May 25, 2018

Rotator Cuff Injuries & Impingement

Shoulder pain is a common complaint to both employees and athletes who use their shoulders in a repetitive action, particularly in an overhead or raised position, or repetitive heavy lifting. Sudden unaccustomed use or a single traumatic event may also trigger shoulder injury.  Injuries to the rotator cuff may be acute, eg, muscle strain, and partial or complete  tendon tears; overuse, such as tendinitis; or acute on chronic, such as a complete tear in a previously degenerative tendon.

Anatomy

The shoulder is a complex, highly mobile joint which depends on muscular function and control for full painfree movement. The 4 muscles of the rotator cuff arise from the shoulder blade, and their respective tendons blend to form with the shoulder joint capsule.

Their function is to stabilise the shoulder joint and thus allow larger muscles to act on and move the arm. There is also a large bursa between the cuff tendons and the outer boney prominence of the shoulder which allows smooth movement of the rotator cuff muscles during elevation of the arm.

Etiology

Impingement syndrome is the most common shoulder injury.  As the rotator cuff tendons pass below the outer bony prominence of the shoulder, these tendons together with the bursa get squeezed when the arm is held out from the body.  If this movement is sustained or applied repetitively, the tendons may become irritated, inflamed and swollen.

This swelling reduces the space in which the tendons can pass therefore leading to impingement each time the arm is lifted particularly above shoulder height. Continued rubbing/impingement of the tendon may eventually cause the tendon(s) to tear causing further weakness and pain, and changes the balance of the muscles around the shoulder.

If a rotator cuff tendon is torn (usually after the fourth decade), it is not possible for the tendon to heal fully as the blood supply to the area is poor.

Treatment

Initially treatment involves temporary rest from aggravating activities. Modification of technique/movement either for work or sport may be required.

The aims of physiotherapy treatment are to:

Reduce pain and inflammation (anti-inflammatory medication may be prescribed by your GP)

Assess shoulder dysfunction to allow retraining of the muscles around the the shoulder to work appropriately. In particular, the rotator cuff muscles need to be retrained to provide control and stability of the arm in the shoulder joint during movement to prevent continued impingement.

An exercise program is also required to strengthen and balance the muscles that control and move the shoulder blade.

Stretching may be important to regain lost flexibility/muscle length in sport, assessment of technique may be appropriate to decrease the risk of injury.

Where no improvement in symptoms is obtained with the above rehabilitation program, or for those with long-standing impingement, referral may be required to an Orthopaedic Specialist for advice, cortisone injection or ultimate surgery.