rotator cuff - definition of rotator cuff in English | Oxford Dictionaries Definition of rotator cuff in English: rotator cuff A tough sheath of tendons and ligaments that supports the arm at the shoulder joint. Example sentences ‘The rotators of the hip are like the rotator cuff of the shoulder.’ ‘You don't need to be a major-league fastballer to have problems with your rotator cuff - the sheath of muscle that connects your arm to your shoulder.’ ‘Tendinitis of the shoulder, particularly the rotator cuff, is prevalent among swimmers and athletes who perform repeated overhead motions.’ ‘He still has trouble with his lower and upper back and both shoulders, especially the right rotator cuff, which stabilizes the head of the humerus within the shoulder joint.’ ‘In several clinical studies, the use of ultrasonography or arthrography has shown residual defects in surgically repaired rotator cuffs, with an incidence as high as 50% in some reports.’ Word of the Day Which is the correct spelling? revultion Which is the correct spelling? population Which is the correct spelling? edition Which is the correct spelling? production Which is the correct spelling? invacion Which is the correct spelling?

coersion Which is the correct spelling? solucion Which is the correct spelling? commosion Which is the correct spelling? suspision Which is the correct spelling? tension You scored /10 practise again? Retry Most popular in the world Australia Knee and Shoulder Joints Knee and Shoulder Joints PowerPoint consisting of 15 slides, 1) Introduce the anatomy of the knee and shoulder joints (articulating surfaces of bone). 2) Discuss the anatomy of the knee and shoulder. Include labels of: Knee The ligaments ACL, MCL, PCL, LCL, (LABEL WITH THE FULL NAMES) the menisci The muscles that cross the knee joint: the quadriceps (label all four) and the hamstrings (label all three) Shoulder rotator cuff muscles rotator cuff ligaments the major muscles that cross the shoulder to move the humerus: deltoid, pectoralis major, and trapezius 3) Label the tendons, ligaments, and/or internal joint structures that are commonly damaged and what motions cause that damage. 4) Provide examples of therapies used to treat those injuries.

Solution Preview Slide 1 Definition: - Knee joint ( tibiofemoral joint) is the largest and most complex joint of the body, consisting of three joints within a single synovial cavity. o 1. Laterally: tibiofemoral joint is between the lateral condyle of the femur, lateral meniscus, and lateral condyle of the tibia. It is a modified hinge joint. o 2. Medially: tibiofemoral joint is between the medial condyle of the femur, medial meniscus, and medial condyle of the tibia. It is also a modified hinge joint. o 3. Intermediate patellofemoral joint is between the patella and the patellar surface of the femur. It is a planar joint. Slide 2 Anatomical Components 1. Articular capsule - No complete, independent capsule unites the bones of the knee joint. The ligamentous sheath surrounding the joint consists mostly of muscle tendons or their expansions. There are capsular fibers connecting the articulating bones. 2.

Medial and lateral patellar retinacula- Fused tendons of insertion of the quadriceps femoris muscle and the fasica lata ( deep fascia of thigh) that strengthen the anterior surface of the joint. 3. Patellar ligament - Continuation of the common tendon of insertion of the quadriceps femoris muscle that extends from the patella to the tibial tuberosity. This ligament also strengthens the anterior surface of the joint. The posterior surface of the ligament is separated from the synnovial membrane of the joint by an infrapatellar fat pad. Slide 3 Anatomical Components Continue 4. Oblique popliteal ligament - Broad, flat ligament that extends from the intercondylar fossa of the femur to the head of the tibia. The tendon of the semimembranous muscle is superficial to the ligament and passes from the medial condyle of the tibia to the lateral condyle of the femur. The ligament and tendon strengthen the posterior surface of the joint. 5. Arcuate popliteal ligament - Extends from the lateral condyle of the femur to the styloid process of the head of the fibula.

It strengthens the lower lateral part of the posterior surface of the joint. Slide 4 6. Tibial collateral ... Solution Summary Knee joint ( tibiofemoral joint) is the largest and most complex joint of the body, consisting of three joints within a single synovial cavity. Knee joint is a synovial joint. Shoulder joint is a ball and socket joint formed by the head of the humerus and the glenoid cavity of the scapula. Both of these joints provide movement necessary for our everyday life. We will explore the anatomical components of these two joints and elucidate how they function in locomotion. $2.19 ... ing right and left shoulders, hips, knees, ankles, heels ... of planar motions: hip flexion and knee extension, as in ... Dynamics of the shoulder and muscles in soccer ... ... We control of knee stability may elucidate further their potential ... with their feet a com- fortable width apart (shoulder width), knees straight, and toes ... ... 5. - Articular disks at some joints - Movement: flex ... and-socket trapezium - Examples are shoulder and hip ... rotation B. Hinge - Examples are knee, elbow, ankle ... ...

are the following examples: proximal radioulnar joint (as can be found on the knees), atlanto axial ... The joints of the shoulder and the knee contain bursae ... ... The hinge joints include the knee, elbow, ankle, and ... commonly characterized by the hip joint or the shoulder joint. These joints are tri-axial in that they ... ... ing right and left shoulders, hips, knees, ankles, heels ... of planar motions: hip flexion and knee extension, as in ... Dynamics of the shoulder and muscles in soccer ... ... tissue called tendons. Bursa - a fluid-filled sac in the knee and shoulder joints to cushion the bones. Ligament - tough, flexible ... ... muscles and tendons of her shoulders, legs, and ... often are required for heavy weight-bearing joints. ... of substance P nerve fibers in osteoarthritis knee joint. ... ... muscles and tendons of her shoulders, legs, and ... often are required for heavy weight bearing joints. ... of substance P nerve fibers in osteoarthritis knee joint. ...

View More Shoulder Tendons | ShoulderDoc Shoulder Tendons Shoulder Tendons Shoulder Tendons Tendons are extensions of muscles that attach muscles to bone. Muscles move the bones by pulling on the tendons . Rotator Cuff The rotator cuff tendons are a group of four tendons that connect the deepest layer of muscles to the humerus . They are the tendons of the rotator cuff muscles. These are (from front to back): teres minor The supraspinatus is the most commonly affected tendon , both by overuse and trauma. It is the muscle that lifts your arm out to the side (a very important movement for most daily taks). Injury to the tendon can result in a Rotator Cuff Tear . Overuse can lead to Subacromial Impingement . Biceps Tendons The biceps muscle has two tendons at the shoulder, called the Long Head and Short Head. The Long Head of Biceps (LHB) is a very important tendon that travels through the shoulder joint (glenohumeral joint).

