Shoulder Rotator Cuff Injuries

Rotator cuff related shoulder pain is one the most common presentations which we encounter at Premier Physiotherapy.
What is the rotator cuff?
Your rotator cuff is comprised of a group of muscles which work to stabilise the “ball” of your shoulder in the “socket” as you move your arm ¹.

Why does it get painful?

This is a complex question and the answer is likely different between individuals. It is thought that discomfort is caused by a reaction to one (or a combination) of ¹:
• Impingement(pinching) of sensitive structures inside/outside the shoulder joint
• Tendinopathy of the rotator cuff or surrounding muscles
• Degeneration/tearing of the rotator cuff tendons

Do I need a scan?

Again, this is a question which we are frequently asked. There are certain situations where imaging of the shoulder complex can absolutely be useful. However, as the majority of people we see who report rotator cuff related shoulder pain do not require anything other than conservative treatment², imaging is not typically required.

What if I have a tear – will I need surgery?

A lot of the time in medicine, the terminology used can sound intimidating and is often unhelpful. A “rotator cuff tear” sounds finite and significant. There are, of course, times where surgery is an appropriate choice in the management of cuff dysfunction. However, it can help to understand that many people with evidence of tearing on MRI do not have any shoulder pain ³ and so repairing the “tear” may not be clinically appropriate. In fact, it may be more useful to see rotator cuff degeneration/tearing as we would see grey hair and wrinkles – a normal, mostly harmless, feature of ageing.

What can physiotherapy help me with?

First and foremost, we are experts in the diagnosis of rotator cuff related shoulder pain and can assess whether you are likely to benefit from physiotherapy treatment or if you need onward referral for orthopaedic opinion or imaging.
We can advise you on how best to manage your discomfort and may use manual therapy techniques along with exercises to assist you in pain relief and to restore your confidence in movement.

Ultimately, treatment will consist of an exercise programme to restore your ability to tolerate loading of the shoulder complex and rotator cuff and to facilitate a return to your individual baseline.

Tim is an experienced chartered physiotherapist with a masters degree in Sports Physiotherapy who has worked in several highly renowned clinics in Ireland, as well as in the Southern Hemisphere.
As one of our Senior Physiotherapists, Tim has experience in treating all kinds of shoulder problems. These range from athletic injury and dislocation, to frozen or stiff shoulders – as well as everything in between. Contact the clinic to arrange for an expert opinion as to how best to manage your shoulder pain.

References:
1. Lewis J, Rotator cuff related shoulder pain: Assessment, management and uncertainties, Manual Therapy (2016), doi: 10.1016/j.math.2016.03.009.
2. Boorman, Richard S. et al. What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. Journal of Shoulder and Elbow Surgery , Volume 27 , Issue 3 , 444 – 448
3. Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. Journal of Orthopaedics. 2013;10(1):8-12. doi:10.1016/j.jor.2013.01.008.
4. Ainsworth R, Lewis JS. Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review. British Journal of Sports Medicine 2007;41:200-210.