This is a very common shoulder problem with which patients present in a clinic. The shoulder is relatively an unstable joint owing to the greater size of humerus head compared to socket in which it fits.
The coraco-acromial arch forms an additional socket over the shoulder joint to provide additional stability and protect structures underneath the arch. These structures are the SITS muscles (subscapularis, supraspinatus, infraspinatus and teres minor). These muscles controls and stabilizes the shoulder movement on shoulder blade. These muscles forms a cuff around the head of humerus, so also referred as rotator cuff muscles. The long head of biceps (bicipital tendonitis) also comprises among the structures that lie under the coraco-acromial arch.
Rotator cuff injuries may vary from mild rotator cuff tendonitis, shoulder bursitis, calcific tendonitis (bone formation within the rotator cuff tendon) through to partial and full thickness rotator cuff tears, which may require rotator cuff surgery.
The rotator cuff tendons are protected from the overlying coracoacromial arch (bony arch) by subacromial bursa, which provide a smooth surface for the tendons to glide over.
These tendons and bursa can get inflamed if the shoulder working mechanism gets distorted due to any shoulder injury or instability as a result of faulty posture or muscle imbalance.
The Rotator cuff impingement syndrome occurs as a result of injury to shoulder tendons and bursa (intermittent entrapment/ compression of rotator cuff muscles) during shoulder movements resulting into painful shoulder.
In general a patient presents with following signs and symptoms, though specific rotator cuff muscle injury will have its own specific symptoms and signs –
- Painful range at shoulder height and or in overhead activities.
- Pain located at the shoulder joint or may travel to elbow.
- Pain while lying on the affected shoulder.
- Pain while shoulder at rest in more severe rotator cuff injuries.
- Pain in reaching out activities. Patient is cautious while performing reaching out activity.
- Pain in shoulder while taking the hand at the back.
The condition can be diagnosed on the basis of signs and symptoms, careful observation and thorough evaluation of the shoulder joint. Specials test such as Neer’s, Hawkins Kennedy, Speed’s, Yergason’s, Lift off sign, empty can test are some of the important test to diagnose a rotator cuff involvement. Examination of other structures around the shoulder should also be performed to rule out their involvement. Neck and thoracic areas should also be assessed for any contributing factor.
An X-ray is of little diagnostic help but may be used to look out for bony spurs and acromion angulations.
A diagnostic ultrasound scan may be needed to accurately diagnose the specific rotator cuff muscle involvement. An MRI is also equally helpful in diagnosing the condition.
It is of utmost importance to diagnose the exact form of rotator cuff injury as treatment varies depending on the specific or combination of rotator cuff injuries.
The ultimate aim of treatment should be to centralize the shoulder ball into its socket, which is the actual function of rotator cuff muscles. This will allow proper slides and glides of the shoulder ball in its socket while dynamically moving the arm over a stable shoulder blade. So it is also very important to ensure a dynamically stable shoulder blade.
The treatment progresses through the following stages to achieve the desired result.
- Early Injury Protection
- Regain Full Range of Motion
- Restore Scapular Control
- Restore Rotator Cuff Strength
- Restore strength, Power and Proprioception.
- Return to Sport/ Work
Get in touch with our expert at PAIN FREE PHYSIOTHERAPY CLINIC to understand your shoulder problem better.