The biceps tendon begins at the top of the shoulder socket (the glenoid) and then passes across the front of the shoulder to connect to the biceps muscle. (The biceps is the muscle that weightlifters are always showing off). The LHB is a common source of shoulder pain and can rupture. Click Here for more . Search ShoulderDoc.co.uk Questions and Answers about Shoulder Problems April 2014 Questions and Answers about Shoulder Problems This publication contains general information about shoulder problems. It describes what shoulder problems are, their causes, and treatment options. Highlights of research are also included. At the end is a list of key words to help you understand the terms used in this publication. If you have further questions, you may wish to discuss them with your doctor. What Are the Most Common Shoulder Problems? The most movable joint in the body, the shoulder is also one of the most potentially unstable joints. As a result, it is the site of many common problems. They include sprains, strains, dislocations, separations, tendinitis, bursitis, torn rotator cuffs, frozen shoulder, fractures, and arthritis. Specific shoulder problems will be discussed later in this publication.

Treat Shoulder Injuries With RICE How Common Are Shoulder Problems? According to the Centers for Disease Control and Prevention, nearly 1.2 million people in the United States visited an emergency room in 2010 for shoulder problems. 1 1 Centers for Disease Control and Prevention (CDC)/National Center for Health Statistics (NCHS), National Hospital Ambulatory Medical Care Survey. National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department Summary Tables. Accessed April 10, 2014, at What Are the Structures of the Shoulder and How Does It Function? To better understand shoulder problems and how they occur, it helps to begin with an explanation of the shoulder’s structure and how it functions. The shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) (see illustration). Two joints facilitate shoulder movement.

The acromioclavicular (ah-KRO-me-o-klah-VIK-u-lahr or AC) joint is located between the acromion (ah-KRO-me-on, the part of the scapula that forms the highest point of the shoulder) and the clavicle. The glenohumeral joint, commonly called the shoulder joint, is a ball-and-socket-type joint that helps move the shoulder forward and backward and allows the arm to rotate in a circular fashion or hinge out and up away from the body. (The “ball,” or humerus, is the top, rounded portion of the upper arm bone; the “socket,” or glenoid, is a dish-shaped part of the outer edge of the scapula into which the ball fits.) The capsule is a soft tissue envelope that encircles the glenohumeral joint. It is lined by a thin, smooth synovial membrane. Structure of the Shoulder In contrast to the hip joint, which more closely approximates a true ball-and-socket joint, the shoulder joint can be compared to a golf ball and tee, in which the ball can easily slip off the flat tee.

Because the bones provide little inherent stability to the shoulder joint, it is highly dependent on surrounding soft tissues such as capsule ligaments and the muscles surrounding the rotator cuff to hold the ball in place. Whereas the hip joint is inherently quite stable because of the encircling bony anatomy, it also is relatively immobile. The shoulder, on the other hand, is relatively unstable but highly mobile, allowing an individual to place the hand in numerous positions. It is, in fact, one of the most mobile joints in the human body. The bones of the shoulder are held in place by muscles, tendons, and ligaments. Tendons are tough cords of tissue that attach the shoulder muscles to bone and assist the muscles in moving the shoulder. Ligaments attach shoulder bones to each other, providing stability. For example, the front of the joint capsule is anchored by three glenohumeral ligaments. The rotator cuff is a structure composed of tendons that work along with associated muscles to hold the ball at the top of the humerus in the glenoid socket and provide mobility and strength to the shoulder joint. Two filmy sac-like structures called bursae permit smooth gliding between bones, muscles, and tendons.

They cushion and protect the rotator cuff from the bony arch of the acromion. What Are the Origins and Causes of Shoulder Problems? The shoulder is easily injured because the ball of the upper arm is larger than the shoulder socket that holds it. To remain stable, the shoulder must be anchored by its muscles, tendons, and ligaments. Although the shoulder is easily injured during sporting activities and manual labor, the primary source of shoulder problems appears to be the natural age-related degeneration of the surrounding soft tissues such as those found in the rotator cuff. The incidence of rotator cuff problems rises dramatically as a function of age and is generally seen among individuals who are more than 60 years old. Often, the dominant and nondominant arm will be affected to a similar degree. Overuse of the shoulder can lead to more rapid age-related deterioration. Shoulder pain may be localized or may be felt in areas around the shoulder or down the arm. Disease within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that travels along nerves to the shoulder.

However, these other causes of shoulder pain are beyond the scope of this publication, which will focus on problems within the shoulder itself. How Are Shoulder Problems Diagnosed? As with any medical issue, a shoulder problem is generally diagnosed using a three-part process. Medical history. The patient tells the doctor about any injury or other condition that might be causing the pain. Physical examination. The doctor examines the patient to feel for injury and to discover the limits of movement, location of pain, and extent of joint instability. Tests. The doctor may order one or more of the tests listed below to make a specific diagnosis. These tests may include the following. Standard x ray. A familiar procedure in which low-level radiation is passed through the body to produce a picture called a radiograph. An x ray is useful for diagnosing fractures or other problems of the bones. Soft tissues, such as muscles and tendons, do not show up on x rays. Arthrogram. A diagnostic record that can be seen on an x ray after injection of a contrast fluid into the shoulder joint to outline structures such as the rotator cuff.

In disease or injury, this contrast fluid may either leak into an area where it does not belong, indicating a tear or opening, or be blocked from entering an area where there normally is an opening. Ultrasound. A noninvasive, patient-friendly procedure in which a small, hand-held scanner is placed on the skin of the shoulder. Just as ultrasound waves can be used to visualize the fetus during pregnancy, they can also be reflected off the rotator cuff and other structures to form a high-quality image of them. The accuracy of ultrasound for the rotator cuff is particularly high. MRI (magnetic resonance imaging). A noninvasive procedure in which a machine with a strong magnet passes a force through the body to produce a series of cross-sectional images of the shoulder. Other diagnostic tests, such as one that involves injecting an anesthetic into and around the shoulder joint, are discussed in detail in other parts of this publication. What Should I Know About Specific Shoulder Problems, Including Their Symptoms and Treatment? The symptoms of shoulder problems, as well as their diagnosis and treatment, vary widely, depending on the specific problem. The following is important information to know about some of the most common shoulder problems.

