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Oww…My Shoulder Hurts!

It has been suggested in the literature that as many as 30-50% of people will experience shoulder pain at some point in their lives with many experiencing pain annually. As there are many reasons why you may have shoulder pain, it is important to have a thorough assessment to figure out the cause of your pain and commence a treatment plan.  However, one of the most common presentations of shoulder pain we see in the clinic is due to rotator cuff pathology.

There are multiple terms given in the literature to describe rotator cuff pathology including rotator cuff tendinopathy/tendinosis/tendinopathy, supraspinatus tendinopathy/tendinosis/tendinitis, impingement syndrome, subacromial bursitis, partial thickness, full thickness and massive rotator cuff tear1.

The humeral head sits within the socket and the rotator cuff is a group of 4 muscles which all work together to help centralise the humeral head within the socket during movement. The rotator cuff can become dysfunctional due to acute injury, pain inhibition, and more commonly due to repetitive micro trauma over time, in which the rotator cuff becomes overloaded and can develop into a tendinopathy.

Have a read of our previous blog on tendinopathy here.

Most people with rotator cuff dysfunction present with symptoms that include pain with :-

  • Overhead reaching
  • Reaching your arm out to the side ( Abduction)
  • Reaching your hand behind your back
  • Pain when sleeping on the affected shoulder at night time
  • Aching over the front and side of shoulder and occasionally referring into the upper middle part of the arm.
  • Weakness with lifting objects.

Imaging such as ultrasound and MRI cannot effectively tell us where your shoulder pain is coming from. It has been suggested in the literature that the prevalence of rotator cuff tears in asymptomatic (symptom free) people is approximately 50% in the 40-60 years old individuals and 80% in the 80+ years category. On ultrasound of 51 asymptomatic males, 96% of them showed findings such as bursitis, acromioclavicular joint degeneration and rotator cuff tendinopathy2.

This is staggering and indicates that we must look beyond the traditional biomedical model of pain taking a more holistic approach to pain management to improve patient outcomes and function. Many factors have been suggested to contribute to pain including genetics, lifestyle factors including smoking, alcohol consumption, level of education, changes within the cortex of the brain and psychosocial factors but it is accepted that excessive and maladaptive load on the tissues appears to have a major influence3.

Keep a look out for our future blog on understanding pain and it’s management.

In fact, ageing is the highest predictor for a rotator cuff tear, just as we get wrinkles on our face as we age, we get changes in the structure of the muscles and tendons which can lead rotator cuff tendinopathy.   Physiotherapy can be hugely beneficial in the management of rotator cuff dysfunction, there is much research that consistently demonstrates improvement in symptoms with an individualised and graded exercise program. When compared with surgery for rotator cuff tears, shoulder impingement and tendinopathy, there are many benefits, including a quicker return to work, less sick leave and reduced healthcare costs associated with conservative management. Exercise has been shown to be as effective as surgery at 5 years follow up4.

Indeed it has been questioned as to if the main benefit of surgery is due to the relative rest that the patient must undertake, thus allowing their symptoms to settle and tissues to heal.   Here at Janet Brandt-Sarif Physiotherapy, we perform a thorough assessment of your shoulder movement, strength and functional abilities. We utilise manual techniques to help restore range of motion, reduce pain and most importantly tailor an individualised graded exercise program to empower you, the patient, to take control of your recovery.

We believe that education is a fundamental component of the healing process and that active management through exercise therapy when appropriate is of utmost important. Physiotherapy can help guide you on when to rest, how to modify painful activities and plan a controlled exercise program to reload your rotator cuff and re-establish good control and movement patterns.

References:

  1. Lewis JS Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment? British Journal of Sports Medicine 2009;43:259-264.2.2.
  2. Lewis JS Management of Rotator Cuff Tendinopathy Intouch 2014; 1493.
  3. McCreesh K, Lewis J. Continuum model of tendon pathology – where are we now?  International Journal of Experimental Pathology 2013, 94:242-7
  4. Lewis JS, McCreesh K, Roy JS, Ginn K Rotator Cuff Tendinopathy: Navigating the Diagnosis.    Management Conundrum JOSPT 2015; 45:923-937
  5. Chester R, Jerosch-Herold C, Lewis J, et al Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study Br J Sports Med Published Online First: 21 July 2016, doi: 10.1136/bjsports-2016-096084.
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