while my shoulder began to hurt.

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Treatment

Watch the videos at the end of the Webinar

Friction

Watch the videos at the end of the Webinar

Tendon Injury Exercise Program (TIEP)

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1.  Warm up

2.  Stretch

3.  Strength

4.  Stretch

5.  Ice

TIEP Exercise Therapy

Active Isolated Stretching

Questions

Facebook.com/DrBenBenjamin

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Reviews

Facebook.com/DrBenBenjamin

Post-test 1. The infraspinatus muscle tendon unit is the primary mover when

a. serving in tennis b. hitting backhand c. hitting forehand d. none of the above

2. The infraspinatus muscle tendon unit is usually as strong as strong as the biceps.

True or False? 3. When the infraspinatus muscle tendon unit is injured lying on

either side is often painful. True or False?

4. The antagonist to the infraspinatus is the: a. supraspinatus b. subscapularis c. teres major and minor d. pectoralis and subscapularis

5. The infraspinatus muscle works with the teres major to laterally rotate the shoulder.

True or False?

Continuing Education Credit

  You can get 1 CE credit for this Webinar for the National Certification Board and the AMTA, as well as Florida CE Broker.

  If you are in Florida call me at 617-576-0555.

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Off the Computer, and off to Costa Rica!

•  Accelerated assessment skills course •  Beautiful Pura Vida retreat center •  7 days: January 22-29, 2011 •  20 hours training, 88 hours vacation

Special Offer for the next 7 days

Call toll-free 1-866-331-PAIN (7246) For more information: www.benbenjamin.com

20% off any series

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http://www.benbenjamin.com/webinarFiles.php?id=783732218