Dislocation The shoulder joint is the most frequently dislocated major joint of the body. In a typical case of a dislocated shoulder, either a strong force pulls the shoulder outward (abduction) or extreme rotation of the joint pops the ball of the humerus out of the shoulder socket. Dislocation commonly occurs when there is a backward pull on the arm that either catches the muscles unprepared to resist or overwhelms the muscles. When a shoulder dislocates frequently, the condition is referred to as shoulder instability. A partial dislocation in which the upper arm bone is partially in and partially out of the socket is called a subluxation. Signs and symptoms. The shoulder can dislocate either forward, backward, or downward. When the shoulder dislocates, the arm appears out of position. Other symptoms include pain, which may be worsened by muscle spasms, swelling, numbness, weakness, and bruising. Problems seen with a dislocated shoulder are tearing of the ligaments or tendons reinforcing the joint capsule and, less commonly, bone and/or nerve damage. Diagnosis. Doctors usually diagnose a dislocation by a physical examination; x rays may be taken to confirm the diagnosis and to rule out a related fracture. Treatment.

Doctors treat a dislocation by putting the ball of the humerus back into the joint socket, a procedure called a closed reduction. The arm is then stabilized for several weeks in a sling or a device called a shoulder immobilizer. Usually the doctor recommends resting the shoulder and applying ice three or four times a day. After pain and swelling have been controlled, the patient enters a rehabilitation program that includes exercises. The goal is to restore the range of motion of the shoulder, strengthen the muscles, and prevent future dislocations. These exercises may progress from simple motion to the use of weights. After treatment and recovery, a previously dislocated shoulder may remain more susceptible to reinjury, especially in young, active individuals. Ligaments may have been stretched or torn, and the shoulder may tend to dislocate again. A shoulder that dislocates severely or often, injuring surrounding tissues or nerves, usually requires surgical repair to tighten stretched ligaments or reattach torn ones. Sometimes the doctor performs surgery through a tiny incision into which a small scope (arthroscope) is inserted to observe the inside of the joint. After this procedure, called arthroscopic surgery, the shoulder is generally stabilized for about 6 weeks. Full recovery takes several months.

In other cases, the doctor may repair the dislocation using a traditional open surgery approach. Separation A shoulder separation occurs where the collarbone (clavicle) meets the shoulder blade (scapula). When ligaments that hold the joint together are partially or completely torn, the outer end of the clavicle may slip out of place, preventing it from properly meeting the scapula. Most often, the injury is caused by a blow to the shoulder or by falling on an outstretched hand. Signs and symptoms. Shoulder pain or tenderness and, occasionally, a bump in the middle of the top of the shoulder (over the acromioclavicular or AC joint) are signs that a separation may have occurred. Diagnosis. Doctors may diagnose a separation by performing a physical examination. They may confirm the diagnosis and determine the severity of the separation by taking an x ray. While the x ray is being taken, the patient makes the separation more pronounced by holding a light weight that pulls on the muscles. Treatment. A shoulder separation is usually treated conservatively by rest and wearing a sling. Soon after injury, an ice bag may be applied to relieve pain and swelling.

After a period of rest, a therapist helps the patient perform exercises that put the shoulder through its range of motion. Most shoulder separations heal within 2 or 3 months without further intervention. However, if ligaments are severely torn, surgical repair may be required to hold the clavicle in place. A doctor may wait to see if conservative treatment works before deciding whether surgery is required. Rotator Cuff Disease: Tendinitis and Bursitis These conditions are closely related and may occur alone or in combination. Tendinitis is inflammation (redness, soreness, and swelling) of a tendon. In tendinitis of the shoulder, the rotator cuff and/or biceps tendon become inflamed, usually as a result of being pinched by surrounding structures. The injury may vary from mild inflammation to involvement of most of the rotator cuff. When the rotator cuff tendon becomes inflamed and thickened, it may get trapped under the acromion. Squeezing of the rotator cuff is called impingement syndrome. Bursitis, or inflammation of the bursa sacs that protect the shoulder, may accompany tendinitis and impingement syndrome.

Inflammation caused by a disease such as rheumatoid arthritis may cause rotator cuff tendinitis and bursitis. Sports involving overuse of the shoulder and occupations requiring frequent overhead reaching are other potential causes of irritation to the rotator cuff or bursa and may lead to inflammation and impingement. If the rotator cuff and bursa are irritated, inflamed, and swollen, they may become squeezed between the head of the humerus and the acromion. Repeated motion involving the arms, or the effects of the aging process on shoulder movement over many years, may also irritate and wear down the tendons, muscles, and surrounding structures. Signs and symptoms. Signs of these conditions include the slow onset of discomfort and pain in the upper shoulder or upper third of the arm and/or difficulty sleeping on the shoulder. Tendinitis and bursitis also cause pain when the arm is lifted away from the body or overhead. If tendinitis involves the biceps tendon (the tendon located in front of the shoulder that helps bend the elbow and turn the forearm), pain will occur in the front or side of the shoulder and may travel down to the elbow and forearm.

Pain may also occur when the arm is forcefully pushed upward overhead. Diagnosis. Diagnosis of tendinitis and bursitis begins with a medical history and physical examination. X rays do not show tendons or the bursae, but may be helpful in ruling out bony abnormalities or arthritis. The doctor may remove and test fluid from the inflamed area to rule out infection. Impingement syndrome may be confirmed when injection of a small amount of anesthetic (lidocaine hydrochloride) into the space under the acromion relieves pain. Treatment. The first step in treating these conditions is to reduce pain and inflammation with rest, ice, and anti-inflammatory medicines such as aspirin and ibuprofen (Advil, 2 Motrin 3 ). In some cases, the doctor or therapist will use ultrasound (gentle sound-wave vibrations) to warm deep tissues and improve blood flow. Gentle stretching and strengthening exercises are added gradually. These may be preceded or followed by use of an ice pack. If there is no improvement, the doctor may inject a corticosteroid medicine into the space under the acromion. Although steroid injections are a common treatment, they must be used with caution because they may lead to tendon rupture.

If there is still no improvement after 6 to 12 months, the doctor may recommend either arthroscopic or open surgery to repair damage and relieve pressure on the tendons and bursae. 2 Brand names included in this publication are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory. 3 All medicines can have side effects. Some medicines and side effects are mentioned in this publication. Some side effects may be more severe than others. You should review the package insert that comes with your medicine and ask your health care provider or pharmacist if you have any questions about the possible side effects. Torn Rotator Cuff Rotator cuff tendons often become inflamed from overuse, aging, or a fall on an outstretched hand or another traumatic cause. Sports or occupations requiring repetitive overhead motion or heavy lifting can also place a significant strain on rotator cuff muscles and tendons. Over time, as a function of aging, tendons become weaker and degenerate. Eventually, this degeneration can lead to complete tears of both muscles and tendons.

