Rotator cuff injuries
As an osteopath, one of the more common types of pain I see in clinic is pain in the shoulder. The shoulder joint is made up of three bones – the humerus (upper arm bone), the clavicle (collar bone) and the scapula (shoulder blade). It is one of the most mobile joints in the body and through the make-up of its muscles, ligaments and other surrounding structures, allows us to move our arms in nearly every direction. However, anatomically speaking, great joint mobility usually means reduced joint stability and this is one of the reasons why shoulder injuries are fairly common.
The most common shoulder pain injury I see by far is a rotator cuff injury. The rotator cuff muscles are made up of four muscles that surround the top of the humerus and attach to the shoulder blade. Together they work to help lift and rotate the arm as well as keep it in its socket at the shoulder joint. If the rotator cuff muscles become injured, this can cause pain in the affected shoulder as well as weakness and reduced range of movement in the joint.
Any of the four rotator cuff muscles can become injured, but the most commonly injured one is the supraspinatus muscle which sits over the top of the shoulder joint.
Causes of rotator cuff injuries
There are several different causes and contributing factors for rotator cuff injury. These include:
Arthritis of the acromioclavicular joint
Over-use of the tendons, particularly in repetitive shoulder activities e.g. sport, DIY etc.
Age related/general wear and tear around the shoulder
Acute injury e.g. falling on an out stretched hand, shoulder dislocation or other sudden injury etc.
Rotator cuff injuries can range from mild to severe and tend to fall into one of three categories:
Tendonitis – caused by overusing the rotator cuff muscles leading to swelling in the rotator cuff tendons – common in activities such as bowling, overhead tennis serves etc.
Bursitis – a bursa is a fluid filled little sac which acts like a cushion in a joint and allows tendons to freely glide and prevent friction between the different tissues. There are six bursae in the shoulder joint. If the shoulder joint is injured or chronically overused, this can affect the surrounding bursae leading to inflammation, otherwise known as bursitis.
Rotator cuff strains – unlike tendonitis, where the tendon of the rotator cuff becomes swollen and inflamed, a rotator cuff strain refers to a physical tear in the muscle. This is usually caused by over-use or acute trauma. Rotator cuff tears are referred to as either partial or complete depending on how big the tear is.
Signs and symptoms of rotator cuff injuries
The signs and symptoms of rotator cuff injuries include:
Pain in the shoulder, especially at night
Difficulty sleeping on the affected shoulder
Reduced range of movement of the shoulder
Pain around the shoulder when reaching overhead or reaching behind the back e.g. when dressing/undressing, undoing bra straps etc.
Progressive weakness of the shoulder
Although rotator cuff injuries can feel very painful, not all injuries cause pain. This is quite common particularly if the rotator cuff injury is a result of degenerative wear and tear. Often, the rotator cuff could be damaged for months or years before any symptoms appear.
Treatment for rotator cuff injuries
Conservative methods include:
Rest – this is always the first suggestion when dealing with a rotator cuff injury. Resting from the aggravating activity e.g. avoiding any overhead activity etc. can make a big difference, particularly in rotator cuff tendonitis.
Ice/heat advice to reduce swelling and improve the blood circulation to the shoulder can help the recovery process.
Anti-inflammatory medication can help to reduce the swelling and pain in the shoulder – although if after two weeks, they haven’t improved the symptoms, it is important to get your symptoms re-checked.
Physical therapy e.g. osteopathy to help focus on restoring normal movement to the shoulder as well as any home care advice such as stretching and strengthening exercises to assist in the healing.
Occasionally, if conservative methods haven’t worked, options such as cortisone injections or surgery may be required. Research has shown the timing of surgery does not affect shoulder outcomes therefore, non-surgical options are always likely to be tried first.
Tips to prevent rotator cuff injuries
If you have a job or play sport regularly that requires lots of shoulder use, take frequent breaks to reduce the load of the shoulder.
Perform regular back and shoulder strengthening exercises to increase the stability of the shoulder joint.
Try not to slouch as this puts a lot of pressure on the structures of the shoulder.
If the shoulder starts feeling painful, apply ice over the affected area for ten minutes to help reduce pain and swelling.
If you are suffering with shoulder pain or a rotator cuff injury or would like some advice on how to strengthen your shoulders, don’t hesitate to get in touch!