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Rotator cuff related shoulder pain

What is it?

Rotator cuff related shoulder pain (sometimes known as subacromial shoulder pain) is very common and causes pain in the shoulder and upper arm. It can spread further down the arm and up towards the neck and shoulder blade. It can feel worse when the arm is moved away from the body such as reaching up or when placing the hand behind the back.  Pain can come on slowly over time or quite quickly if the shoulder has been used for an activity that is much more demanding than it is used to doing each day.

The ‘Rotator Cuff’ is the name given to the set of muscles and tendons that all have to work together to stabilise the shoulder through movement. Rotator cuff disorders are often due to age-related changes to the tendon however they can also be caused by trauma, overload, or repetitive movements. It commonly affects people between the ages of 35-75 years.

Rotator cuff muscles and tendons – back view of right shoulder

 

  1. Supraspinatus tendon
  2. Infraspinatus tendon
  3. Teres minor tendon
  4. Teres minor muscle
  5. Infraspinatus muscle
  6. Supraspinatus muscle
Rotator cuff muscles and tendons – front view of right shoulder

 

  1. Subscapularis tendon
  2. Subscapularis muscle
  3. Supraspinatus muscle

What are the common symptoms?

Pain

Pain occurs in and around the shoulder joint and can spread down the top of the arm. If there has been an injury, the pain may come on suddenly. Pain is usually worse when you use your arm for activities above your shoulder level. This means that combing your hair or trying to dress yourself can be painful but writing and typing may produce little in the way of pain. Pain may also be worse at night and affect sleep.

Weakness 

Occasionally your arm may also feel weak and you may have reduced movement in your shoulder. Some people feel clicking or catching.

Factors that may contribute to rotator cuff related shoulder pain:

You may be told you have impingement from your GP or physiotherapist or after having an ultrasound scan, this is another term to describe subacromial pain or rotator cuff related shoulder pain.

Rotator cuff tendons 

The rotator cuff works together to hold the ball on the socket during movement of the arm. If one or more of the tendons are weak they will not be able to do their job properly. Pain may start due to an overload of the tendons this can lead to some weakness. Age related changes in the tendon can also have an effect on the strength. The good news is exercises can help the tendon strengthen and reduce pain.

Stiffness of the shoulder 

If the shoulder is stiff, the mechanics of movement and the way the tendons work to support the joint will be changed. This is why continuing to move the joint as pain allows is so important.

Posture 

How you hold your head and shoulders is important. If the head and shoulder blade are pushed forward (for example, hunched or rounded shoulders), this position forces the shoulder muscles to work in an abnormal way. This can then lead to a reduction in the mechanical efficiency of the shoulder during movement.

Other factors influencing pain

Pain can be influenced by a number of factors. What we have learnt through research is that pain, especially persistent pain is more complex than just what is going on locally to where you feel the pain. It can be affected by many things including poor sleep, poor general health, reduced fitness, stress, past experience of pain and our beliefs about pain and our physical structure. We know that thoughts and emotions will impact your recovery.

How to manage it

The aims of treatment are pain relief; to improve range of motion; reduce duration of symptoms and return to normal activities. One or more of the following may help ease your symptoms.

Investigations

Investigations are not usually required as it can be diagnosed easily from an examination and assessment of your symptom, it will often get better with time following education and exercise.

Exercises 

These are commonly advised with the aim of regaining movement in your shoulder and decreasing pain. For most benefit, it is important to do the exercises regularly and they should be comfortable to perform. Please give the following exercises a try and see if it helps with the management of your shoulder condition.

Exercises

Your shoulder should start to feel better within 6-12 weeks if you do the simple exercises below. These have been recommended by the UK’s leading shoulder physiotherapists and proven to reduce pain and improve your shoulder. This guide will show you how to do them within the comfort of your own home.

You may only be able to move your arm a small amount at the start but this will improve over time. A small increase in pain while exercising is ok as long as it goes away within 30 minutes and is not worse the next day. If this happens, don’t worry, do less repetitions the next time and then gradually build up again.

It may take 6 weeks before you start to see improvement.

If your shoulder does not improve over 6-12 weeks, or gets worse despite the exercises, you will need to speak with your doctor again.

Please see the below for the exercises from the British Elbow and Shoulder Society alternatively click on the link below where you should find videos of the exercises and be able to download the exercise leaflet.

Exercise videos and booklet from the British Elbow and Shoulder Society.

Wall slides

Exercises for Shoulder Pain: Wall Slides – YouTube

Find a smooth wall or wall mirror and a cloth that will slide easily on the wall (or put clean socks on your hands). Stand facing the wall. Place the edges of your hands against the wall with your thumbs facing you.

Now step forward as you gently push into the wall and slide your hands up as far as you can. Relax and return to start position.
– Repeat 8 times

– Rest for a minute

– Repeat 8 times

– Rest for a minute

– Repeat 8 times

When you can do this exercise easily you can progress by doing it without the support of the wall and adding a light weight.

Push-ups against the wall

Exercises for Shoulder Pain: Push-ups against a wall – YouTube

Now put your hands on the wall as if you are going to do a pushup. Make sure your hands are placed a little wider than the width of your shoulders, your hands are turned out slightly and your elbows are below your shoulders.

Now lower your body towards the wall keeping your body nice and tall.
– Repeat 8 times

– Rest for a minute

– Repeat 8 times

– Rest for a minute

– Repeat 8 times

When you can do this exercise easily you can progress and increase load by moving your feet further from the wall.

Shoulder rotation exercises

Exercises for Shoulder Pain: Shoulder Rotation – YouTube

Sit next to a table with your elbow supported just below shoulder height on a rolled up towel.

Now make a gentle fist, keep your elbow bent and then rotate your forearm to point upwards.

Return to the start position and relax

Make sure you sit up tall whilst you do this.

When it is easy for you to do this you can add a light weight – start with half kilo or a small 500ml water bottle.

As the exercise gets easier you can increase the weight:

– First to 1 kilo

– Then to 1 and half kilos

– Then to 2 kilos

Simple painkillers

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Rest or activity modification 

This does not mean you stop moving or using your shoulder altogether. It means reducing activities over your head or behind your back as this can help to reduce the irritation in your shoulder.

Ice therapy 

May be helpful to relieve pain. Place a damp cloth on your shoulder and then place an icepack (or bag of frozen peas) over the top of this. Leave it on for 10-15 minutes use up to 3 times a day.

  • People should be cautious using these treatments if they have altered skin sensation or circulatory problems.
  • Check the skin regularly
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing shoulder pain. Click here to self-refer to a physiotherapist.

How to prevent and manage future symptoms?

This is a common condition. As with all MSK conditions try to keep active with regular exercise. Try to follow the advice above and keep to a routine of daily activity. Whenever doing more, whether that is gardening or weight training, remember to gradually build up your load on the shoulder. If you are returning from an injury the same principle of building up to your usual activity applies. If performing repetitive overhead tasks, make sure you are taking breaks and change position regularly.

If you are having difficulty managing your shoulder pain or having difficulty returning to your usual activities, please refer yourself to a physiotherapist.

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