These tears are surprisingly common. In fact, a tear of the rotator cuff is not necessarily an abnormal situation in older individuals if there is no significant pain or disability. Fortunately, these tears do not lead to any pain or disability in most people. However, some individuals can develop very significant pain as a result of these tears and they may require treatment. Signs and symptoms. Typically, a person with a rotator cuff injury feels pain over the deltoid muscle at the top and outer side of the shoulder, especially when the arm is raised or extended out from the side of the body. Motions like those involved in getting dressed can be painful. The shoulder may feel weak, especially when trying to lift the arm into a horizontal position. A person may also feel or hear a click or pop when the shoulder is moved. Pain or weakness on outward or inward rotation of the arm may indicate a tear in a rotator cuff tendon. The patient also feels pain when lowering the arm to the side after the shoulder is moved backward and the arm is raised. Diagnosis. A doctor may detect weakness but may not be able to determine from a physical examination where the tear is located. X rays, if taken, may appear normal.

An MRI or ultrasound can help detect a full tendon tear or a partial tendon tear. Treatment. Doctors usually recommend that patients with a rotator cuff injury rest the shoulder, apply heat or cold to the sore area, and take medicine to relieve pain and inflammation. Other treatments might be added, such as electrical stimulation of muscles and nerves, ultrasound, or a cortisone injection near the inflamed area of the rotator cuff. If surgery is not an immediate consideration, exercises are added to the treatment program to build flexibility and strength and restore the shoulder’s function. If there is no improvement with these conservative treatments and functional impairment persists, the doctor may perform arthroscopic or open surgical repair of the torn rotator cuff. Treatment for a torn rotator cuff usually depends on the severity of the injury, the age and health status of the patient, and the length of time a given patient may have had the condition. Patients with rotator cuff tendinitis or bursitis that does not include a complete tear of the tendon can usually be treated without surgery. Nonsurgical treatments include the use of anti-inflammatory medication and occasional steroid injections into the area of the inflamed rotator cuff, followed by rehabilitative rotator cuff-strengthening exercises.

These treatments are best undertaken with the guidance of a health care professional such as a physical therapist, who works in conjunction with the treating physician. Surgical repair of rotator cuff tears is best for the following individuals. Younger patients, especially those with small tears. Surgery leads to a high degree of successful healing and reduces concerns about the tear getting worse over time. Individuals whose rotator cuff tears are caused by an acute, severe injury. These people should seek immediate treatment that includes surgical repair of the tendon. Generally speaking, individuals who are older and have had shoulder pain for a longer period of time can be treated with nonoperative measures even in the presence of a complete rotator cuff tear. These people are often treated similarly to those who have pain but do not have a rotator cuff tear. Again, anti-inflammatory medication, use of steroid injections, and rehabilitative exercises can be very effective. When treated surgically, rotator cuff tears can be repaired by either arthroscopic or traditional open surgical techniques.

Frozen Shoulder (Adhesive Capsulitis) As the name implies, movement of the shoulder is severely restricted in people with a “frozen shoulder.” This condition, which doctors call adhesive capsulitis, is frequently caused by injury that leads to lack of use due to pain. Rheumatic disease progression and recent shoulder surgery can also cause frozen shoulder. Intermittent periods of use may cause inflammation. Adhesions (abnormal bands of tissue) grow between the joint surfaces, restricting motion. There is also a lack of synovial fluid, which normally lubricates the gap between the arm bone and socket to help the shoulder joint move. It is this restricted space between the capsule and ball of the humerus that distinguishes adhesive capsulitis from a less complicated painful, stiff shoulder. People with diabetes, stroke, lung disease, rheumatoid arthritis, and heart disease, or those who have been in an accident, are at a higher risk for frozen shoulder. People between the ages of 40 and 70 are most likely to experience it. Signs and symptoms. With a frozen shoulder, the joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm.

Stiffness and discomfort may worsen at night. Diagnosis. A doctor may suspect a frozen shoulder if a physical examination reveals limited shoulder movement. X rays usually appear normal. Treatment. Treatment of this disorder focuses on restoring joint movement and reducing shoulder pain. Usually, treatment begins with nonsteroidal anti-inflammatory drugs and the application of heat, followed by gentle stretching exercises. These stretching exercises, which may be performed in the home with the help of a physical therapist, are the treatment of choice. In some cases, transcutaneous electrical nerve stimulation (TENS) with a small battery-operated unit may be used to reduce pain by blocking nerve impulses. If these measures are unsuccessful, an intra-articular injection of steroids into the glenoid humeral joint can result in marked improvement of the frozen shoulder in a large percentage of cases. In those rare people who do not improve from nonoperative measures, manipulation of the shoulder under general anesthesia and an arthroscopic procedure to cut the remaining adhesions can be highly effective in most cases. Fracture A fracture involves a partial or total crack through a bone. The break in a bone usually occurs as a result of an impact injury, such as a fall or blow to the shoulder.

A fracture usually involves the clavicle or the neck (area below the ball) of the humerus. Signs and symptoms. A shoulder fracture that occurs after a major injury is usually accompanied by severe pain. Within a short time, there may be redness and bruising around the area. Sometimes a fracture is obvious because the bones appear out of position. Diagnosis. X rays can confirm the diagnosis of a shoulder fracture and the degree of its severity. Treatment. When a fracture occurs, the doctor tries to bring the bones into a position that will promote healing and restore arm movement. If someone’s clavicle is fractured, he or she must initially wear a strap and sling around the chest to keep the clavicle in place. After removing the strap and sling, the doctor will prescribe exercises to strengthen the shoulder and restore movement. Surgery is occasionally needed for certain clavicle fractures. Fracture of the neck of the humerus is usually treated with a sling or shoulder stabilizer. If the bones are out of position, surgery may be necessary to reset them. Exercises are also part of restoring shoulder strength and motion.

Arthritis of the Shoulder Arthritis is a degenerative disease caused by either wear and tear of the cartilage (osteoarthritis) or an inflammation (rheumatoid arthritis) of one or more joints. Arthritis not only affects joints, but may also affect supporting structures such as muscles, tendons, and ligaments. Signs and symptoms. The usual signs of arthritis of the shoulder are pain, particularly over the acromioclavicular joint, and a decrease in shoulder motion. Diagnosis. A doctor may suspect the patient has arthritis when there is both pain and swelling in the joint. The diagnosis may be confirmed by a physical examination and x rays. Blood tests may be helpful for diagnosing rheumatoid arthritis, but other tests may be needed as well. Analysis of synovial fluid from the shoulder joint may be helpful in diagnosing some kinds of arthritis. Although arthroscopy permits direct visualization of damage to cartilage, tendons, and ligaments, and may confirm a diagnosis, it is usually done only if a repair procedure is to be performed. Treatment. Treatment of shoulder arthritis depends in part on the type of arthritis.

