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technique CLASSROOM TO CLIENT | @WORK | ESSENTIAL SKILLS | MYOFASCIAL TECHNIQUES Differentiating Rotator Cuff Injuries Proper Assessment is Key By Ben E. Benjamin Is it helpful when a client arrives at your office and says, "I was told I have a rotator cuff injury"? The statement may be somewhat useful, but it's not specific enough. It usually means that a general diagnosis was given with no specifics. In order to work with each client successfully, you have to know exactly which tendon or tendons are strained so you know where to work. The rotator cuff consists of four separate tendons that form a continuous band encased in fascia: the subscapularis, supraspinatus, infraspinatus, and teres minor. These tendons work together synergistically to ensure smooth, coordinated movement of the shoulder. When there is pain during arm or shoulder movement, one or more of those tendons is usually injured. In this article, we will look at how you differentiate which tendon is injured when your client presents with this diagnosis. The rotator cuff consists of four separate tendons that form a continuous band encased in fascia: the subscapularis, supraspinatus, infraspinatus, and teres minor. TESTING FOR SUBSCAPULARIS TENDON INJURY The subscapularis muscle-tendon unit is difficult to visualize because the tendon goes through the body from back to front. This muscle helps you clap your hands, hug someone, lift things, open jars, throw a ball, and complete the forehand and serving actions in tennis. The subscapularis is by far the strongest of the four rotator cuff muscles. If a client under age 40 has a shoulder injury, there is a 70 percent chance it is to the subscapularis tendon. Yet, it is the shoulder injury most likely to be missed by the health-care professional. Before I understood how to assess this problem, it was the most perplexing shoulder injury imaginable. One likely reason for this confusion is that the subscapularis is such a 108 massage & bodywork july/august 2012