Monthly Archives: October 2012

The Rotator Cuff Explained

At some point in time, chances are good that you will experience discomfort in your shoulder.  It is usually then that people are acquainted with the rotator cuff muscles and tendons.  The rotator cuff plays an important role in the normal function of the shoulder, and is one of the structures which are commonly implicated in shoulder pathology.

Anatomy

The four muscles that comprise the rotator cuff originate on the scapulae (shoulder blade) and insert through a common tendon to the humerus (long arm bone.)  This group of muscles and tendons cross a ball and socket joint commonly thought of as the shoulder joint.  Above the rotator cuff is an arch comprised of bone and ligaments which help to protect the cuff from impact injury.  There is a bursae in between the cuff and the arch which allows for a smooth passage of the tendon during shoulder movements.

Biomechanics

The role of the rotator cuff muscles is to work in conjunction with other shoulder muscles to move the humerus for activity of the arm including pushing, pulling, and reaching.  It also plays a role in keeping the ball centered in the socket at the shoulder joint.  A healthy cuff will prevent an upward rise of the humerus (ball joint) into the protective arch.

Pathology

The rotator cuff tendon can be injured from direct trauma such as a car accident or a fall onto the shoulder.  It can also be injured through an overload stress such as lifting something too heavy or throwing a ball too hard.  The tendon, like most other body parts will degenerate over time with repetitive use.  This degeneration eventually leads to fraying and possible tearing of the tendon without any specific trauma.

Prevention

Maintaining rotator cuff strength, coordination and flexibility are important for the health of the shoulder joint.  After injury, cuff exercise helps to prevent secondary trauma and degeneration.  Consult with your physician about specific exercise for care of the rotator cuff.

Written by: Steven L. Bernstein PT,OMT

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What is Iontophoresis?

Iontophoresis is a modality that is used frequently in physical therapy. It has been around since the 1700’s, but new technology has made this treatment user friendly. Iontophoresis is non-invasive and delivers water soluble, ionic drugs or other compounds through the skin using electrical current. The deliverance of medication with iontophoresis can help control pain and inflammation, improve scar quality, decrease edema, control hyperhidrosis and decrease calcium deposits.

Advantages of Iontophoresis:

1)  Reduced risk of infection due to non-invasive nature

2)  Medications delivered directly to the treatment site

3)  Provides option for patient reluctant or unable to receive injection

4)  Treatments are completed within minutes.

Agents that can be used for Iontophoresis are as follows:

1) Dexamethasone: this is the most common used for tendinitis, fascitis, bursitis, neuritis, capsulitis, metatarsalgia, and neuromas.

2) Acetic Acid: Ionized acetic acid binds with calcium and dissolves, which decreases the density of calcium deposits.

3) Tap Water: using iontophoresis with tap water to treat hyperhidrosis can be effective.

4) Lidocaine: for temporary pain relief, or prior to a painful procedure.

5) NaCl: Iontophoresis with NaCl (sodium chloride) may decrease the thickness of the scar and improve the quality. The theory behind using NaCl is that chloride ions interrupts the way collagen fibers are formed. Pressure is applied with this type of treatment. Patient report feeling more comfort and scar softer.

Although iontophoresis has many advantages, it may not be for everyone. It should not be used for someone who has sensitive skin. It can cause skin irritation and even tiny blisters can develop.

There is not a certain number of treatments with iontophoresis, as long there is reported relief and there is progression it can be continued. Some patients report improvement with 6 treatments of iontophoresis.

A person may have a quicker recovery time and improve healing with iontophoresis. When combining iontophoresis with other physical therapy treatment procedures it can help improve range of motion and decrease pain with all the benefits and minimal side effect of iontophoresis.

Iontophoresis requires a requires a prescription by a physician with the quantity, drug solution, strength, and directions for clinical use.

Prior to new technology administering iontophoresis was more challenging to perform. Traditional units had wires, required extensive wear time, patient patch sensitivity, inaccurate dosage delivery, which could all lead to unpredictable results. The medication can now be delivered through a patch which is then placed on the skin at the affected area being treated. The patient will remove that patch after a set amount of time. The goal of iontophoresis is to help with the healing process which hopefully allows a person to resume a higher level of function without pain.

By: Rita Zimmermann, LPTA/CLT