Osteoarthritis of the shoulder is usually treated with nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen. Rheumatoid arthritis may require physical therapy and additional medications such as corticosteroids. When nonoperative treatment of arthritis of the shoulder fails to relieve pain or improve function, or when there is severe wear and tear of the joint causing parts to loosen and move out of place, shoulder joint replacement (arthroplasty) may provide better results. In this operation, a surgeon replaces the shoulder joint with an artificial ball for the top of the humerus and a cap (glenoid) for the scapula. Passive shoulder exercises (where someone else moves the arm to rotate the shoulder joint) are started soon after surgery. Patients begin exercising on their own about 3 to 6 weeks after surgery. Eventually, stretching and strengthening exercises become a major part of the rehabilitation program. The success of the operation often depends on the condition of rotator cuff muscles before surgery and the degree to which the patient follows the exercise program. Treat Shoulder Injuries With RICE (Rest, Ice, Compression, and Elevation) If you injure a shoulder, try the following: Rest.

Reduce or stop using the injured area for 48 hours. Ice. Put an ice pack on the injured area for 20 minutes at a time, 4 to 8 times per day. Use a cold pack, ice bag, or a plastic bag filled with crushed ice that has been wrapped in a towel. Compression. Compress the area with bandages, such as an elastic wrap, to help stabilize the shoulder. This may help reduce the swelling. Elevation. Keep the injured area elevated above the level of the heart. Use a pillow to help elevate the injury. If pain and stiffness persist, see a doctor. What Research Is Being Conducted on Shoulder Problems? Numerous studies are supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and other institutes of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH) to better understand shoulder problems and improve their treatment. The specific goals of those studies include: Improving the results of surgery to repair shoulder injuries. Exploring the role of possible biopsychosocial and genetic risk factors in which the development of chronic shoulder pain is likely to occur.

Developing and testing the effectiveness of biomechanically based rehabilitation strategies to improve upper extremity function and reduce pain in people with shoulder problems. Identifying or developing agents (such as growth factors) that help the muscle and tendon repair process. Better understanding the factors that lead to the progression of rotator cuff tears and using new materials and techniques to diagnose and manage rotator cuff tears clinically. Using animal models for better understanding of the healing response after surgery to repair shoulder injuries, and for helping to determine the most effective postoperative activity protocol. More information on research is available from the following websites: NIH Clinical Research Trials and You was designed to help people learn more about clinical trials, why they matter, and how to participate. Visitors to the website will find information about the basics of participating in a clinical trial, first-hand stories from clinical trial volunteers, explanations from researchers, and links on how to search for a trial or enroll in a research-matching program. ClinicalTrials.gov offers up-to-date information for locating federally and privately supported clinical trials for a wide range of diseases and conditions.

NIH RePORTER is an electronic tool that allows users to search a repository of both intramural and extramural NIH-funded research projects from the past 25 years and access publications (since 1985) and patents resulting from NIH funding. PubMed is a free service of the U.S. National Library of Medicine that lets you search millions of journal citations and abstracts in the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and preclinical sciences. Where Can People Find More Information About Shoulder Problems? National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse Website: If you need more information about available resources in your language or another language, please visit our website or contact the NIAMS Information Clearinghouse at NIAMSinfo@mail.nih.gov . Other Resources American Academy of Orthopaedic Surgeons Website: (con informaciï¿½n en espaï¿½ol) American College of Rheumatology American Orthopaedic Society for Sports Medicine Website: Website: (con informaciï¿½n en espaï¿½ol) American Shoulder and Elbow Surgeons Website: Website: Key Words Acromioclavicular (AC) joint.

The joint of the shoulder located between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle (collarbone). Acromion. The part of the scapula (shoulder blade) that forms the highest point of the shoulder. Arthrogram. A diagnostic test in which a contrast fluid is injected into the shoulder joint and an x ray is taken to view the fluid’s distribution in the joint. Leaking of fluid into an area where it does not belong may indicate a tear or opening. Bursae. Filmy sac-like structures that permit smooth gliding between bone, muscle, and tendon. Two bursae cushion and protect the rotator cuff from the bony arch of the acromion. Bursitis. Inflammation of the bursae that cushion joints. Bursitis is a common cause of shoulder pain. Capsule. A soft tissue envelope that encircles the glenohumeral joint and is lined by a thin, smooth, synovial membrane. Clavicle. The collarbone. Corticosteroids. Powerful anti-inflammatory hormones made naturally in the body or manmade for use as medicine.

Injections of corticosteroid drugs are sometimes used to treat inflammation in the shoulder. Glenohumeral joint. The joint where the rounded upper portion of the humerus (upper arm bone) joins the glenoid (socket in the shoulder blade). This is commonly referred to as the shoulder joint. Glenoid The dish-shaped part of the outer edge of the scapula into which the top end of the humerus fits to form the glenohumeral shoulder joint. Humerus. The upper arm bone. Impingement syndrome. Squeezing of the rotator cuff, usually under the acromion. Ligaments. Tough bands of connective tissue that attach bones to each other, providing stability. Magnetic resonance imaging (MRI). A procedure in which a strong magnet is used to pass a force through the body to create a clear, detailed image of a cross section of the body. The procedure may be used to confirm the diagnosis of some shoulder problems. Nonsteroidal anti-inflammatory drugs (NSAIDs). A class of medications that ease pain and inflammation and are available over the counter or with a prescription.

Commonly used NSAIDs include ibuprofen (Advil, Motrin), naproxen sodium (Aleve), and ketoprofen (Actron, Orudis KT). Osteoarthritis. The most common form of arthritis. It is characterized by the breakdown of joint cartilage, leading to pain, stiffness, and disability. Rheumatoid arthritis. A form of arthritis in which the immune system attacks the tissues of the joints, leading to pain, inflammation, and eventually joint damage. RICE. An acronym for rest, ice, compression, and elevation. These are four steps often recommended for treating musculoskeletal injuries. Rotator cuff. Composed of tendons that work with associated muscles, this structure holds the ball at the top of the humerus in the glenoid socket and provides mobility and strength to the shoulder joint. Scapula. The shoulder blade. Synovial fluid. Lubricating fluid secreted by the synovial membrane that lines a joint. Synovium. The membrane that lines the joint and secretes a lubricating liquid called synovial fluid. Tendinitis. Inflammation of the tendons.

