Cuffia Dei Rotatori Esercizi Per Essay

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Tra i quattro muscoli che compongono la cuffia dei rotatori, il sovraspinato è quello che si lesiona più frequentemente. In realtà quando si parla di rottura della cuffia dei rotatori non si fa riferimento a lesioni di natura muscolare ma tendinea.

Il tipo di ferita può variare da un'infiammazione tendinea locale, senza alcun danno permanente, ad una lesione parziale o completa che potrebbe richiedere l'intervento di riparazione chirurgica.

In entrambi i casi si registrerà un deficit più o meno marcato nella forza di abduzione del braccio. In particolare il soggetto faticherà a mantenere il braccio sollevato lateralmente tra i 60° ed i 120°. Un apposito test per diagnosticare la lesione della cuffia dei rotatori andrà proprio a testare la risposta muscolare del paziente in questi angoli di movimento.

Test diagnostici - Per approfondire: Valutazione funzionale nelle patologie di spalla

TEST DELLA CUFFIA DEI ROTATORI: il paziente solleva lateralmente il braccio ruotandolo verso l'interno (in modo che il pollice sia rivolto verso il basso) e flettendolo in avanti di 20-30°. Il medico opera una leggera pressione sul braccio spingendolo verso il basso. Se è presente dolore o una perdita di forza importante (rispetto al braccio sano controlaterale) il test è positivo. L'impossibilità di mantenere il braccio immobile sotto i 120° (segno diagnostico chiamato "braccio cadente" o segno di JOBE) si correla ad una lesione completa del tendine.

Sebbene sia in grado di diagnosticare soltanto una lesione del sovraspinato questo test viene chiamato test della cuffia dei rotatori proprio perché il tendine di questo muscolo è, tra i quattro, quello che si lesiona più frequentemente.

Ulteriori movimenti contro resistenza limitati e dolorosi possono essere invece sintomi di una lesione che coinvolge altri tendini della cuffia.

Se è presente dolore o un importante deficit di forza nella rotazione esterna potrebbe trattarsi di una lesione dell'infraspinato (il secondo muscolo che si lesiona più frequentemente) o del piccolo rotondo. Il test in questo caso consiste nel far ruotare esternamente il braccio contro resistenza con il gomito appoggiato sul fianco e flesso a 90°. Utili informazioni possono essere raccolte paragonando la forza delle due braccia, nel caso la sospetta lesione interessi una sola spalla.

Per diagnosticare una lesione del tendine del muscolo sottoscapolare (il più importante rotatore interno della parte prossimale del braccio) è utile il test "lit off" riportato in figura. Il paziente ruota internamente il braccio leso in modo che il dorso della mano appoggi nella parte bassa della schiena. A questo punto viene chiesto al paziente di allontanare posteriormente la mano mentre il medico esegue una leggera pressione in modo da ostacolare il movimento. Anche in questo caso se si registra un calo sensibile della forza o dolore al movimento si è con tutta probabilità in presenza di una lesione del tendine del muscolo sottoscapolare.

Il test di conflitto di Neer, che consiste nel sollevare in avanti il braccio di 180° sul piano della scapola (mantenuta ferma dalla mano del medico) in completa rotazione interna, è positivo se il paziente accusa dolore alla spalla nella posizione finale (quando il tendine del sovraspinato urta contro la superficie inferiore dell'acromion).

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