SHOULDER PAIN FROM ROTATOR CUFF TENDINOPATHY

Do you have pain in your shoulder?
More specifically, do you experience dull aching pain in the shoulder joint?
Do you find it difficult to reach overhead and with lifting?
Do you have pain when reaching behind the back?
Have you felt more weakness along with pain in your shoulder over time?
You might be suffering with rotator cuff tendinopathy. This blog will outline rotator cuff tendinopathies, the associated symptoms and effective management. Shoulder pain can have implications on youron the ability to carry out daily tasks. If this has not improved over time, symptoms may become chronic and cause further long-term issues. Your Brisbane local Physiotherapist is the best professional to have this assessed, identified and treated. Be sure to book in now.

WHAT IS THE ROTATOR CUFF?
Rotator Cuff Tendinopathy 1

Source: https://www.ncbi.nlm.nih.gov/books/NBK513344/figure/article-29638.image.f1/

I always say to everyone I see with shoulder pain, that the rotator cuff is essential in maintaining the stability of the most mobile joint in the body. This group of muscles consists of four muscles and their tendons. Together they provide the necessary support for the entire shoulder joint. An injury to this group of muscles impacts the overall stability of the shoulder.

HOW DOES ROTATOR CUFF TENDINOPATHY OCCUR?
Rotator Cuff Tendinopathy 2

Source: https://www.rehabmypatient.com/shoulder/rotator-cuff-tendinopathy

Usually, rotator cuff tendinopathies occur due to excessive loading of the rotator cuff system. The most commonly injured muscle in the rotator cuff is the supraspinatus muscle. It can become wedged between two bony points. As shown in the diagram above, the bony surfaces of the shoulder can cause pressure on the supraspinatus tendon. Tiny tears start to occur in the tendon of the affected muscle and this leads to pain.

WHAT ARE THE RISK FACTORS FOR ROTATOR CUFF TENDINOPATHIES?
These are the associated risk factors for the development of rotator cuff tendinopathy

Occupationally Related Factors General Risk Factors
Prolonged sitting with bad or awkward postures Muscle imbalances
Heavy lifting Reduced flexibility
Direct pressure on the shoulder (carrying) High BMI/being overweight
Repetitive movements of the shoulder Metabolic disorders such as diabetes
Working above shoulder height with hands Old age
Inadequate rest
WHAT ARE THE COMMON PRESENTING SYMPTOMS?
  • Pain locally in the shoulder, but can be non-specific and hard to identify
  • Pain when lifting arm above 90 degrees
  • Worsening of pain with overhead movements
  • Inability to lie on affected side when sleeping
  • Waking nocturnally due to pain
  • Progressively weakening arm if pain spans a long period

HOW TO MANAGE YOUR ROTATOR CUFF TENDINOPATHY

DO'S

Rotator Cuff Tendinopathy 3

Source: https://charmaustin.com/how-heavy-is-your-head-from-forward-head-posture/

Sit with good posture: Head over shoulders and shoulder blades tucked in towards spine

DON’TS

Rotator Cuff Tendinopathy 4

Source: https://charmaustin.com/how-heavy-is-your-head-from-forward-head-posture/

Do not sit with poor posture: No chin poking forward and no rounded shoulders

Rotator Cuff Tendinopathy 5

Source: https://www.sportsinjuryclinic.net/wp-content/uploads/2016/11/rotator-cuff-tear-rehabilitation800.jpg

Rotator cuff strengthening exercises (explained in more depth below)

Rotator Cuff Tendinopathy 6

Source: https://www.elcosh.org/image/1128/i001331/1331.html

Limit work in awkward overhead positions

DO'S cont.

Rotator Cuff Tendinopathy 7

Source: https://www.simplyfitness.com/pages/seated-cable-row

Strengthening shoulder blades, mid/lower back

HOW CAN PHYSIOPHI HELP?
  • Exercise therapy: One of the most effective methods to treat and prevent rotator cuff tendinopathy. Strengthening and lengthening structures at fault will reduce pain and reduce future recurrence. We can tailor exercise programs specifically for your shoulder to reduce pain, increase strength and improve function.
    Rotator Cuff Tendinopathy 9

    Source: https://thumbs.dreamstime.com/b/female-physiotherapist-inspecting-her-patient-medical-check-shoulder-physiotherapy-center-medical-check-99989928.jpg

  • Manual therapy: By providing manual therapy we can allow the shoulder to begin to move properly without poor muscle control and bad habits.
    Rotator Cuff Tendinopathy 10

    Source: https://www.popsugar.com.au/fitness/what-it-like-to-get-dry-needling-does-it-hurt-46987258