In tendinitis of the shoulder, the rotator cuff and/or biceps tendon become inflamed, usually as a result of being pinched by surrounding structures. Tendons. Tough cords of connective tissue that attach the shoulder muscles to bone and assist the muscles in moving the shoulder. Transcutaneous electrical nerve stimulation (TENS). A technique that uses a small battery-operated unit to send electrical impulses to the nerves to block pain signals to the brain. Acknowledgments The NIAMS gratefully acknowledges the assistance of the following individuals in the preparation and review of the originial version of this publication: James Panagis, M.D., M.P.H., NIAMS/NIH; Frank A. Pettrone, M.D., Arlington, VA; and Ken Yamaguchi, M.D., Washington University School of Medicine, St. Louis, MO. The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the U.S.

Department of Health and Human Services’ National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. The NIAMS Information Clearinghouse is a public service sponsored by the institute that provides health information and information sources. Additional information can be found on the NIAMS website at . For Your Information This publication contains information about medications used to treat the health condition discussed here. When this publication was developed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released. For updates and for any questions about any medications you are taking, please contact U.S. Food and Drug Administration Toll free: 888-INFO-FDA (888-463-6332) Website: For additional information on specific medications, visit Drugs@FDA at . Drugs@FDA is a searchable catalog of FDA-approved drug products.

For updates and questions about statistics, please contact Centers for Disease Control and Prevention, National Center for Health Statistics Toll free: 800-232-4636 Website: This publication is not copyrighted. Readers are encouraged to duplicate and distribute as many copies as needed. Additional copies of this publication are available from: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse Shoulder Joint Anatomy: Overview, Gross Anatomy, Microscopic Anatomy Shoulder Joint Anatomy Author: Stephen Kishner, MD, MHA; Chief Editor: Thomas R Gest, PhD more... Share Overview Overview The human shoulder is the most mobile joint in the body. [ 1 ] This mobility provides the upper extremity with tremendous range of motion such as adduction, abduction, flexion, extension, internal rotation, external rotation, and 360° circumduction in the sagittal plane. Furthermore, the shoulder allows for scapular protraction, retraction, elevation, and depression. This wide range of motion also makes the shoulder joint unstable. [ 1 ] This instability is compensated for by rotator cuff muscles, tendons, ligaments, and the glenoid labrum.

[ 2 , 3 , 4 , 5 , 6 ] An image depicting shoulder anatomy can be seen below. Shoulder joint, anterior view. Next: Gross Anatomy The shoulder or pectoral girdle is composed of the bones that connect the upper extremity to the axial skeleton. Two bones comprise the shoulder girdle. These are the clavicle and scapula. Osteology Scapula The scapula is a triangular-shaped bone that functions mainly as a site for muscle attachment. Four rotator cuff muscles that act on the shoulder take their origin from the scapula. These are the supraspinatus, infraspinatus, teres minor, and subscapularis (see the following image). Shoulder anatomy, lateral view. View Media Gallery Additionally, the trapezius, serratus anterior, rhomboids, and levator scapulae insert on the scapula and are responsible for scapular mobility and stability. The scapula is freely moveable, because it is suspended by these muscles. The scapula has 4 processes, the spine, the acromion, the coracoid, and the glenoid.

The glenoid cavity (or, alternatively, the glenoid fossa) is set on the expanded aspect of the lateral angle of the scapula. The glenoid cavity is an irregularly shaped oval and has been compared to an inverted comma shape. It articulates with the head of the humerus, forming the glenohumeral joint, which serves as the main joint of the shoulder. Clavicle The clavicle is an S-shaped bone that forms the anterior portion of the shoulder girdle that keeps the arm away from the trunk, allowing it to move freely. The clavicle has 2 articulations, the sternoclavicular joint and the acromioclavicular joint. The sternoclavicular joint is formed by the medial aspect of the clavicle articulating with the manubrium of the sternum. This is the only skeletal connection between the axial skeleton and the upper extremity. Furthermore, the clavicle provides protection for the subclavian artery, subclavian vein, and brachial plexus posteriorly and inferiorly. See the images below. Shoulder anatomy muscle, anterior view.

View Media Gallery Humeral head The proximal articular surface of the humerus is termed the humeral head. The humeral head articulates against the shallow glenoid cavity. Only 25% of the humeral head surface makes contact with the glenoid cavity. [ 7 ] The glenoid labrum, a fibrocartilaginous ring attached to the outer rim of the glenoid cavity, provides additional depth and stability. Articulations Sternoclavicular joint The sternoclavicular joint is the sole connection between the axial skeleton and the upper extremity. The sternoclavicular joint allows 30-35 º of upward elevation, 35 º of anteroposterior movement, and 44-50 º of rotation about the long axis of the clavicle. [ 8 ] Acromioclavicular joint The acromioclavicular (AC) joint is the only articulation between the clavicle and scapula. It is formed by the distal clavicle articulating with the acromion of the scapula. Little motion exists in this joint.

The AC joint is an encapsulated diarthrodial joint held together by its joint capsule and the coracoacromial ligaments: the trapezoid and conoid ligaments. Glenohumeral joint The glenohumeral joint is the main articulation of the shoulder joint. It is the multiaxial ball-and-socket synovial joint formed by the articular surfaces of the glenoid cavity and the head of the humerus. The glenoid cavity depth is increased by a rim of fibrocartilage that surrounds it. This rim of fibrocartilage is the glenoid labrum. Labrum The glenoid labrum is a ring composed of mostly dense fibrous tissue. The average depth of the glenoid cavity is 2.5 mm, but the labrum serves to increase this depth. Although the labrum increases the depth and volume of the glenoid cavity, it does not seem to increase the stability of the glenohumeral joint. [ 8 ] Ligaments Coracoclavicular The conoid and trapezoid ligaments comprise the coracoclavicular ligaments (CCLs) (see the image below).

They function to maintain the articulation of the clavicle with the coracoid process of the scapula. Studies have concluded that the coracoclavicular ligaments are the primary restraint to superior and posterior clavicular dislocation. [ 9 ] Shoulder joint, anterior view. View Media Gallery Glenohumeral Three glenohumeral ligaments exist: (1) the superior glenohumeral ligament (SGHL), (2) the middle glenohumeral ligament (MGHL), and (3) the inferior glenohumeral ligament (IGHL). The SGHL has a variable origin and inserts on the humerus near the lesser tubercle; this ligament resists inferior translation of the humeral head in the adducted shoulder. The MGHL originates from the labrum and inserts on the humerus medial to the lesser tubercle; this ligament resists inferior translation in the adducted and externally rotated shoulder. The IGHL originates from the labrum and the adjacent glenoid neck, inserts on the anatomic neck of the humerus, and resists humeral head anterior and posterior translation.

