Rotator Cuff Treatment Diet

The Ultimate Rotator Cuff Training Guide

The Ultimate Rotator Cuff Training Guide is the most comprehensive manual available on the market today with A to Z information on injury, anatomy, clinically proven exercises, and step-by-step training techniques to alleviate & prevent these all too common shoulder injuries! It is packed full of over 40 descriptions and pictures of detailed exercises. Reveals 12 proven exercises you should be doing for your rotator cuff. Includes tips on how to avoid injury associated with risky traditional lifting exercises. Discover how poor posture and your own anatomy may lead to injury. Reduce the chances that rotator cuff tendonitis will sideline you or your clients. Immediate access to a proven 6 week rotator cuff training program for inflamed shoulders. Straightforward training outline for people with healthy shoulders. Finally learn how to end pain related to rotator cuff tendonitis/bursitis. Avoid surgery with a proven blueprint for fixing your shoulder injuries Read more here...

The Ultimate Rotator Cuff Training Guide Summary


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Effective Rotator Cuff Exercise Program

Here are the Benefits of The Effective Rotator Cuff Exercise Program: A list of rare but effective rotator strengthening exercises will be revealed. Common and uncommon rotator cuff stretching exercises are given. A suggested list of range of motion exercises will be demonstrated. You will discover a ready-to- use 12 week rotator cuff exercise program. Recommended rotator cuff strengthening exercises will be taught. An outline of pulley exercises for the rotator cuff will be explained. An introduction to the 7 structures that make up the shoulder joint. Discover the structures that stabilizes the shoulder joint. The 5 most common causes of rotator cuff injuries will be discussed. Be introduced to the 12 factors that influence the risk of a rotator cuff injury. Learn the 3 most common injuries that occur to the rotator cuff. Have common assessment and diagnostic tools explained to you. Review the 6 treatment options when it comes to rotator cuff injuries. You get my best rotator cuff exercise program that you

Effective Rotator Cuff Exercise Program Summary

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Author: Rick Kaselj
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Partialthickness Tears

Surgical management of partial thickness tears remains controversial a wide range of options exist, from conservative therapy to open rotator cuff debridement and repair. Prior to arthroscopic surgery, excision and repair of significant partial-cuff tears was common. However, since the advent of arthroscopic techniques, recommendations for the operative management of partial tears vary between investigators. Essentially, there are three surgical options debridement alone, decompression and debridement, and excision of damaged tendon with primary repair.

Diagnosis And Investigations

Primary or idiopathic frozen shoulder is diagnosed from the history and investigation. As has been stated, it is a diagnosis of exclusion after other causes of painful shoulder stiffness are precluded. As part of the assessment, an attempt should be made to define the particular stage that the disease is presenting. This designation is invaluable in informing the patient about their individual prognosis and their best treatment. Codman's original description of the condition is still valid (7). Pain, in the early stages, can be severe and usually radiates to the deltoid insertion. It is worse when the affected shoulder attempts movement but can also be present at rest, invariably interfering with sleep. The patient often notices a gradual loss of motion specifically, movements overhead and behind the back become difficult. Patients with rotator cuff pathology can also present with these complaints, which can lead to difficulties in diagnosis. Enquiries should be directed at...

Tendon Healing To A Bone Surface

Tendon healing to a bone surface can be observed in numerous structures, including the rotator cuff tendons in the shoulder, flexor tendons in the hand, tibial insertion site of the medial collateral ligament in the knee, and the Achilles tendon in the foot. This section focuses on the rotator cuff and the supraspinatus tendons, particularly, as representatives. It is interesting to note that the number of studies investigating tendon-to-bone healing in the knee joint far exceed those performed for the shoulder. This could be somewhat explained by the lack of an appropriate animal model of the rotator cuff tendons. Injuries of the rotator cuff tendons in the shoulder are among the most common problems that cause shoulder pain and dysfunction in adults. Cuff tear can be partial- or full thickness, acute or chronic, and traumatic or degenerative (56,57). Rotator cuff surgery is considered when nonoperative treatment fails to reduce pain and does not improve shoulder function. The most...