  • Dry needling: Can be used to reduce tension in parts of the rotator cuff that are compensating for overall weakness.
    Rotator Cuff Tendinopathy 11

    Source: https://www.researchgate.net/figure/Thoracic-taping-for-hyperkyphosis-A-Instruct-the-patient-to-stand-and-elongate-the_fig6_44639136

  • Taping: Pain from rotator cuff tendinopathy can cause the shoulder to protract, causing a "rounded shoulder" appearance. Taping initially can correct this posturing to reduce strain on the rotator cuff.
  • Shockwave Therapy: There is good evidence for the effective treatment of rotator cuff tendinopathy with shockwave therapy. Particularly if the injury is longstanding (greater than three months) where the healing process has halted, we find shockwave has yielded great results in reducing pain, improving range and quality of movement.
  • Advice and education: There are many more do's and don'ts that are specifically related to each occupation that would be outlined to allow for the most effective recovery from rotator cuff tendinopathy. Your healthcare professional can provide the most evidence based advice, exercises and tips to improve posture, future management strategies and many more that are individualised to every person.
DISCLAIMER
At Physiophi, we pride ourselves in our ability to treat every condition specifically to the individual we see. As a result, if your shoulder pain is not improving, we strongly recommend booking an appointment so that we can get you back to full function. We have a breadth of experience with rotator cuff tendinopathies and we draw upon that knowledge to treat each and every individual shoulder.

PLEASE CONTACT US ON: (07) 3172 4332 TO HAVE A CHAT WITH OUR FRIENDLY STAFF OR SIMPLY BOOK ONLINE ON: WWW.PHYSIOPHI.COM.AU

REFERENCES
Desjardins-Charbonneau, A., Roy, J. S., Dionne, C. E., Frémont, P., MacDermid, J. C., &Desmeules, F. (2015). The efficacy of manual therapy for rotator cuff tendinopathy: a systematic review and meta-analysis. J Orthop Sports Phys Ther, 45(5), 330-350. https://doi.org/10.2519/jospt.2015.5455
Holdaway, L. A., Hegmann, K. T., Thiese, M. S., &Kapellusch, J. (2018). Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: a cross-sectional study. BMC MusculoskeletDisord, 19(1), 408. https://doi.org/10.1186/s12891-018-2319-9
Leong, H. T., Ng, G. Y., Chan, S. C., & Fu, S. N. (2017). Rotator cuff tendinopathy alters the muscle activity onset and kinematics of scapula. J ElectromyogrKinesiol, 35, 40-46. https://doi.org/10.1016/j.jelekin.2017.05.009
Louwerens, J. K., Veltman, E. S., van Noort, A., & van den Bekerom, M. P. (2016). The Effectiveness of High-Energy Extracorporeal Shockwave Therapy Versus Ultrasound-Guided Needling Versus Arthroscopic Surgery in the Management of Chronic Calcific Rotator Cuff Tendinopathy: A Systematic Review. Arthroscopy, 32(1), 165-175. https://doi.org/10.1016/j.arthro.2015.06.049
McCreesh, K. M., Purtill, H., Donnelly, A. E., & Lewis, J. S. (2017). Increased supraspinatus tendon thickness following fatigue loading in rotator cuff tendinopathy: potential implications for exercise therapy. BMJ Open Sport Exerc Med, 3(1), e000279. https://doi.org/10.1136/bmjsem-2017-000279
Miccinilli, S., Bravi, M., Morrone, M., Santacaterina, F., Stellato, L., Bressi, F., &Sterzi, S. (2018). A Triple Application of Kinesio Taping Supports Rehabilitation Program for Rotator Cuff Tendinopathy: a Randomized Controlled Trial. OrtopTraumatolRehabil, 20(6), 499-505.
Parle, P. J., Riddiford-Harland, D. L., Howitt, C. D., & Lewis, J. S. (2017). Acute rotator cuff tendinopathy: does ice, low load isometric exercise, or a combination of the two produce an analgaesic effect? Br J Sports Med, 51(3), 208-209. https://doi.org/10.1136/bjsports-2016-096107
Spargoli, G. (2019). TREATMENT OF ROTATOR CUFF TENDINOPATHY AS A CONTRACTILE DYSFUNCTION. A CLINICAL COMMENTARY. Int J Sports Phys Ther, 14(1), 148-158.
Tang, Z. Y., Wee, J. J. Y., & Lim, H. H. R. (2021). Effects of shockwave therapy on pain and disability in individuals with rotator cuff tendinopathy: a systematic review protocol. JBI Evid Synth. https://doi.org/10.11124/JBIES-20-00169

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