Rotator Cuff Related Shoulder Pain and Physiotherapy - Rotator Cuff Tears, Tendinopathy and Bursitis
As physiotherapists we see a lot of patients with both new and persistent shoulder pain. Each year 1 in 50 adults will seek care for new onset of shoulder pain. Without tailored and evidence-based treatment, 40-50% of shoulder pain cases will continue to have pain after 6-12 months. While there are a lot of structures in the shoulder that may cause pain the rotator cuff is the most affected structure and plays a part in around 80% of shoulder pain cases.
The rotator cuff is a group of four muscles that run from the scapula (shoulder blade) to the upper humerus (upper arm bone). These muscles work together to provide stability and assist with the movement of the shoulder joint. The most commonly injured of the four muscles is the supraspinatus. Due to its location (running under the acromion of the shoulder blade) and actions it is commonly injured due to overuse and is susceptible to wear and tear. When injured common issues people will have include;
pain when reaching overhead
weakness in overhead movements
pain with rotation of the shoulder
Sub acromial shoulder pain can result from overuse or injury to the rotator cuff muscles and their tendons. Overuse often occurs when the load placed on the muscles increases rapidly and the body doesn’t have adequate time to adapt to the change. Importantly, psychological factors such as stress can also contribute to the pain experience and due to this working with a physiotherapist to reduce pain and find ways to increase movement in safe and tolerable ways can be crucial for a fast recovery.
What are Rotator Cuff Tears
Rotator cuff tears can occur from traumatic injuries such as a fall but are also very common as we get older due to normal degenerative changes. Around 25% of people over 65 will have a rotator cuff tear and this increases to 50% at 80 years old. Importantly, not everyone with a rotator cuff tear will experience pain. In most cases, slow degenerative tears allow the body time to adapt and compensate for the injured muscle which can lead to a tear being present with no pain or functional restrictions. Even in cases where these tears become painful, exercise and strength training usually lead to very good outcomes. In the case of younger patients with acute or traumatic tears to the rotator cuff a surgical opinion is usually suggested.
Tendinopathy refers to pain and/or structural changes within a tendon and often occurs due to an increase in load on the tendon. The supraspinatus tendon and long head of biceps tendon are the two most commonly affected tendons in the shoulder. Load management is very important when trying to settle down an angry tendon. It’s important to note while tendons don’t like being overloaded they also don’t like complete rest as this can lead to a further decline in the tendons load tolerance. Once pain is controlled the aim is to increase the load tolerance of both the tendon and the muscle it attaches to, to prevent pain from recurring.
What is Shoulder Bursitis?
A bursa is a fluid filled sac that reduces friction between tendons and their surrounding structures. Bursitis is inflammation of the bursa which occurs when the bursa becomes irritated. Due to the rotator cuff tendons and subacromial bursa sitting so close to one another, an issue in the rotator cuff tendon is likely to cause inflammation of the bursa. While bursitis can be painful, due to this close relationship it is rarely the cause of the problem, rather a symptom of something else going on in the shoulder.
Do I need a scan for shoulder bursitis?
In most cases of shoulder pain, imaging results are unlikely to change initial management. Imaging is unlikely to be needed unless
a traumatic injury has occured
pain has persisted despite treatment for a period of 3 months
there is a severe loss of strength
a fracture is suspected
As previously mentioned, rotator cuff tears and other abnormalities in the shoulder will not always cause pain. Around 90% of people with no shoulder pain will have a finding on a scan that is considered abnormal. This may include tears, arthritis, bursitis, labral changes or tendinopathies. For this reason, if something is found on a scan this does not necessarily mean it is the source of your pain.
Physiotherapy VS Surgery for Rotator Cuff Tear or Tendinitis
Rotator Cuff Tear - For degenerative tears that haven’t been caused by a single injury, physiotherapy lead strength training leads to outcomes as good, if not better than a surgical repair. Consistent progressive strength training can help people avoid surgery in 75% of cases. Unfortunately a rotator cuff repair will not stop the natural progression of a degenerative rotator cuff and retear can occur. If pain is well controlled in the first 12 weeks with consistent and progressive exercises it is very unlikely surgery will be needed in the future.
Rotator Cuff Tendinopathy - similarly research has shown there is no difference in outcomes at both 5 and 10 year follow up between a decompression surgery or non surgical management for rotator cuff tendinopathy and surgery is not recommended for tendinopathy patients.
How does exercise and strength training help shoulder bursitis without a surgical repair?
WIth progressive strength training we can improve the rotator cuffs and shoulder joints ability to tolerate load. The rotator cuff tendons need to be able to store and release energy and deal with compressive loads. Increasing the capacity of the tendons and muscles to tolerate an increased load will allow you to manage your day to day task or sport without pain. Furthermore, strengthening the surrounding muscle will allow your body to compensate for the injury and reduce your risk of pain recurring. Working with a physiotherapist will allow you to start exercising in a safe and controlled setting and their guidance will get you back on track as quickly as possible. Book online or call our clinic to get your journey to recovery started.
How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!