As physiotherapists, we encounter numerous patients with shoulder injuries, and one of the most common conditions is rotator cuff-related shoulder pain. The rotator cuff plays a critical role in stabilising and facilitating shoulder movement, making it susceptible to various issues. In this blog post, we will explore the anatomy of the rotator cuff. We will also discuss common injury causes, typical symptoms, and the most effective physiotherapy treatments.
Rotator Cuff Anatomy
The rotator cuff comprises four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. The supraspinatus is the smallest of the rotator cuff muscles and helps with the initiation of abduction of the arm. The infraspinatus is the main external rotator of the shoulder and also assists with shoulder extension. Teres minor lies below the infraspinatus, and primarily acts to assist it with external rotation of the shoulder, but also supports shoulder adduction and extension. The subscapularis muscle is the largest of the four, its main role is the internal rotation of the shoulder.
Despite having different primary actions, each of the four muscles of the rotator cuff works together to aid with the stability of the shoulder whilst allowing a full range of motion. They each originate from different points of the scapula (shoulder blade) and insert around the head and neck of the humerus, the upper arm bone, keeping it firmly in the shoulder socket for good glenohumeral joint stability.
Common Causes of Rotator Cuff related shoulder pain
Rotator cuff injuries can result from various factors, including:
1. Overuse and Repetitive Movements: Activities involving repetitive shoulder motions, such as throwing, painting, or lifting, can lead to muscle strain and rotator cuff tendon irritation over time.
2. Acute Trauma: A fall, direct impact, or sudden forceful movement can cause a rotator cuff tear or strain.
3. Age-Related Degeneration: With age, the blood supply to the rotator cuff tendons may diminish, increasing the risk of degenerative tears.
4. Poor Posture and Muscle Imbalances: Weakness around your shoulder and upper back, or postural problems can affect the quality of the rotator cuff muscles and tendons due to repeated additional strain.
Recognising Rotator Cuff Injury Symptoms
Identifying the signs of a rotator cuff injury is vital for early diagnosis and prompt intervention. Common symptoms include:
1. Shoulder Pain: Pain in the shoulder, or upper arm, which can be persistent or have intermittent rises with certain tasks. Some of these may include pain with brushing your hair, reaching your hand behind your back, raising your arm to the side, carrying or lifting.
2. Weakness: Difficulty with active movement, or more specifically with daily activities that involve the affected arm (as above).
3. Limited Range of Motion: Reduced ability to move the shoulder freely and comfortably.
4. Pain at Night: Discomfort that worsens during sleep, especially when lying on the affected shoulder.
5. Shoulder Instability: A feeling of sudden sharp pain or “catching” during movement.
Physiotherapy Treatment for Rotator Cuff Injuries
We prioritise conservative and evidence-based treatments to address rotator cuff injuries. Here are some of the key interventions we recommend:
1. Therapeutic Exercises: Personalised exercise programs that focus on progressive strengthening of the rotator cuff and surrounding muscles can help improve function and reduce pain.
2. Manual Therapy: Hands-on techniques, such as soft tissue massage and joint mobilisation, can aid in alleviating pain and improving shoulder function.
3. Posture Correction: Correcting posture and addressing muscle imbalances can reduce strain on the rotator cuff and promote better shoulder mechanics.
4. Other modalities: Ultrasound or electrical stimulation to complement the treatment plan for pain relief and to promote healing.
5. Activity Modification: Temporary modification or avoidance of activities that exacerbate the injury can aid in the recovery process.
6. Home Exercise Program: I often provide patients with a tailored home exercise program to reinforce the progress made during physiotherapy sessions.
The Importance of Early Intervention
Early detection and intervention play a significant role in the successful management of rotator cuff injuries. If you experience any of the symptoms mentioned above or suspect a shoulder problem, seek assessment and guidance from a qualified physiotherapist. Timely treatment can prevent worsening and improve your chances of a full recovery.
Preventing Rotator Cuff Injuries
Physiotherapists place a high value on injury prevention. Here are some tips to protect your shoulders:
1. Strengthening and Stretching: Regularly perform exercises that target the shoulder muscles to maintain strength and range of motion.
2. Proper Warm-Up: Always warm up before engaging in physical activities that involve the shoulders.
3. Correct Lifting Techniques: When lifting heavy objects, use proper lifting techniques and avoid straining the shoulders.
4. Listen to Your Body: Pay attention to any signs of discomfort or pain during physical activities, and take breaks when needed.
Extra tip – consider your upper back! The thoracic spine plays a large role in the rotation of your upper body, and in certain activities assists the shoulder in movement and power production. Poor thoracic mobility may therefore have a detrimental effect on your shoulder, making it have to work harder to achieve the same result in movement (especially in sports like tennis!) – which could increase the risk of an overuse injury due to increased repeated loading.
As physiotherapists, we understand the impact of rotator cuff injuries on daily life and mobility. Early diagnosis, appropriate physiotherapy treatment, and injury prevention are essential for the best outcomes. If you suspect a rotator cuff injury or experience persistent shoulder pain, please book an appointment with one of our expert physiotherapists online or call 0330 024 1377.