Understanding Rotator Cuff Related Shoulder Pain
The shoulder is an incredible joint that allows for a wide range of motion, thanks in large part to a group of muscles and tendons called the rotator cuff. If you think of your shoulder joint as a ball and socket, the ball is your upper arm bone and the socket is part of your shoulder blade. Part of what gives your shoulder such a large range of movement is that ball is big and the socket is small. The socket also moves since the shoulder blade actually rotates about 40°during full arm movement. The trouble with such mobility however is ensuring that there is adequate stability. The rotator cuff, which wraps around the shoulder joint, contributes significantly to stability whilst helping to control movement.
In essence, you can think of the rotator cuff as the support system for your shoulder. It not only helps to hold the bones of your shoulder joint together but also allows you to lift and rotate your arm with ease. Without a healthy rotator cuff, simple tasks like reaching for something on a high shelf or throwing a ball can become challenging.
This condition can affect people of all ages and backgrounds, but it's more commonly seen in individuals over 40, especially those who engage in repetitive overhead activities or have a history of shoulder injuries. Interestingly, rotator cuff issues also tend to affect women more than men, although the reasons for this are not entirely clear.
Several pathologies and injuries can lead to rotator cuff-related shoulder pain including:
Rotator Cuff Tears: These can occur suddenly, such as from a fall or lifting something heavy, or develop gradually over time due to wear and tear. A tear in the rotator cuff can cause pain and weakness, making it difficult to perform everyday tasks.
Tendinopathy: This occurs when the tendons of the rotator cuff fail to repair quickly enough to meet the demands placed on them, through overuse or repetitive motions. It may present as a dull ache in the shoulder, particularly with overhead movements
Bursitis: The bursa, which are small fluid-filled sacs that cushion the rotator cuff tendons, can become inflamed and painful, especially with repetitive activities or trauma.
When someone experiences rotator cuff-related shoulder pain, it typically presents as a deep ache towards the outside of the shoulder that worsens with certain movements, such as reaching overhead or behind the back. You might also notice weakness and stiffness in the shoulder, making it challenging to perform daily activities.
Diagnosing the underlying cause starts with a thorough clinical assessment accompanied by further investigations:
Imaging Studies: X-rays are performed to look for other issues like calcium deposits in the tendons and arthritis. Ultrasound is commonly utilised as it can be performed within the clinic appointment and provides excellent visualisation of the tendons and surrounding structures such as an inflamed bursa. MRI is helpful where the diagnosis remains uncertain or there is suspicion about problems deep inside the shoulder joint, which cannot be seen with ultrasound.
Diagnostic Injections: Sometimes injecting local anaesthetic into the shoulder joint or bursa to see if this alleviates your pain, helps to confirm the source of your symptoms.
Treatment options for rotator cuff-related shoulder pain vary depending on the severity and underlying cause:
Conservative Management: This may include rest, activity modification, physical therapy to strengthen the muscles around the shoulder, and anti-inflammatory medications to reduce pain and swelling.
Injections: Corticosteroid injections into the shoulder joint can provide temporary relief of pain and inflammation, allowing for better participation in physical therapy. Platelet Rich Plasma (PRP) can also be used to help reduce inflammation and improve pain.
Shockwave therapy: This can be effective for treating rotator cuff tendinopathy or inflammation caused by calcium forming within the tendon.
Surgery: In cases of severe rotator cuff tears or failure to respond to conservative measures, surgical repair may be necessary to restore function and alleviate pain.
Rotator cuff-related shoulder pain can significantly impact quality of life. Securing an accurate diagnosis and tailoring treatment accordingly offers the best chance for regaining function and improving symptoms.
