Rotator cuff injuries/weakness are a significant cause of shoulder pain. They occur mainly in patients between 40 and 60 years of age and may be from trauma, but many do not involve an injury. They can slowly evolve from deconditioning, weakness and or overuse. The rotator cuff is made up of 4 muscles that attach from the scapula/shoulder blade to the humerus and are responsible, for you guessed it, rotating the shoulder. They are also essential in shoulder stabilization and help depress the humerus (arm bone) out of the shoulder joint to allow easier movement. In between the rotator cuff and the bone above (the acromion) sits a flattened membrane called the Subacromial bursae. The bursae allows for greater movement and shock absorption.
The shoulder or glenohumeral joint is an extremely mobile joint, with little in terms of bone stability, to allow for greater movement. The rotator cuff is therefore under a fair amount of pressure to stabilize the joint, and can be problematic and prone to injuries or overload. Patients usually present to us with pain, weakness, and restricted motion in the shoulder. Typically pain is felt on the top or "tip" of the shoulder, especially with arm at 90 degrees.
Rotator cuff muscles are all so closely related in terms of location and action that it is very hard to differentiate which one is causing the problem, so we treat them together. Due to this connection it is not abnormal for the pain and symptoms to move around the shoulder. Patients might experience pain at the front, back or side of the shoulder and is often made worse by overhead activities like hanging out the washing or movements like putting on a jacket.
Types of Rotator Cuff injuries:
Shoulder Impingement or Shoulder Tip Pain: When you lift you arm above your head the space between the rotator cuff tendons and the bone above them (the acromion) narrows, the RC tendons can get compressed and sometimes cause pain and irritation.
Bursitis: There is a shock absorbing sac called a bursa between the rotator cuff tendons and the acromion. The bursa allows the tendons to glide freely when you move your arm. Just like the tendons, this can become compressed and irritated and inflammatory cells infiltrate the sac and can become a shoulder irritant
Rotator cuff tears: Tears can occur in people who repeatedly perform the same shoulder motions. Symptoms generally include shoulder pain and weakness. It is important to note that a study has recently found that 54% of asymptomatic (i.e. not having pain or problems) patients aged 60 years or over, were found to have partial or complete tears of the rotator cuff on MRI. Showing us that tissue damage doesn't always equal pain.
Tendinopathies: This is the term used to describe physical changes in the tendons of the rotator cuff over time from overload.
How Do You Treat These issues?
As always a thorough case history is necessary to rule out other causes of shoulder pain. Then a detailed investigation of how you use your shoulder on a daily basis and any exercise programs you might already do. We need to get a clear picture of what sort of loads you put through your shoulder and any overload that may be occurring.
Treatment will start with a physical examination. Some manual therapy may be done to decrease pain in the short term.
For long term resolution a graduated exercise program will be constructed to restore strength and motion to your shoulder and ultimately decrease the pain you are experiencing.
Do I need injections or X-rays?
Steroid or cortisone injections are rarely used due to their risks and they are generally ineffective in helping these problems.
Depending on your case history, imaging (eg xrays, ultrasound, MRI) may be requested but it is rare to order these tests as it wont change our treatment plan and as noted above many people with no pain in their shoulders will have rotator cuff wear and tear on ultrasound and on MRI.
If you have any further questions contact us directly.