Furthermore, the IGHL is the primary restraint to inferior dislocation in the abducted shoulder. Coracohumeral The coracohumeral ligament (CHL) originates on the base and lateral border of the coracoid process of the scapula and inserts on the greater tubercle. The biomechanical function of this ligament is not fully understood; however, it appears to have suspensory function of the humeral head. Rotator cuff The supraspinatus, infraspinatus, teres minor, and subscapularis muscles comprise the rotator cuff (see the following image) (see Table 1, below). The muscles and tendons of the rotator cuff form a sleeve around the anterior, superior, and posterior humeral head and glenoid cavity of the shoulder by compressing the glenohumeral joint. In addition to stabilization, the rotator cuff provides the shoulder with tremendous mobility. Shoulder anatomy, lateral view. Table 1.

Origins, Insertions, Actions, and Nerve Supplies of the Rotator Cuff Muscles (Open Table in a new window) Muscle (See also Multidirectional Glenohumeral Instability , Anterior Glenohumeral Instability , Posterior Glenohumeral Instability .) Acromioclavicular joint sprain or dislocation (shoulder separation) The AC joint is frequently injured in athletes. The injury commonly occurs when direct force is applied to the acromion with the arm adducted. The force causes the acromion to suddenly move inferiorly, which first strains or tears the AC ligaments and may subsequently strain or tear the coracoclavicular ligaments as well. Rotator cuff tear Rotator cuff tears are common injuries; such a diagnosis indicates one or more of the rotator cuff tendons have torn. The injury may be result of chronic impingement and tendonitis that has progressed, or it may refer to an acute injury such as a fall or direct trauma. People with a rotator cuff tear may experience pain and weakness in their shoulder.

Subacromial/subdeltoid bursitis Rotator Cuff Injuries: Symptoms and Treatment Rotator Cuff Injuries: Symptoms and Treatment by Phil Gilliam / Thursday, 05 July 2012 / Published in Injury , Shoulder Injury Rotator Cuff Injuries What is a rotator cuff injury? The rotator cuff is a term used to describe the tendons and muscles that support, stabilize and allow the arm to move up and down, as well as rotate. The four muscles include the supraspinatus, infraspinatus, subscapularis, and teres minor. Injury to muscles or tendons that attach to bones comprise contractile units. These units stabilize the shoulder and allow its motion. A strain occurs at a unit’s weakest point. How do you prevent a rotator cuff injury? Warm up adequately prior to any physical activity, practice or competition. The athlete should participate in a strength and flexibility program appropriate for their sport especially a shoulder strengthening and conditioning program prior to throwing sports. For participation in contact sports, protect shoulders with special equipment such as the Antibody Angle Shoulder brace™ or shoulder pads. After recovery, strapping or elastic wraps may protect against re-injury.

What are the signs of a Rotator cuff injury? The signs of a rotator cuff injury are: Noticeable pain in the soft tissues surrounding the strain, including nerves, periosteum (covering of bone), blood vessels and lymph vessels at the time of injury. Loss of strength (moderate to severe strain) A common symptom of a rotator cuff injury is aching, and weakness in the shoulder when the arm is lifted overhead. Crepitation (“cracking” feeling and sound when the injured area is pressed with finger). Calcification of the shoulder muscle or tendon (visible with x-rays). Inflammation of the tendon sheath. A less severe injury may result in swelling, bleeding and bruising. This creates pain and inflammation as the swollen muscle pushes on the nearby bone. This can last several months before the muscle is entirely healed. Continued activity can increase the swelling, and lengthen the recovery time. What body parts are involved in a Rotator cuff injury? The specific body parts involved are four muscles including the supraspinatus, infraspinatus, subscapularis, and teres minor. The bones in the shoulder area, including the humerus, scapula and clavicle.

What are the main causes of a rotator cuff injury? The main causes of a rotator cuff injury are: Prolonged overuse of muscle-tendon units in the shoulder. Single violent blow or force applied to the shoulder. Powerful muscle twisting or a violent muscle contraction. Am I at risk for a rotator cuff injury? The risk of sustaining a rotator cuff injury increases with contact sports, especially boxing, wrestling or rugby. The risk increases with: Any activity that involves forceful throwing, lifting or throwing sports such as baseball, football, basketball or tennis. Any cardiovascular medical problem that results in decreased circulation. Medical history of any bleeding disorder. Obesity Previous shoulder injury. What is the proper care for a rotator cuff injury? The appropriate health care for a shoulder dislocation is a doctor’s diagnosis. This will include: A tear needs to be seen and evaluated by a physician to determine if surgery is needed to repair the muscle. If large tears are left alone, they often lead to arthritis, due to continual rubbing and inflammation of the joint. Surgical repair of a torn rotator cuff muscle can often be done with arthroscopic techniques, which use a very small incision, and the patient can go home the same day.

Recovery involves medication to reduce inflammation, and physical therapy exercises to increase range of motion and strength. Physical therapy (Moderate or severe strain) Self-care during rehabilitation. Are there any complications with rotator cuff injuries? Some possible complications can be: Prolonged healing time if activity is resumed too soon. Proneness to repeated injury. Unstable or arthritic shoulder following repeated injury Inflammation at the attachment to the bone(periostitis). Prolonged disability, usually weakness and pain, when using arm in the overhead position. How long does a rotator cuff injury take to heal? If this is a first time injury. Proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as fractured bones do. The average healing times are: Mild strain: 2 to 10 days Moderate strain: 10 days to 6 weeks Severe strain: 6 to 10 weeks. If this is a repeat injury the complications listed above are more likely to occur. What treatment should I use for a rotator cuff injury? The most important part about treating a rotator cuff injury is to get the right diagnosis.

Some supplemental first aids are the “R.I.C.E.” instructions: Rest, Ice, Compression, and Elevation (if possible). It is helpful, as continuing care, to use an ice pack 3 or 4 times a day for 15 minutes at a time. Place ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured area. After the first 72 hours, application of localized heat promotes healing by increasing blood circulation in the injured area. Use heat lamps, hot baths, showers, heating pads or heat liniments and ointments. Take whirlpool treatments, if available. Massage gently and often to provide comfort and decrease swelling. Wrap the injured shoulder with an elasticized bandage between treatments. What medications, if any, are recommended? Your doctor may prescribe: (1) Aspirin, Acetaminophen or ibuprofen to relieve minor pain. Topical liniments and ointments (2) Your doctor may prescribe stronger pain relievers or an injection of a long-acting local anesthetic to reduce pain. Your doctor may also prescribe injections of corticosteroids, such as triamcinolone to reduce inflammation .

