Rotator Cuff Tendinopathy – Jacob Taylor
Rotator cuff tendinopathy is a very common cause of shoulder pain and loss of function. It’s frustrating, it’s painful and it can cause painful shoulder impingement, stopping you from doing what you love to do!
What is the rotator cuff?
The rotator cuff complex is made up of 4 muscles; the supraspinatus muscle; the infraspinatus muscle; the subscapularis muscle; and the teres minor muscle. These muscles all arise from the shoulder blade and work as a functional unit to help stabalise the shoulder joint as the shoulder moves through its range of motion. The shoulder is a ball and socket joint, and each of the rotator cuff muscles attaches at various points on the humeral head via tendons, which attach the muscles to the bone. Their role is to keep the humeral head in the socket when the arm lifts up or abducts, to prevent shoulder impingement from happening.
What goes wrong?
Due to their anatomical position, the tendons, and most commonly the supraspinatus tendon can become impinged under the acromion and cause tendon fraying and wear and tear. In their study of current theories for rotator cuff tendinopathy, Factor & Dale (2014) found that rotator cuff tendinopathy arises from a combination of factors, overloading the tendons. In summary, however, poor shoulder blade (scapular) control, tight muscles, repetitive overhead activities and poor activation of the rotator cuff muscles, leads to overload of the supraspinatus tendon and causes pain. With time, and repetitive stress and loading, the tendon becomes swollen, hyper-cellular and the collagen matrix becomes disorganized and weakens. This in turn, leads to pain when using the shoulder especially for overhead activities.
Signs and Symptoms:
- Pain and weakness with overhead activities such as cleaning, lifting things above the head, swimming and reaching up
- Pain with tucking shirt into your pants, combing and washing your hair
- Tenderness and aching pain over the lateral part of the shoulder.
- Often a painful arc – pain when lifting your arm up to the side and up over your head, especially between 90 and 120 degrees of abduction.
- Reduced internal rotation of the shoulder – difficulty tucking shirt into pants
When to scan and what scan to choose:
Your physio will help you know whether or not to get a scan done and which option is best for you. Scan options are as follows:
- MRI – gold standard as can also determine the presence of a partial tear in the rotator cuff and rule out other shoulder pathologies
- Ultrasound – Usually the first line of scans recommended for confirming rotator cuff tendinopathy. Shows the condition of the tendons and thus helps predict the prognosis and time tendon healing will take.
- X-ray – Often taken to rule out calcific tendinopathy – calcium build up in the tendon, and also to rule out AC (acromio-clavicular) joint osteoarthritis.
So how do I fix my rotator cuff tendinopathy?
Treatment for rotator cuff tendinopathy involves 2 main processes:
- De-loading the rotator cuff tendon – manual physiotherapy, massage, muscles release techniques, dry needling, stretches and taping techniques can be great for this
- Scapular and rotator cuff stability and strengthening – your physio will set you up with a specific home exercise programme designed to strengthen your rotator cuff muscles and tendons and your scapular (shoulder blade) posture stability. Tendons respond well to eccentric strengthening, so incorporating this into your rehabilitation exercise program is important.
Don’t put up with shoulder pain – do something about it! See your local physiotherapist who can help fix your rotator cuff tendinopathy and help get you back doing what you loving doing!
Jacob Taylor
POGO Physio Master clinician
References:
- Brukner and Khan (2006). Clinical Sports Medicine (3rd ed.). McGraw-Hill Australia Pty Ltd, North Ryde.
- Factor, D. & Dale, B. (2014). Current Concepts of Rotator Cuff Tendinopathy. International Journal of Sports Physical Therapy 9 (2), 274-288. Found online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004132/
