The shoulder joint is a very mobile joint and requires high amounts of dynamic stability. The shoulder joint is surrounded by a group of muscles that provide this stability known as the rotator cuff. The rotator cuff is however susceptible to injury and inflammation, which is a very common cause of shoulder pain. There are three common conditions that can affect the rotator cuff muscles: tendonitis (inflammation of a tendon), impingement syndrome (pinching of a tendon) and a rotator cuff tear. Most people with these problems can be successfully treated by a combination of the correct treatment and rehabilitation. Steroidal injections and surgery can also be an option if conservative treatment should fail. Figure 1.
Shoulder tendonitis (rotator cuff)
What causes shoulder rotator cuff tendonitis?
Rotator cuff tendonitis is caused by irritation and inflammation of the tendons of the rotator cuff muscles, often having an acute onset and often relating to recent overuse of the shoulder. For example, it can occur in athletes, particularly those who participate in throwing sports. In non-athletes, there may be a history of recent heavy lifting or activities involving repetitive movements of the shoulder, maintained by poor posture. In more chronic cases the tendons can become weakened and calcified. This is when calcium is deposited in the tendons, due to long-standing inflammation. This is worse for prognosis.
What are the symptoms of shoulder tendonitis?
The main symptoms are an acute onset of pain and painful movement of the shoulder. Pain is worst when you use your arm for activities above your shoulder level. This means that the pain can affect your ability to lift your arm up - for example, to comb your hair or dress yourself. Pain may also affect sleep.
What are the treatment options for rotator cuff tendonitis?
Rest from any aggravating activities and movement as best as possible. However, do not completely rest your shoulder. You should still try to keep your shoulder mobile.
Osteopathy: here at Dynamic Osteopaths we provide regular treatment for should pain and tendinitis. This treatment consists of both manual and physical therapy aimed at reducing pain and inflammation, and longer term consisting of correcting muscular imbalances that may predisposed the injury in the first instance.
Paracetamol and anti-inflammatories are usually helpful. Occasionally, stronger painkillers may be needed.
Steroid injections: these can help to reduce the inflammation in the rotator cuff tendons and are normally only recommended is conservative treatment should have no benefit.
Calcific tendonitis is treated in the same way with rest, anti-inflammatory medication, steroid injections and physiotherapy. Rarely, surgery is needed. An alternative to surgery is a procedure called lithotripsy. In lithotripsy, shock waves are generated and delivered by an external power source to the affected tendon(s), using a specialised machine known as a lithotripter. This helps to break up the deposits of calcium.
What is the prognosis for rotator cuff tendonitis?
If rotator cuff tendonitis is adequately treated, there can be complete recovery. If treatment of any rotator cuff problem is delayed or inadequate, it can lead to increased pain and the shoulder stiffen. this can then lead to adhesive capsulitis (frozen shoulder) longer term.
Rotator cuff impingement syndrome
What causes rotator cuff impingement syndrome?
The superior rotator cuff tendon (supraspinatous) passes through a space underneath the shoulder blade. In impingement syndrome, this tendon gets repetitively trapped in the space. After time this can then lead to irritation, inflammation and fraying of the tendon. This means that the tendon weakens and is more likely to tear. Impingement syndrome can occur because of long-standing wear and tear. It can also happen due to problems with the bone on top of the shoulder. These can include arthritis and bony spurs.
Symptoms of rotator cuff impingement syndrome
Rotator cuff impingement syndrome also causes shoulder pain. However, the pain tends to be more chronic. The pain tends to be worse during activities when your arm is raised over your head. Pain can also be worse at night-time.
Treatment for rotator cuff impingement syndrome?
The treatment for rotator cuff impingement syndrome is similar to that for rotator cuff tendonitis. You should rest from any activity that involves repetitive movement of the shoulder. This may mean that you have to modify or change your work activities. However, be careful to keep your shoulder mobile so that it does not stiffen up. Seek advise from your local Osteopath, on treatment and management.
Shoulder rotator cuff tears
Rotator cuff tears are most common in people over the age of 40 years, as this is more so a degenerative related condition.
Causes a rotator cuff tear
Rotator cuff tears are usually tears in the rotator cuff tendon and sometimes in the muscles themselves. In younger people, a rotator cuff tear normally happens as a result of trauma due to a fall or accident. In older people, they are often caused by degenerative causes and rotator cuff impingement syndrome (see above). Rotator cuff tears can be minor/partial or full/complete depending on the degree of damage to the tendon.
What are the symptoms of a rotator cuff tear?
Pain is the most common symptom of a rotator cuff tear. The pain tends to be over the front and outer part of the shoulder. It is worse when your shoulder is moved in certain positions. For example, when your arm is moved above your head. Your shoulder or arm can also feel weak and you may have reduced movement in your shoulder. Some people feel clicking or catching when they move their shoulder.
What are the treatment options for a rotator cuff tear?
Rest from any aggravating activities and movement as best as possible. However, do not completely rest your shoulder. You should still try to keep your shoulder mobile.
Osteopathy: here at Dynamic Osteopaths we provide regular treatment for should pain and tendinitis. This treatment consists of both manual and physical therapy aimed at reducing pain and inflammation, and longer term consisting of correcting muscular imbalances that may predisposed the injury in the first instance.
Paracetamol and anti-inflammatories are usually helpful. Occasionally, stronger painkillers may be needed.
Steroid injections: these can help to reduce the inflammation in the rotator cuff tendons and are normally only recommended is conservative treatment should have no benefit.
What is the prognosis (outlook) for rotator cuff tears?
Symptoms caused by a rotator cuff tear may be successfully eased with non-surgical treatments, including rest, physiotherapy, painkillers, anti-inflammatories and steroid injections. Surgery may be considered when troublesome symptoms persist despite the above treatments. However, there is no definite agreement on the best treatment for people with rotator cuff tears or when surgery is needed.
Any further questions or advise please contact Dynamic Osteopaths on:
E: info@dynamicosteopaths.com
T: 07966 317712 (Clinic Mobile)