Rotator cuff tendinopathy is the most common type of shoulder pain. The rotator cuff is a group of four muscles that assist with stability of the shoulder joint and and movement of the arm. The bellies of these muscles are called supraspinatus, infraspinatus, teres minor and subscapularis, and they sit around your shoulder blade. Each connects to a tendon which travels to attach onto the ball of the shoulder joint. These muscles work collaboratively to lift and rotate your arm.
Injury most commonly occurs in one of two ways: trauma/acute or degeneration/overuse. Traumatic events can cause a tear in the tendon or the muscle from a specific injury, for example getting your arm wrenched whilst playing contact sports, or falling off your bike. Injury to the tissue can range in size and can be termed a partial tear (a small separation), full tear (a hole through the tissue) or a rupture (completely separated in two). Acute tendinopathy can also occur when the demands on the shoulder suddenly increase without training, for example lifting furniture one weekend to move house when usually those loads aren’t put through the shoulder. Degenerative injury can be from consistent poor postural loads or repetitive/overuse lifting of loads too heavy for the muscle to handle, and can lead to chronic tendinopathy.
Up to 30% of the general population will experience shoulder pain at some point in their life. The risk of rotator cuff pathology increases with age, previous injury, smoking and are use/job dependent (e.g. painters have repetitive overhead movements, desk workers may spend 8+ hours hovering the arm over a keyboard, active individuals may lift heavy loads overhead).
Symptoms commonly consist of pain at the shoulder that can sometimes travel down the arm. This generally worsens with lifting loads, lifting the arm above shoulder height, reaching behind your back or sleeping on that side. A rotator cuff injury can also present as weakness or reduced range of movement, making some day-to-day activities difficult and painful to complete. If symptoms are related to trauma, they generally have a sudden onset, whereas degenerative issues may build up slowly over several weeks or months.
Physiotherapists are able to perform a detailed physical examination of your shoulder. When they pair this with your history and symptoms, they can diagnose rotator cuff pathology to guide individualised treatment. Physiotherapy treatment is often the first line of treatment. This can consist of massage, dry needling, education on relative rest, manual therapy, biomechanical strengthening, posture training and realignment exercises. Most often returning to normal function with treatment can take 6-12 weeks depending on the nature of the injury mechanism. About 80% of patients are able to manage their conditions with physiotherapy alone, however in some cases a steroid injection or surgery may be required.