Shoulder problems affect young and old and are often due to overuse injuries from sporting activities. Shoulder pain however, is not reserved for the swimmer, weight lifter, tennis player or golfer alone. If you use a computer, snow shovel, garden or sleep on your side, you’re at risk for shoulder pain as well.
Anatomy and Shoulder Mechanics
A major culprit of shoulder pain is injury to the rotator cuff. The rotator cuff is a series of four muscles and their tendons that surround the shoulder. These muscles help to stabilize the ball – the top of the arm bone (the humeral head) in the socket (the glenoid fossa). The glenoid fossa is quite shallow so the shoulder needs to be further stabilized by the rotator cuff muscles and additional ligaments and soft tissue which surround the socket.
The four rotator cuff muscles originate from the scapula (shoulder blade) and insert on the ‘ball’ in the front of the shoulder creating a cuff-like structure – hence the name. The muscles allow for optimal gliding of the ball within the socket which enable complex motions to occur such as the shoulder moving through a tennis serve. The muscles also help to elevate and move the arm to and away from the body.
Rotator Cuff Injury
A rotator cuff injury is characteristically manifested by the sensation of pain around the shoulder which may radiate into the upper arm area, shoulder stiffness, weakness and sometimes instability.
An injury to the rotator cuff may be due to:
– overuse (i.e. a pitcher throwing too repetitively);
– trauma (a fall on a outstretched hand causing injury to the shoulder);
– a stooped posture (i.e. poor posture at the computer)
– degenerative changes which can occur in the rotator cuff tendons of someone over the age of 55.
It is important to note that degenerative rotator cuff pain can come on insidiously without a result of an injury.
There are generally three ways to describe a rotator cuff injury – a tendinosis or tendinitis (inflammation of the tendons), or a partial or complete tear of the rotator cuff. The injury depends obviously on the severity of the injury.
Signs and Symptoms
Common symptoms of a rotator cuff injury are trouble putting on a jacket or bra, difficult reaching forward, upward or behind, sleeping on the shoulder is painful and lifting items especially over one’s head or reaching forward onto a shelf.
The symptoms and length of time to a full or partial recovery will vary with individuals. Seek medical attention if your symptoms persist for more than a few days or weeks and if your discomfort or lack of function escalates.
Physiotherapists are trained to accurately assess the signs and symptoms of a rotator cuff injury and determine the optimal treatment for this shoulder injury.
Physios will ask you about your pain levels, evaluate your posture (important when looking at a shoulder injury!), examine your shoulder range of motion and strength and do particular tests to rule in or out a rotator cuff impairment. The physio will also ask you about your daily routine and how it is affected by your injury.
Physios use a variety of treatments to address a rotator cuff injury. Frictions, myofascial release and massage techniques are used to loosen tight surrounding neck and shoulder muscles and for pain relief. Modalities such as ultrasound and interferential current help reduce pain levels and facilitate quicker healing times. Physio are also trained to provide appropriate and comprehensive exercises to promote rotator cuff strength, maximize appropriate muscle balance of the rotator cuff and the numerous muscles around the neck and shoulder, to ensure optimal shoulder movement and strength. Taping of the shoulder and or shoulder blade helps with posture and positioning of the shoulder joint. Acupuncture is also known to be effective in treating this condition. Comprehensive patient and posture education is provided to explain the injury, shoulder positions to avoid, the recovery process and how to prevent re-injury.
For more information, please contact Pam Honeyman Physiotherapist.