What activity is proper during rehabilitation and recovery? Resume your normal activities gradually. For a moderate to severe strain, use a sling for at least 72 hours. As far as diet, balance the amount of food you eat with any change in your level of physical activity. During recovery eat a variety of foods to get the energy, protein, vitamins, minerals and fiber you need for good health and healing.. You can begin daily rehabilitation exercises when supportive sling is no longer needed and with the blessing of your doctor. Use ice massage for 10 minutes before and after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of the foam from the top so the ice protrudes. Massage firmly over the injured area in a circle about the size of a softball. Recovery involves medication to reduce inflammation, and physical therapy exercises to increase range of motion and strength. The treatment of a strain is different that a tear, so see your physician if you have an injury to the shoulder that results in pain. Stretching and strengthening the shoulder can help prevent injuries, and should be a part of a warm up and general conditioning program.

Call your Doctor if: Be certain to call your doctor if you have symptoms of a moderate or severe rotator cuff strain or a mild strain persists longer than 10 days. Call your doctor if any of the following occurs after surgery: (1) Increased pain, swelling or drainage in the surgical area.(2) Signs of infection (headaches, muscle aches, dizziness or a general ill feeling and fever Drugs used in treatment may produce side effects. How does the Angle Shoulder Brace™ work to prevent some rotator cuff injuries? The Bodyguard™ Angle Shoulder brace provides muscle compression, joint stabilization and support, muscle heat circulation to increase blood flow and promote healing, strain distribution and it absorbs and spreads direct impact. The inner surface of the The Angle Shoulder brace™ attaches to the surface of the shoulder, bicep, chest and upper back to spread strain over all those surfaces instead of concentrating it on the shoulder as is the case with the unprotected shoulder under an injury condition. How does the Angle Shoulder Brace™ help if you have an existing rotator cuff injury?

When used to protect an existing shoulder injury, The Bodyguard™ Angle Shoulder brace and the Angle Double Shoulder Brace stabilize and supports the shoulder joint, spreads strain and impact over the entire surface of the garment, raises muscle temperature to increase blood flow and promote healing in the joint and surrounding tissue. 3 strength and conditioning exercises to help you stay injury-free - Injuries - 220Triathlon Training > Injuries 3 strength and conditioning exercises to help you stay injury-free Nick Beer explains 3 essential exercises that should be part of every training programme to help keep you injury-free, and gain maximum benefit and results from your training schedule. Posted: 25 January 2016 Tweet In the winter the cold weather causes our muscles to contract a lot more than usual and become tighter in order to conserve as much heat as possible. If our bodies are not conditioned correctly, then our muscles will over compensate in order to restore balance. The cold temperatures will add more stress than usual, which increases the risk of injury. This is why strength and conditioning exercises are essential in preventing injuries and maximising our training.

1) Rotator Cuff and posture (upper back) The Rotator Cuff is a tough sheath of tendons and ligaments that supports the arm at the shoulder joint. It is a collection of muscles that is associated with upper back posture and plays a very important role when we are swimming. Keeping these muscles activated and strong will help improve our posture and help iron out any imbalances in our back. Good posture is very important when cycling and running, as it will lead to improved efficiency and the ability to sustain form under fatigue. Exercise Lying on your front on the floor. Place a towel underneath your forehead and rest your head on to it, eyes looking down. Stretch your arms outwards at shoulder height, so your body forms a cross. Bend your elbows, so your forearm and upper arms are at right angles to each other with your fingers pointing forward and the back of your hands facing upwards; palms on the floor. Keep your elbow in line with your shoulders while maintaining the right angle. The shape you will form is a “W.” Once in this position, relax the whole body. Without moving any other parts of the body lift both arms off the floor contracting your upper back only. Hold this position for 5 seconds.

From here, extend forward both your arms in an outward direction while rotating your hands to finish off with your thumbs pointing towards the ceiling, forming a “Y” shape. Hold for 5 seconds and return to starting position. Repeat 5-10 times depending on strengthen and carry out for 3 sets. To develop this exercise further add lightweight dumbbells and continue with the same movement and increase the reps. 2) Core Strength Core strength should be a staple of any fitness-training plan. Strong core will help maintain form, preserve technique and prolong efficiency when fatigued. It is imperative that we constantly train this group of muscles as this will, ultimately, lead to a better performance. There are many effective core exercises, but one of my favourites is called the ‘Get Up.’ Exercise Kneel on the floor with a matt or a cushion under your knees. Back straight, shoulders back maintaining good posture. Looking straight ahead, raise one arm above your head and the other arm out to the side like an airport traffic controller. To activate your core, pretend to cough and feel your stomach tighten and hold that contraction all through the exercise. Keeping your arms extended upwards and to the side, stand up without holding on to anything.

With the leg you stood up on, bend and return back to the floor into the kneeling position - this is 1 rep. Repeat 8-10 times on one leg and then change and repeat. To develop this exercise further add a weight to the extended arm as this will work on developing shoulder stability, as well as making it more difficult to execute the exercise. 3) Single leg balance Strong ankles and stable knees are very important conditioning characteristics that everyone should consider developing during their winter training in order to stay injury free. Increasing the training volume will test their reliability as they act to keep us aligned and out of trouble. A very good exercise for this are ‘single leg half moons’. Exercise Standing still, raise one leg and maintain balance. Point your raised leg forward and gently touch your big toe on to the floor. Hold for 5 seconds and from this position, draw a semi circle with your big toe by pushing the raised leg as far wide as you can without losing balance, so the leg stops at full extension behind your static leg. During this movement, bend the opposite knee causing the quad to contract. Hold for 5 seconds and then bring the raised leg back to start, standing straight while keeping the leg off the floor.

Repeat 6 times without lowering the leg onto the floor. The tension will build in your static leg and will force your stabilising muscles in your ankle and knee to work overtime in order to maintain balance. To develop this exercise further - increase the time of the two holds to 10 seconds and the flexion in your knee in the static leg. Also, introduce a Bosu Ball or a wobble board for your static leg to stand on to increase the difficultly by making the surface unstable. Consistency is key during winter. Staying fit and healthy is just as important as hitting target sessions. Training week in week out for months will lead to massive fitness improvements and to achieve this you must remain injury-free. Once out of the bleakness of winter and into the glorious summer days, you will be rewarded with the results you have been aiming for all year. Remember the saying “Winter miles, summer smiles.” Nick Beer is an Endurance Specialist and Corrective Exercise Coach, with a wealth of experience providing nutrition advice for weight loss and performance. Find out more on his website here and follow @BeerNickTri for more tips. Posted: 25 January 2016

Question: The rotator cuff is a tough sheath of tendons and ligaments which supports the human?
Answer: Shoulder