The Rotator Cuff: How it works and why you have shoulder pain

The rotator cuff muscles and tendons are located in the shoulder. They play an important role in stabilizing the shoulder joint and enabling us to lift our arm. Tendinopathies (inflammations or tears of the tendon) can occur in these muscles and tendons, causing pain and difficulty with movement. If you are experiencing these symptoms, it is important to see a physiotherapist as soon as possible for treatment. In this blog post, we will discuss what a rotator cuff tendinopathy is, how it develops, and some of the best treatment options available.

What is the rotator cuff anatomy?

The rotator cuff muscles and tendons attach the shoulder blade to the upper arm bone (humerus). There are four rotator cuff muscles: supraspinatus, infraspinatus, subscapularis, and teres minor. These muscles work together to lift the arm and stabilize the shoulder joint. They hold the ball of the arm into the socket of the shoulder.

Rotator cuff tears are one reason for shoulder pain. What should I do if I have a tear?

What is a rotator cuff tendinopathy?

A rotator cuff tendinopathy is an inflammation of one of the rotator cuff muscles or tendons. This condition can cause pain and difficulty moving the shoulder. Tendinopathies are more common in people who are over the age of 40. However, they can occur at any age. See what to do for tears here

What causes rotator cuff tendinopathies?

There are many factors that can contribute to the development of a rotator cuff tendinopathy. These include:

- Overuse: Repeatedly using the rotator cuff muscles and tendons can lead to inflammation and irritation. This is often seen in people who participate in overhead activities, such as throwing a baseball or swimming.

- A sudden increase in load: Seemingly innocuous tasks such as painting the house, mixing batter or washing the car are some of the most common causes. It's simply because these aren't "normal" to your routine and you don't use the tendons in this manner all the time.

- Age: As we age, our tendons become less flexible and more susceptible to injury. However this is just one factor and you can recover no matter what your age.

- Injury: A sudden injury to the rotator cuff muscles or tendons can cause a tendinopathy.

- Poor posture: Poor posture can put extra stress on the rotator cuff muscles and tendons, leading to inflammation.

- Poor biomechanics or technique: especially in throwing sports such as cricket, baseball and volleyball.

What are the symptoms of a rotator cuff tendinopathy?

Symptoms of a rotator cuff tendinopathy include:

- Pain: This is often worse at night or when you move your arm overhead.

- Weakness: You may find it difficult to lift your arm or reach for things.

- Stiffness: Your shoulder may feel stiff and painful when you try to move it.

If you are experiencing any of these symptoms, it is important to see a physiotherapist as soon as possible.

How is a rotator cuff tendinopathy diagnosed?

Your physiotherapist will take a detailed history and perform a physical examination. They will ask about your symptoms, when they started, and what makes them better or worse. They will also, most importantly, test your range of motion and strength. Imaging tests, such as an MRI scans are seen as important in difficult to diagnose cases though for 90% of cases will not be necessary.

What should I do if I think I have a rotator cuff tendinopathy?

If you are experiencing any of the symptoms described above, it is important to see a physiotherapist as soon as possible. They will be able to diagnose your condition and develop a treatment plan to help you recover.

Treatment for rotator cuff tendinopathy

The good news is that rotator cuff tendinopathies are treatable. Treatment will depend on the severity of your condition. Early treatment is important to prevent the condition from becoming worse.

Treatment options include:

- Relative Rest: Avoiding activities that aggravate your symptoms is an important part of recovery. This may mean taking a break from sports or other overhead activities. At Fixio we are experts in ensuring that you can continue to do what you love even while completing rehabilitation for shoulder pain.

- Ice: Applying ice to the affected area for 15-20 minutes several times a day can help to reduce pain and inflammation. We advise starting this before you see us.

- Exercise: Specific exercises prescribed by your physiotherapist can help to stretch and strengthen the rotator cuff muscles and tendons. These exercises will be different depending on the severity of your condition.

- Dry needling: This is a technique that can help to release tight muscles and improve blood flow to the area.

- Manual therapy: Your physiotherapist may use techniques such as massage, joint mobilisation or manipulation to help reduce pain and improve range of motion.

What not to do

There are also a few things you should avoid doing if you have a rotator cuff tendinopathy. These include:

-Avoiding activity altogether: It is important to stay active and not rest for long periods of time. This will only make your symptoms worse.

- Don't overhead activities: Avoid activities that cause pain! This will only aggravate your condition.

- Don't self-diagnose: If you are experiencing pain, it is important to see a physiotherapist to get an accurate diagnosis and treatment plan. Trying to treat yourself could make the condition worse.

Ok, I think I have a rotator cuff tendinopathy, now what?

It's time to get it assessed. Any shoulder pain needs to be assessed to ensure that treatment to the rotator cuff will get you back to doing what you love, sooner. So help yourself now and book an appointment with a shoulder expert at our Dee Why Physio clinic.