The shoulder girdle has a relatively unstable ball and socket joint and it uses surrounding muscles to stabilise it. The rotator cuff muscles form a cusp around the shoulder joint and are responsible for shoulder rotation aside other movement in the upper limb. There are four muscles which make up the rotator cuff: subscapularis, supraspinatus, infraspinatus and the teres minor. These muscles or their tendons are susceptible to inflammation, tears, impingement and tears.
Some of the commonly encountered rotator cuff injuries are:
Rotator Cuff Impingement
Impingement can be structural or dynamic. Structural impingement refers to naturally occurring small sub-acromial space in some individuals. The occurrence of osteophytes or bony spurs can also reduce the sub-acromial space further.
Dynamic rotator cuff impingement is usually associated with repetitive movement and compounded by weak muscles, lax ligament and excessive joint movement. When the muscles are weak, they are unable to form a tight cusp around the humerus which then migrates into the sub-acromial space reducing it and causing inflammation of the bursa or rotator cuff tendons.
A bursa is a thin sack which contains synovial fluid which acts as a lubricating fluid reducing the friction between the joint structures. The bursa which is normally thin can become inflamed and this causes bursitis. The sub-acromial bursa is the most commonly affected bursa in the shoulder though there are several which occur there.
Symptoms of shoulder bursitis are:
- Pain which spreads down the arm towards the elbow or wrist
- Gradual onset of pain over several weeks or months
- Shoulder pain with overhead movement
- Shoulder pain when lying on that side.
- Shoulder pain when trying to tie wrapper, head gear or reach for things high above.
Symptoms of Rotator Cuff Injury
The symptoms of rotator cuff injury varies depending on the specific pathology. Some of the commonly encountered symptoms are:
- Shoulder pain at rest in severe rotator cuff injury
- Shoulder pain when lying on the affected shoulder
- A painful arc when trying to lift the arm above the head
- Shoulder pain when trying to lift or reach for objects
- Shoulder pain when trying to tie wrapper, head gear or reach for seatbelt
Causes of shoulder pain or rotator cuff injury
Injury can happen to the rotator cuff by repetitive movements which cause compression of the joint space causing entrapment of the tendons of the muscles. The bursa which is a fluid sack which acts as a shock absorber can also become inflamed. As more people become interested in exercising and going to the gym, people may use wrong techniques and cause damage to the shoulder muscles too and this can lead to rotator cuff injury.
There are instances when there is an impingement in the shoulder-where the bone impinges on the tendon of the rotator cuff muscles called tendonitis or when the bursa becomes inflamed called bursitis. It can also occur that bones form within the tendon called calcific tendonitis. In some cases, there can be tears in one or many of the rotator cuff muscles and this may require surgery.
Treatment of shoulder pain
There are essentially several stages in the management of shoulder pain:
- Pain relief, protection and rest
- Regain full range of motion
- Restore normal rhythm and function to the entire shoulder girdle
- Restore rotator cuff strength, speed and proprioception
- Return to normal activity
If you or a loved one has shoulder pain, why don’t you give call the PhysioCraft team and we’d be happy to answer any questions that you may have for free.