Physiotherapy and Rotator Cuff Disorders

What are Rotator Cuff Disorders?

The Rotator Cuff refers to a small group of muscles and tendons, including the subscapularis, supraspinatus, infraspinatus and teres minor, found in the shoulder joint.

The shoulder is a ball and socket joint, the rotator cuff muscles and tendons form a cuff around the head of the humerus (the shoulder ball), controlling the movement of the shoulder as well as providing stability and preventing the shoulder joint from dislocating.

Shoulder pain is a common complaint – a major musculoskeletal disorder, shoulder instability occurs when the head of the humerus does not move correctly in the socket, usually as a result of injury or inflammation. This can cause a range of painful symptoms, making everyday activities difficult to manage.

Symptoms

Frequently described symptoms include:

• Sharp pain in the shoulder region
• A continuous dull ache
• Disturbed sleep (due to painful symptoms)
• Pain which worsens when lifting the arm above shoulder level
• Weakness of the arm

Causes

The location and frequent use of the rotator cuff makes it vulnerable to injuries and wear and tear – injuries are frequently seen in those who engage in repetitive activities where the arm is lifted above the head, such as playing tennis, painting or throwing sports such as Javelin. Tears and inflammation can cause painful symptoms and are usually a result of injury, overuse or degenerative conditions.

Rotator Cuff Tendonitis and Bursitis

Tendonitis describes inflammation of a tendon and bursitis is inflammation of the bursa – a fluid filled sack which lies between bones, surrounding soft tissue, serving as a cushioning lubricator.  Bursitis and tendonitis present similar symptoms and can occur at multiple locations in the body, but are frequently seen in the Rotator Cuff – both conditions worsen during movement with the onset of symptoms at times, sudden and severe.

Inflammation in the shoulder socket means there is less space within the joint for both the tendons and muscles to move, causing the tendon or bursa to become trapped between the bones. This is known as impingement syndrome.

Tears

Injury, overuse and degenerative conditions can cause muscles or tendons to tear more easily, causing severe pain and often a lack of mobility. Tendons weaken as we age and become increasingly more prone to tears over the age of 40. A Rotator Cuff tear may be partial or full thickness – a full thickness tear may completely pull the tendon off the bone or tear right through, provoking extremely painful symptoms.

Osteophytes

More commonly referred to as bone spurs, osteoarthritis may provoke the formation of bony outgrowths in the shoulder in response to the degeneration and inflammation of the shoulder joint and its surrounding tissues. The extra bone can limit the space available for the tendons and muscles of the rotator cuff, causing inflammation – tendonitis and or bursitis.

Diagnosis

‘Rotator Cuff disorders’ is often used as a blanket term to describe a range of shoulder related conditions – and although some individuals suffering from degenerative shoulder related conditions may experience painful symptoms, others may feel nothing at all. A diagnosis involving a thorough physical examination, specific test exercises and imaging tests such as an MRI Scan, X-Ray or Ultrasound can help to identify any specific physiological changes, such as a severely torn tendon.

Rotator Cuff Physiotherapy

Physiotherapy is key to the recovery of Rotator Cuff related disorders – targeted exercises and stretches, with hands on manipulation and massage can not only provide pain relief but can also be extremely beneficial in the rehabilitation of muscles, building strength and restoring flexibility.

A comprehensive rotator cuff physiotherapy program can also not only help patients regain a full range of motion, but also provide invaluable psychological support and encouragement. Recent studies suggest that how we deal with pain plays a key role in our recovery – feeling pain can be extremely stressful, this can have a knock-on effect psychologically. Depression and anxiety are intrinsically linked to chronic pain, feeling constant pain is stressful and anxiety inducing, this in turn may heighten painful symptoms turning into a vicious cycle which can severely disrupt day to day life and our recovery from the original injury.

This article published in the British Journal of Sports Medicines not only describes the benefits of physiotherapy in the recovery of those suffering from musculoskeletal shoulder disorders, it also illustrates the importance of considering the biopsychosocial (biological/genetic, psychological and social factors – economic circumstances etc.) during assessment and subsequent referral to physiotherapy programs. The findings appear to suggest that our individual biological make up, psychological state and social circumstances can heavily influence how we perceive pain and our attitude towards subsequent treatment.

Physiotherapy can be extremely useful in recovery helping to case manage, enthuse and progress patients into a better condition with strong evidence demonstrating that rest, exercise and physiotherapy are fundamental to treating Rotator Cuff related disorders.

Other Treatments

Physiotherapy can be used in conjunction with other treatments such as pain relief medication, steroid injections or surgery.

Medication

For immediate pain relief, over the counter medication such as analgesics and anti-inflammatory drugs (NSAIDs) can be helpful. Stronger pain relief medication may be prescribed in more severe cases.

Steroid Injections

A combination of anaesthetic and steroid can be injected into the shoulder joint in order to reduce swelling and pain, this can be used in conjunction with physiotherapy.

Surgery

In some cases, physiotherapy alone is not sufficient, and surgery may be required. Arthroscopic tendon repair is often favoured by surgeons and involves reattaching the tendon to the bone through a small incision. Open surgery may be necessary in some cases to prevent recurrent dislocation. Follow up to surgery usually includes a course of physiotherapy.

If you are suffering from recurrent pain in your shoulder, get in touch with ProPhysiotherapy today for a consultation. Our highly experienced clinicians specialise in the management of pain, sports injuries and disabilities.