Coracohumeral Ligament

Delamination Tear Rotator Cuff

The CHL passes over the top of the shoulder and fans out laterally before joining the shoulder capsule. A small segment of the CHL blends with the rotator cuff attachments as it attaches to the anterior aspect of the greater humeral tuberosity. A larger segment extends posteriorly through the joint capsule (beneath the infraspinatus and over the bicep tendons) to attach to the lesser tuberosity of the humerus. By attaching on either side of the bicipital groove, the CHL provides a tunnel for the biceps tendon. Renditions of the CHL in the various layers of the rotator interval are shown in Fig. 3 (20,26, 28,31,32).

Clinical Significance

Postmortem studies suggest that degeneration of the rotator cuff is progressive with age, but controversy continues to exist concerning the pathogenesis of rotator cuff disease. The heterogeneity of the disorder and the notion that rotator cuff disease may not actually represent a continuum of the same process, but instead, is a compilation of independent disorders, may partly explain the differing viewpoints on its origin. Epidemiological studies imply that the prevalence of symptomatic shoulder disorders may decrease in years beyond middle age (21). It is not always possible to determine precisely what proportion of shoulder discomfort is caused by rotator cuff pathology, but several studies (21,22) support the widespread clinical impression that most shoulder discomfort in middle and old age is because of rotator cuff pathology. Chard et al. (21) and Chakravarty and Webley (23), studying apparently healthy people, suggested a prevalence of identifiable symptomatic shoulder...

Abnormal Biomechanics

Movement at the shoulder occurs between the two articular surfaces of the glenohumeral joint and between the scapula and thoracic wall in a ratio of 2 1 (31). Movement at the glenohumeral joint is facilitated by the mutual sliding of a set of bursal-lined surfaces, including the deep sides of the deltoid, acromion, corocoid process, and its tendons against the proximal humerus, rotator cuff, and long biceps head. Matsen et al. (8) and Romeo have coined the term humeroscapular motion interface (HSMI) to describe this articulation. Another term, the scapulothoracic motion interface has also been proposed to describe the bursal-lined surface between the scapula blade and thoracic wall. In a glenohumeral joint with healthy articular surfaces, stiffness can occur with three scenarios (1) contractures that produce shortening of capsule, ligament or muscle-tendon units (2) adhesions between gliding structures, e.g., the cuff and biceps tendon and (3) adhesions crossing the HSMI. Clearly, the...

Coracoacromial Ligament

The coracoacromial ligament (CAL) is a trapezoidal shaped ligament twisted into a helix between the coracoid and acromion (13). As shown in Fig. 2, the CAL courses an oblique pattern over the rotator cuff and shoulder capsule, with which it has a close spatial relationship (4). In fetal development, the CAL is visible by 13-wk gestation as a band that is continuous with the acromion's undersurface. By 36-wk gestation, fibers of the CAL are well organized (14).

Clinical Case For Artificial Ligaments

The knee is clearly the main focus for work on ligaments owing to the frequency of ligament injuries at the knee from both sport and other accidental trauma with the disability caused by knee joint instability. Although there are numerous other sites around the body that have clinical applications for this technology, the knee, and particularly the cruciate ligaments, drive the subject forward. This chapter considers the reconstruction of tissues other than ligaments that are primarily collagenous, such as tendon and capsular tissues, as the applications are similar and often have research studies relevant to ligaments. Of the other sites, the rotator cuff is probably the structure affected most frequently and causes sufficient disability for surgery to be considered. However, this disability arises as a result of degenerative changes in the tissues of an older patient population thus, factors such as healing responses may be different.


Tears of the rotator cuff typically involve the supraspinatus tendon, and they will often include the posterior cuff to a variable degree. The subscapularis tendon, although less frequently involved, may be easily overlooked if not considered during diagnostic evaluation. The torn rotator cuff can demonstrate variably shaped defects that should be noted with surgical reconstruction. A vertical tear, in line with the course of the tendon, can often be repaired with a side-to-side closure. Horizontal tears run transverse to the normal course of the tendon and demonstrate variability in size and the extent of retraction. Typically, closure of such defects requires a transosseous repair to the greater tuberosity. Complex tears that contain both horizontal and vertical components also occur and may require a combination of the techniques.


