Relative contributions of infraspinatus and deltoid during external rotation in healthy shoulders

Balanced forces around the shoulder are important for normal function; however, rehabilitation guidelines are not well defined because the muscle contributions and optimal exercise technique to recruit them are poorly understood. This study aimed to determine (1) the conditions of resisted isometric external rotation that optimized the contribution of infraspinatus and (2) the load of external rotation at which the adduction strategy was most effective at reducing deltoid contributions. Eighteen subjects with healthy shoulders (n = 36) performed resisted isometric external rotation at 3 increasing loads- 10%, 40%, and 70% of their maximal resisted external rotation voluntary isometric contraction-with and without adduction. Surface electromyographic activity of the infraspinatus, posterior and middle deltoid, and pectoralis major was recorded and normalized against the average activity of all 4 muscles, representing each muscle's relative contribution to the task. To optimize the relative contribution of the infraspinatus with the least deltoid involvement during isometric external rotation, a load between 10% and 40% maximal voluntary isometric contraction is appropriate. At low loads, use of the adduction strategy during external rotation reduces middle deltoid involvement. In contrast, the posterior deltoid is activated in parallel with the infraspinatus at low loads and may even act as an adductor with the arm by the side. This study provides a useful guide to optimize rehabilitative exercises for rotator cuff dysfunction; in particular, highlighting that activation of the deltoid could be counterproductive to infraspinatus retraining.