Rotator cuff dyskinesia

I have several patients with traumatic shoulder problems, all recovering, seem to have got stuck at same spot. One fell on outstretched hand, one was dragged by arm in MVA, one has degenerative supraspinatus problem exacerbated by lifting; so different presenting problem. They all have limited abduction, appro 90 degrees, some pain on flexion, sometimes limited flexion range. I can re-establish normal or near-normal ROM abduction after manual release of subscapularis and infraspinatus/ teres minor on the first two, but it doesn't last longer than a couple of days. Particular problem is abduction / internal rotation, as in turning a car steering wheel; this sets up pain and spasm in all three , mostly at deltoid insertion area. A/C jt tests normally.
I have treated with neck release, strengthening of the rhomboids, adductor /extensor complex, pec stretches and GH AP mobilizations. I think there's something missing in my rotator cuff assessment in strengthening; any ideas anyone?

Nothing much seems to help the guy with the degenerative supraspinatus condition. I have treated him with above plus local electro, dry needling and massage to supraspinatus.
Would appreciate any guidance here, getting frustrated, all of us! thanks!

[Physiobase]

Perhaps you could consider the axillary nerve as a potential area to investigate. The dermatome of this is close the the insertions of the rotator cuff into the lateral humerus. A traction injury could account for a lesion in the area. You transient relief from the subscap. release is a good indicator to continue on that track.

Perhaps additionally look for active "trigger points" or more casually painful spots in the infraspinatus and teres muscles and you can use acupressure to release these.

I would also begin some eccentric internal rotation. You can achieve this with the client in sitting and their elbow resting on a table at about 70 degrees to the side of the body (slightly forward of the coronal plane "Scaption" not abduction). Then bend the elbow to 90 degrees and have the patient perform active external rotation exercises of the humerus with focus on the eccentric contraction (of the external rotators) as the arm moves back to end of range internal rotation. You can progress reps, then speed, then without elbow support before you increase the weight. You can also do this with theraband resistance. holding one end and standing on the other. To assist depression of the humeral head while performing the exercise they can gently press the elbow into the supporting surface.

One thing, don't worry about slight neural discomfort in the area of the rotator cuff attachments when initially performing this exercise. This is common and with resolve after a few days as their control increases. Best of luck 8o

Many thanks, will keep you posted on how it goes.

I would suggest MRI and referral to ortho surgeon to rule out intraarticular pathology.