The relationship between the microvascular blood supply of the rotator cuff and tendon degeneration remains a subject of debate. Conflicting reports about the vascularity of the supraspinatus tendon exist however, in many investigations, the methods employed were limited. Moreover, although vascular-mediated mechanisms have been suggested as an important factor in the genesis of rotator cuff disease, studies have been unable to sufficiently attribute hypovascularity as a direct cause for observed tears of the rotator cuff. An early physiological study suggested that tendons received a vascular supply from three sources muscular, osseous, and direct tendinous sites (25). Subsequently, it was proposed that a critical portion existed within the distal rotator cuff tendon, predisposing it to degeneration and calcification (26). A vascular or ischemic mechanism was recommended, which in association with trauma, leads to tearing of the rotator cuff. This concept was reinforced when normal...

Patient Choice

Patients with rotator cuff problems will typically complain of pain, weakness, or both. Many patients cannot recall an injury in others, symptoms may have begun after a trivial trauma. McLaughlin (58) noted about 25 of cadavers studied had a rotator cuff tear and hypothesized that not all of these had been symptomatic in life. Hence, if not all rotator cuff tears are symptomatic, the aim of nonoperative treatment is to help a patient with symptomatic rotator cuff disease become asymptomatic. This may involve activity modification, corticosteroid injections, and physical therapy. The physiotherapy is primarily based on scapula stabilization, capsular stretching, and rotator cuff strengthening. Data suggests that nonoperative treatment of rotator cuff tears is successful in 3392 of cases, with most studies reporting a satisfactory result in approx 50 of patients. Bokor et al. (59) reported on 53 patients with documented rotator cuff tears undergoing nonoperative treatment at an average...

Natural History

A number of mechanisms have been proposed to explain the etiology of the primary frozen shoulder. Early suggestions localizing the pathology to the rotator cuff-bursa interface have been dismissed (6,7). Most agree that the defining pathology is a capsular fibrosis, but the exact cause of this fibrosis is not clearly understood. An inflammatory process has been suggested based on the histological observations of synovial or subsynovial inflammatory reactions (11,20). This, in turn, has led investigators to attempt to identify a particular inflammatory stimulus in the frozen primary shoulder. Bulgen and coworkers have found increased levels of circulating immune complexes together with an elevation of serum C-reactive protein level. This is suggestive of an autoimmune type IV reaction (23). Reduced serum immunoglo-bulin A levels have also been noted in patients with frozen shoulder, which have persisted after recovery (24). Unfortunately, further studies have failed to confirm this...

Clinical Evaluation

Imaging techniques help to determine the ligament or tendon integrity, but they do not provide much information about the mechanical properties. Several useful imaging techniques are available that allow assessment of both ligaments and tendons and include arthrography, ultrasound, and magnetic resonance imaging (MRI). Arthrography is an indirect method of evaluating ligament and tendon continuity. It relies on ligaments and tendons to be arranged in such a way to create an enclosed space. A radio-opaque dye is injected into this space, and a standard roentgenographic assessment is made. If there is a breach in this envelope, the radio-opaque dye extravasates from the space, giving characteristic appearances. This method can be used for assessing the integrity of the rotator cuff in the shoulder and the triangular fibrocartilage (TFCC) in the wrist. Ultrasound imaging also provides an effective modality to examine ligament and tendon integrity. It is a safe, quick, and inexpensive...

Suture Anchor

Suture anchors are increasingly being used for a wide variety of orthopedic applications that include rotator cuff repairs, Bankart repairs, and reattachment of various tendons and ligaments to bone (106-110). Recently, different suture anchors have been developed (111,112) that are made of metal, nonabsorbable (34), and absorbable materials (e.g., Expanding Suture Plug Arthrex (35,111-114). Barber et al. performed a comprehensive series of experiments analyzing the pullout strength and mode of failure of over 30 different types of suture anchors (111,113,114). A fresh porcine femur model was used to test pullout strength in three different environments the diaphyseal cortex, metaphyseal cortex, and cancellous bone trough created by decortication of the metaphyseal cortex. Whenever possible, the anchors were threaded with wire to test the strength of the implant itself and the implant-bone interface. Overall, it was found that the holding strength of screw type anchors, e.g. Fastak...


