Guest Post by Anna Walsh – Physiotherapist
I’m sure many health practitioners would agree that the shoulder joint is the most complex joint in the whole body. There is a ball and socket joint between the top of the arm bone (humerus) and the socket (glenoid) on the side of the shoulder blade (scapula). As the glenoid is a shallow cavity, this makes the glenohumeral joint inherently unstable.
One of the most common injuries that can occur at the shoulder is globally referred to as “rotator cuff pathology”. In essence, this means that there is damage to part of the group of four muscles collectively named the rotator cuff. Each of these four muscles connects the scapula to the humerus. As a group, these muscles contribute to the dynamic stability of the shoulder joint, holding the humeral head against the shallow glenoid socket. Individually, they each exert an action at the shoulder, including internal and external rotation, and elevation.
Injuries to the rotator cuff muscles and their connecting tendons can be acute or chronic. Acute injuries include strained muscles and partial or complete tendon tears. Chronic injuries are typically overuse injuries, and include tendinopathy, whereby the tendon structure is altered leading to pain, altered capacity for load and resultant weakness. Rotator cuff tendon injuries often present with shoulder impingement.
The four rotator cuff tendons pass through a small space above the humeral head, and below the overlying acromion (part of the scapula bone). When a structure in this subacromial space becomes inflamed, there is less space available, and therefore often a pinching sensation felt, especially with raising the arm or rotating it at certain angles. This presents as impingement, which is not a diagnosis in itself, but rather a clinical sign.
A person with rotator cuff tendinopathy will usually experience pain with overhead activities, and not always loaded with weights. For example, swimming, throwing or simply reaching up to a chin up bar can all aggravate this tendinopathy. Treatment will aim to firstly reduce the symptoms, with rest from aggravating activities, local ice therapy, and the possibility of a corticosteroid injection into the subacromial space. Secondly and very importantly, a correctly prescribed rehabilitation program is crucial to correct any predisposing abnormalities, such as muscle imbalance around the scapula, shoulder capsule tightness, or instability.
A partial or complete rupture to one of more of the rotator cuff tendons will present as a sudden onset of pain, often after lifting, pushing, pulling or reaching, with or without load. Similarly, rest from aggravating activities ensures one doesn’t overload the healing tendon structure. In more severe cases and depending on lifestyle requirements, surgery may be advantageous, followed again by a comprehensive rehabilitation program.