The main purpose of the rotator cuff is to keep the head of the humerus bone centered within the shoulder joint The subscapularis muscle functions as the internal rotator of the rotator cuff. It serves to hold the head of the humerus down and to limit forward glide of the humerus while the arm is raised. It is a powerful stabilizer of the shoulder. Repetitive overhead activity such as throwing or swimming may create micro-trauma to the fibers of the subscapularis. The healing process may lead to adhesion formation with a subsequent imbalance of the rotator cuff leading to altered shoulder biomechanics. The genesis of shoulder impingement syndrome!
Manual therapy plays a pivotal role in the effective and expeditious treatment of impingement syndrome as well as recovery from a Type II SLAP repair surgery. Active Release Technique has been clinically shown to resolve the impingement pain caused by a subscapularis dysfunction in as few as 2-6 sessions. We assess the length of the muscle from the lesser tuberosity of the humerus to the subscapular fossa in order to locate the lesion. The lesion is tensioned in a slackened position as the arm is taken through a range of external rotation and elevation in order to release the adhesion. Refer to pictures below. The release is also demonstrated on my website at www.orthowellpt.com/wp.
Standard Type II SLAP repair protocols limit the PROM of external rotation from 0-30 degrees for the first 4 weeks post-op. Most patients are placed in a sling in an internally rotated position. Therefore, this limits the mobility of the subscapularis. Trevor Winnege,DPT demonstrated that massage of the subscapularis in combination with PROM during the first post-op month improved the external rotation motion of the shoulder by 24-25 degrees at the 4 week mark compared to a control group that received PROM only.
Keeping you informed of the latest and most efficacious physical therapy interventions is our goal at OrthoWell Orthopedic and Sports Physical Therapy and WalkWell Rehabilitation. Please call if you have any questions about our subscapularis release and whether it would be right for you.
All the best!
Chris Dukarski,PT, Owner of OrthoWell and WalkWell