Many full-thickness tears of the rotator cuff are associated with tendon lamination to be retracted further that the dorsal layer (DS, personal observation). The multilaminar structure of the rotator cuff has been well described (4), but the mechanism is not understood. It may be multifactorial. It is not uncommon to find a rim rent of the deep surface in the critical zone of Codman (6), representing a partial-thickness tear. A combination of effects, e.g., critical vascularity (9,37,44,45) and arteriolar intimal hyperplasia (10), all render this zone of the supraspinatus prone to initial degeneration and tearing. The layered nature of the cuff tendons lends itself to delamination. The general principles of the histological structure are well described (4,46,47). The dorsal surface consists largely of longitudinally arranged larger diameter collagen fibers, and the articular surface has an increasing number of transversally arranged collagen fibers. Five histological layers describe...


There is no universally accepted classification scheme for rotator cuff disease, making studies difficult to compare. Aspects to consider when reviewing rotator cuff lesions include the duration, depth, and size of a tear, as well as the condition of the muscle and tendon. Tears can be acute or chronic and may be associated with a variable degree of weakness and discomfort. Gradation of partial-thickness lesions has been described however, difficulty lies in the definition and accurate assessment of such lesions. For example, fraying of the tendon observed during an operation may be considered as a partial tear by some surgeons and not by others. Moreover, the incidence of such lesions in relation to symptoms and the treatment results are not easily determined because of variability in imaging capabilities, interpretation, and lack of uniformity in classification. Full-thickness tears may be described as small (5 cm). Additionally, a torn rotator cuff may be retracted, deficient,...


The precise incidence of rotator cuff pathology is not known until recently, estimates were based on postmortem studies (1-3). Some studies do not report age distribution and correlation, some do not distinguish between partial and full thickness of cuff tears, and others only report findings from the examination of the dorsal surface. Many partial thickness tears are confined to the articular (deep) surface and are not visible from the dorsal surface. Human rotator cuff pathology is not uncommon. It includes full and partial thickness tears, macroscopic visibility, and interstial cuff disease that can be identified by numerous imaging techniques and histopathology. Cadaver studies indicate that partial thickness tears, especially those on the deep (articular) side of the cuff, occur in the 4060 yr range, earlier in life, and more frequently than full thickness tears. The incidence of interstitial tears is difficult to determine from clinical or cadaver studies. Tears of partial...

Patient Satisfaction

Not all repairs of the rotator cuff are associated with satisfactory pain relief or the return of shoulder function. Realistic assessment of the likelihood of patient satisfaction is an essential component of preoperative counseling. The surgeons are interested in the precise range of motion and return to strength, whereas the patient's interests are in pain relief and restored ability to undertake activities of daily living, employment, and recreation. Many structural factors, such as tear shape and size, tissue quality, biceps integrity, and degree of muscular atrophy may affect the outcome of rotator cuff repairs. However, several nonstructural variables may also be important, including patient age, gender, workers' compensation status, and revision surgery. In a major review of the senior author's patients (DS) in 667 repairs, the overall subjective patient satisfaction with the outcome was 88 . This level of satisfaction is comparable to several other studies evaluating rotator...

Surgical Technique

Since Codman's first description of rotator cuff repair in 1911, techniques for this operation have evolved. Early reports (6) described various approaches, some crossing the acromioclavicular joint and others splitting the anterior deltoid more laterally. Acromium-splitting approaches have been popularized in the past (62,63). In 1972, Neer (34) described combined acromioplasty and cuff repair through an anterosuperior incision. Since then, the reported outcomes of surgical rotator cuff repair have considerably improved. A number of studies since that time have described successful repair of full-thickness tears with a high degree of satisfactory results, reduced pain and improved shoulder function (64-66). Some debate remains as to whether or not all cuff repairs should be accompanied by acromioplasty and a limited subdeltoid bursectomy (67,68). Other contentious issues in rotator cuff repair include the necessary extent, if any, of distal clavicular excision. Various techniques...

Reconstruction of the Proximal Humerus

Hallux Arthrodesis

The stability of the shoulder depends on appropriate soft tissue reconstruction. Note the strip of biceps femoris tendon which is usually anchored to the glenoid in order to improve the stability of the joint. The rotator cuff is sutured contouring the fibular epiphysis. The soft tissue repair around the transferred epiphysis is complicated by the potential danger for the epiphyseal vascular network related to direct reinsertion on the bone of the rotator cuff and deltoid. For this reason the muscles are just sutured around the fibular head and the strip of biceps femoris tendon is anchored to the glenoid achieving acceptable stability (Fig. 10D.4). In some cases, however, a proximal displacement of the physis does occur due to anatomical discrepancy and insufficient stabilization.

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